The Wills Eye Hospital Neuro-ophthalmology Service was asked to
evaluate a 57-year-old female inpatient with a complaint of new-
onset double vision. The patient was admitted to the Thomas
Jefferson University Neurology Service two days prior with a
chief complaint of dizziness. The double vision was described as
horizontal, side-by-side images, worse at distance than at near.
When either eye was covered, visual acuity was at baseline.
Symptoms were noticed acutely while watching television. She
denied any prior episodes of double vision. Her initial
complaint of dizziness was described as “feeling unbalanced.”
Review of systems was notable for decreased hearing and
sensation of right ear fullness. She denied numbness, weakness,
headache, vertigo or other neurologic complaint. Past medical
history was significant for borderline hypertension, obesity and
one episode of vertigo two years prior. She was on no chronic
medications. She reported a recent episode of bronchitis two
weeks prior to admission, treated wi