A 6-year-old girl presented to the ophthalmology emergency service with 4 days of double vision associated with headache and fever. She had a history of upper respiratory tract infection with nasal congestion and discharge being treated with oral antibiotics. She also recently received a diagnosis of migraines. Computed tomographic imaging from an outside hospital 3 weeks prior was reported as unremarkable. The patient had an uncorrected visual acuity of 20/50 OU. Her pupils were round and reactive without an afferent pupillary defect. Confrontation visual fields revealed superotemporal, inferotemporal, and superonasal defects in both eyes. The results of her motility examination showed a complete absence of abduction on both eyes, consistent with bilateral sixth nerve palsy. The results of a fundus examination showed blurred optic nerve margins nasally (Figure 1).
Osigian CJ, Capo H, Cavuoto KM. Acquired Diplopia in a Child. JAMA Ophthalmol. Published online February 16, 2017. doi:10.1001/jamaophthalmol.2016.4417