Sudden onset of pain in the eye and blurring of vision

doi:10.1136/bmj.a3111

Published 21 January 2009, doi:10.1136/bmj.a3111
Cite this as: BMJ 2009;338:a3111

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Sudden onset of pain in the eye and blurring of vision

Neha R Chopra, foundation year 2, medicine, Daniel A Jones, specialist trainee 3, cardiology, Narasinha Gadi, trust senior house officer, medicine, Farhad Huwez, consultant physician

¹ Basildon Hospital, Basildon and Thurrock NHS Trust, Nethermayne, Basildon Essex SS16 5NL

Correspondence to: D A Jones danieljones@doctors.org.uk

The first 150 words of the full text of this article appear below.

A 64 year old man was admitted with sudden onset of pain inhis right eye, blurred vision, and double vision on lookingto the right. His medical history included hypertension, myocardialinfarction, and a stroke from which there was no residual deficit.

Neurological examination identified intention tremor in botharms, horizontal nystagmus, and diplopia on looking to the right.He had no motor weakness, but the left plantar was extended.Examination of his face provided clues to the diagnosis (figure).

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1 What does the figure show and what is the likely diagnosis?

2 What is the differential diagnosis?

3 How would you localisethe lesion in this patient?

1 The figure shows a unilateral partial ptosis, miosis, andapparent enophthalmos of the patient’s right eye, consistentwith Horner’s syndrome. The sudden onset of the symptoms,the vascular risk factors, and the findings of the examinationmake Wallenberg (lateral . . . [Full text of this article]

Central (first order) neurones
Preganglionic(second order) neurones
Postganglionic (third order)neurones