A 79-year-old man was referred for evaluation because of the enlargement of a pituitary mass with compression of the left optic nerve and chiasm, 2 years after partial resection of a pituitary macroadenoma. An examination revealed a complete right oculomotor nerve palsy with complete ptosis; a dilated, unresponsive pupil; and extreme exotropia. The patient disclosed that this palsy had appeared suddenly 40 years earlier and progressed over the next few years. At that time, there was no known pituitary mass.
Weill Y, Rappoport D. Magnetic Resonance Imaging of a Medially Displaced Optic Nerve in a Rare Case of Extreme Exotropia. JAMA Ophthalmol. 2018;136(12):e183420. doi:10.1001/jamaophthalmol.2018.3420
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