"Look straight at me...
To the left...
And now, to the right!"
The misalignment was most evident when I first awoke this patient, but you can still see that the left eye does not track well, especially when looking to the right. (Hint: look at the slight difference in the reflection between the eyes, subtle but present in all photos.)
I was able to diagnose this patient's underlying condition, which is practically pathognomonic for...
Med students: do you know what it is?
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Left-sided internuclear ophthalmoplegia, caused by an injury to the medial longitudinal fasciculus...
And the most common source of this lesion is multiple sclerosis. This patient has chronic relapsing, remitting multiple sclerosis (curiously, the patient didn't have any visual problems until a week ago.) We prescribed an eye-patch. I was graciously given permission to photograph the eyes for educational purposes and spread the word.
Sometimes double vision can be "monocular," signifying astigmatism in the affected eye. When it is "binocular," requiring BOTH eyes to be open to create double vision, then you worry about cranial nerve and ocular muscle defects.
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