Patients presenting with an acute history of Horners syndrome with neck pain and dysphagia require an urgent MRI neck to investigate for carotid artery dissection. ARMD age-related macular degeneration. Coagulofibrinolytic markers were measured . Causes of anisocoria range in seriousness from a normal, physiologic condition to one that is immediately life threatening. No Result No Result Typically one pupil is abnormal and cannot either dilate or constrict. Because some forms of anisocoria may be present for years before it is noticed, your doctor may ask you to provide old pictures to determine how long you have had the problem. - Exacerbating & relieving factors 05:12 They can shrink or enlarge to regulate the amount of light entering the eye. blepharoptosis. Visit your provider or go to the emergency room if you notice one of your pupils is suddenly larger than the other. Causes include Horners syndrome, Argyll Robertson pupil, iritis, mechanical anisocoria, and pharmacologic anisocoria from miotics, narcotics, or insecticides. Patients: Download as PDF The pupil is the black center of your eyes that expands and contracts to help you see in different amounts of light. NANOS members have successfully presented a poster on Neuro-Ophthalmology Fellowships and Careers at the AAN Faculty and Trainee Reception at the AAN 2018 Annual Meeting. Moeller JJ, Maxner CE. CRITICAL THINKING 2 Chapter 46 Answers REVIEW QUESTIONSCONTENT REVIEW The correct answers are in boldface. Advertising on our site helps support our mission. The study included adult patients with iTBI enrolled from April 2018 to March 2021. Patients and other members of the general public should always seek the advice of a physician or other qualified healthcare professional regarding personal health or medical conditions. Est en el comedor. 1977; 83: 832839. Anisocoria is a condition characterized by an unequal size of the eyes' pupils. Anisocoria is an important exam finding that can be detected by an astute clinician who performs a careful and methodical pupillary exam. The Edinger-Westphal nucleus then supplies parasympathetic fibers to the third cranial nerve which traverses the cavernous sinus and enters the orbit via the superior orbital fissure to synapse at the ipsilateral ciliary ganglion. Some babies are born with anisocoria. The prevalence of transient physiological anisocoria of >0.4 mm is found in up to 20% population. Get to know the basic word parts. Afferent light stimulus is received by retinal ganglion cells whose axons traverse as the optic nerve, optic chiasm, and optic tract to eventually synapse at the pretectal nuclei of the dorsal midbrain at the level of the superior colliculi. An Adie tonic pupil is abnormally large like a 3rd cranial nerve palsy, but the pupil still constricts when focusing on something close to the face, and there is no double vision or droopy eyelid. Hydroxyamphetamine mydriasis in Horners syndrome. life-threatening, including Horner's syndrome (which may be due to carotid artery dissection) and oculomotor nerve palsy (due to a brain aneurysm, uncal herniation, or head trauma). Both anisocoria and Horners syndrome can be caused by serious, life-threatening conditions like a stroke, brain aneurysm or some cancers. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Anisocoria can occur as a result of injury (e.g. Although there are benign causes that do not usually need treatment, it is important to find out what is causing the Horner syndrome because it may be a sign of a life-threatening condition, such as stroke, lung, chest or brain tumor, or break in the wall of the carotid artery (carotid dissection). Breaking a word down into its component parts should help readers ascertain the meaning of an unfamiliar term. 33:21-24. Doctors and medical health professionals also make use of abbreviations to quickly communicate information. Hydroxyamphetamine mydriasis in Horners syndrome. Anisocoria is different pupil sizes in each eye. The views expressed in this brochure are of the contributors and not their employers or other organizations. vision defect in which parallel rays come to a focus beyond the retina, root-kerat-cornea This should include checking accommodation and pupillary light reflexes, as well as slit-lamp examination. Kaiser PK. On this Wikipedia the language links are at the top of the page across from the article title. Chemicals and Drugs 85. Example: hypoglycemia - hypo-below normal, glyc=sugar, emia=blood condition. Therefore, hydroxyamphetamine will correct a preganglionic Horners but will not work for postganglionic causes, where the anisocoria persists.4,5. Physiologic anisocoria may be intermittent, persistent, or even self-resolving. Further pharmacologic work-up (see diagnostic procedures) is useful in confirming Horners and distinguishing the order of the lesion. 3rd Cranial Nerve Palsy: An Abnormally Large Pupil. The oculomotor nerve innervates 4 out of the 6 extraocular muscles (superior rectus, medial rectus, inferior rectus, and inferior oblique), the sphincter pupillae muscle, the ciliary muscle, and the levator palpebrae muscle. Web Site Available at. - Severity 05:32 Medical terms always have at least word root. Cleveland Clinic is a non-profit academic medical center. Copyright 2021. All rights reserved. Consultation with a neurologist or neuro-ophthalmologist is recommended for atypical cases, such as autoimmune autonomic ganglionopathy and trigeminal autonomic cephalalgias [5]. Horner's syndrome is a rare genetic condition that affects the tissue around your eyes. Eye drops may be used to help diagnose the cause of the anisocoria. Cremer SA, Thompson HS, Digre KB, Kardon RH. The use of 1% hydroxyamphetamine (Paredrine) can provide localization to the defect in Horners syndrome. But if it occurs suddenly, this can be a sign of a serious medical condition and you should see an eye doctor immediately. In most cases, anisocoria is mild, constant and no cause for concern. