This is a 60 year old male with a drooping right upper eyelid and a right sided headache worsening over 2 days. He has had intermittent double vision. This is a 40 year old male with a 5 day history of a severe left peri-orbital headache and a drooping left upper eyelid. He experienced mild head trauma 1 weak ago. He denies blurred or double vision, and he has no past ocular or medical problems.
Systemic exam is unremarkable.
Blood count and chemistries normal. There is no Marcus-Gunn pupil. There is severe ptosis of the right upper lid. There is poor adduction and elevation of the right eye, and the eye is out-turned. Confrontational visual fields and penlight eye exam normal.