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JAMA Ophthalmology Clinical Challenge
May 2, 2019

Gaze-Provoked Exotropia in a Young Woman

Author Affiliations
  • 1Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
  • 2Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • 3Department of Neurology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. 2019;137(7):840-841. doi:10.1001/jamaophthalmol.2019.1091

A 25-year-old woman was referred to the neuro-ophthalmology clinic because of a 6-month history of intermittent diplopia. The double vision occurred every day, multiple times throughout the day, and was provoked after looking to the right. There was no eye pain, headache, ptosis, difficulties swallowing, change in voice, or any other ocular or neurological symptoms.

She had no history of strabismus, eye patching, or ocular surgery. Her medical history was notable for a growth hormone–producing pituitary macroadenoma for which she underwent surgical resection 2.5 years prior to presentation, followed by γ-knife radiosurgery (50 Gy) 6 months after the initial surgical procedure. She also had a history of congenital hip dysplasia. Medications included cabergoline, levothyroxine, ethinyl estradiol/drospirenone, and pasireotide.