Geetha Athappilly, MD

A 54-year-old man developed constant binocular diagonal diplopia. He was initially diagnosed with a fourth nerve palsy.

An 88-year-old woman developed an acute onset of painless, monocular vision loss in the right eye.

A 68-year-old woman presented to the Lahey Clinic emergency room with worsening pain, swelling and redness in her right eye.

A 45-year-old woman was admitted to the neurology service at Lahey Hospital and Medical Center with symptoms of double vision, gait disturbance secondary to lower extremity weakness and subjective memory loss.

A 24-year-old African American woman with a medical history of right-sided Bell’s palsy, hidradenitis suppurativa and borderline hypertension was referred to the neuro-ophthalmology clinic at Tufts Medical Center with 3 weeks of right eye discomfort. She initially had a pressure-like discomfort in the right eye that then developed into a dull pain with eye movement. The pain improved somewhat with acetaminophen. She also noticed a blurred spot in the vision of her right eye. Her medications included chlorhexidine skin cleanser, oral contraceptives and artificial tears. She had no known family history of eye or autoimmune disease. She did not smoke cigarettes or drink alcohol. She had no neurologic symptoms and no cough, joint pain or rash.

An 83-year-old woman with diet-controlled type 2 diabetes presented to Lahey Medical Center as a transfer from Bermuda for presumed orbital cellulitis.

An 18-year-old woman presented to Lahey Medical Center with 2 weeks of intermittent diplopia, nausea and headache.

A 78-year-old woman with a medical history of hypertension, hyperlipidemia, diet-controlled type 2 diabetes, gout, osteopenia and herpes zoster presented with a 4-day history of new-onset constant binocular double vision.

A 28-year-old woman presented to the Lahey Eye Clinic reporting a 1-week history of constant binocular, horizontal diplopia. In addition to the diplopia, she described pain with extraocular movements and an associated frontal headache. She denied any blurred vision.

A 47-year-old Caucasian woman with no significant medical or ocular history was referred to the Lahey Eye Clinic with complaints of flashes of light in the periphery of her right eye. Three weeks before presentation, she noted the flashes only at night but denied any floaters, curtain or veil in her vision or acute loss of vision. She originally went to see an outside optometrist who noted possible “swelling of the right nerve.” She was told to come back in a few days for re-evaluation. At the second appointment, the swelling was more significant, thus the patient was sent to Lahey for further evaluation.