Patient has ptosis and vertical diplopia.

A 31-year-old man was referred to the Bascom Palmer Eye Institute in Miami, Florida, in consultation from another ophthalmologist with the chief complaint of ptosis OS for 1 week. He also noted vertical diplopia that began 3 days prior to presentation. He had no other neurologic complaints. His medical history was negative. He immigrated from Cuba 5 years prior and denied any recent travel, trauma, or illnesses. On examination, there was a striking left-sided ptosis. The best-corrected visual acuity was 20/25 OU. The patient had a relative afferent pupillary defect in his left eye. His IOPs were normal and visual fields were full to confrontation. His extraocular movements were grossly abnormal.