A 69-year-old retired radio host and disc jockey was referred to the neuro-ophthalmology service for evaluation of a 3-month history of intermittent binocular diplopia and left-sided ptosis.
He described the diplopia as fluctuating, at times perceiving a vertical “shadow” and at other times horizontal image separation. Symptoms were present only with both eyes open and resolved with either eye closed. The diplopia fluctuated throughout the day, was worse in the evening and was more pronounced at distance, without a consistent gaze-dependent pattern.
He denied systemic, neurologic or other