A 37-year-old white woman 2 weeks postpartum from an uncomplicated pregnancy and normal spontaneous vaginal delivery presented to the Tufts Medical Center emergency room.
She had a 1-week history of intermittent vertical binocular diplopia in downgaze, right eye pain with eye movement, right upper eyelid swelling with ptosis and right eye redness superiorly.
Ocular history was significant only for contact lens wear and glasses. Medical history included four pregnancies, transient hypothyroidism during a previous pregnancy, depression and generalized anxiety. She had a family history of lupus in