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. Adie's pupil may involve an orbital process, while bilateral cases may indicate systemic processes [5]. When pharmacologic and laboratory tests are unequivocal, or when clinical suspicion persists for an underlying aneurysm, hemorrhage or tumor, imaging of the head, neck, and chest can help identify causes of Horners or oculomotor nerve palsies. Congenital anomalies in the structure of the iris may contribute to abnormal pupillary sizes and shapes that present in childhood. QUICK LINKS:Practice Support Tools | Patients | Find a Neuro-Ophthalmologist| NOVEL | YONO Portal | Our Journal | Fellowships, #LookForwardtoNANOS2023 #NANOSinOrlando #NANOS2023. "Adams and Victor's Principles of Neurology, 7th ed." It shrinks (contracts) in bright light and expands (dilates) in dim light. Benign causes of Horners syndrome and oculomotor nerve palsies can be observed with expectant partial or full resolution of symptoms. Anisocoria is composed of prefix, root and suffix: Thus, anisocoria means the condition of unequal pupil(s). Anisocoria which is greater in bright light suggests the larger pupil (which should constrict in bright conditions) is the abnormal pupil. cf-my/o-muscle Nakane S, Higuchi O, Koga M, My Blog anisocoria medical terminology breakdown astigmatism uneven focus, usually due to an ir- regular cornea. anisocoria medical terminology breakdown. "Anisocoria." Blepharochalasis= blepharo-eyelid, chalasis-relaxation 2. Generally, anisocoria is caused by impaired dilation (a sympathetic response) or impaired constriction (a parasympathetic response) of pupils. Pathological anisocoria can be identified by worsening anisocoria in either light or dark conditions. - Over 3000 Free MCQs: https://geekyquiz.com/ When associated with areflexia of the knee and/or ankles, this condition is known as Holmes-Adies syndrome. suffix-graphy-recording node js mysql query in a for loop; saudi arabia lashes punishment video; j frank wilson cause of death. Rubinfeld RS, Currie JN. Ultrasonography, or commonly in medical lingo just ultrasound, is a non-invasive medical technique that utilizes ultrasonic waves for diagnostic or therapeutic purposes. condition in which the eye turns inward; crossed eyes, prefix-ex-out Acad Ophthalmol Otolaryngol. Pathologic anisocoria occurs due to an underlying disease or condition. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. What is her acceleration at the instant she achieves the "knife" position? suffix-opia-sight While 0.5-1% apraclonidine causes constriction of the normal pupil due to its strong -2 adrenergic activity, it causes reversal of anisocoria in Horners by moderately dilating the affected pupil that has undergone denervation supersensitivity (when supersensitivity is present, apraclonidines weak -1 agonist activity predominates) [20]. Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel , Anisocoria refers to the unequal size of pupils and can be a physiological phenomenon. Medical terms may begin with a prefix. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ If anisocoria is the first sign of a more serious condition, the treatment youll need depends on whats causing the anisocoria. 25 Jun. TikTok: https://www.tiktok.com/@geekymedics Some issues like migraines or reactions to medications will resolve themselves on their own. Old photographs may provide information since symptoms may not exist or go unnoticed. Talk about BAL in details 5. everyday anisocoria: Angels trumpet ocular toxicity. If the smaller pupil dilates in response to instillation of. Pe- diatrics 1995; 96 (3 Causes include physical injury from ocular trauma or surgery, inflammatory conditions such as iritis or uveitis, angle closure glaucoma leading to iris occlusion of the trabecular meshwork, or intraocular tumors causing physical distortion of the iris. One pupil may be bigger than normal, or one pupil may be smaller than normal, resulting in unequal pupils. One of the pupils may be larger or smaller. Other causes of 3rd cranial nerve palsy include decreased blood flow to the nerve (microvascular ischemia), tumors pressing on the nerve, and inflammation of the nerve. Anisocoria itself does not cause symptoms. This is because a hemorrhage, tumor or another intracranial mass can enlarge to a size where the third cranial nerve (CN III) is compressed, which results in uninhibited dilatation of the pupil on the same side as the lesion.[8]. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . root-trop-turn Physiologic (also known as simple or essential) anisocoria is the most common cause of unequal pupil sizes, affecting up to 20% of the population [2]. condition in which the individual has difficulty seeing at night, involuntary, constant rhythmic movement of the eyeball, one who specializes in making optical products, cf-opto/o-eye Some of the causes of anisocoria are The root provides the core meaning of the . study and treatment of defective binocular vision resulting from defects in ocular musculature, cf-phac/o-lens Say in what part of the house Ignacio is, based on his clues. For more information, see the Geeky Medics guide to the examination of the eyes and vision. It is crucial for providers to be aware of the diagnostic steps to narrow a differential for anisocoria, as it can be a harbinger of treatable but life-threatening conditions. Lam BL, Thompson HS, Corbett JJ. Problems affecting the muscles or nerves controlling the pupil cause abnormal pupil size. The left pupil is smaller (solid arrow) and the left eyelid is droopy (dashed arrow). Li Y, Jammoul A, Mente K, et An Archive of Our Own, a project of the Organization for Transformative Works Anisocoria can be caused by a lot of conditions in your body, injuries, traumas and even some medicines. Pharmacologic anisocoria typically resolves with cessation of the offending agent. This allows us to get in touch for more details if required. - Timing 03:23 It is relatively common, and causes vary from benign physiologic anisocoria to potentially life-threatening emergencies. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ These nerves also control the muscles that open your eyelids and activate the sweat glands on your face. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://medlineplus.gov/ency/article/003314.htm), (https://www.merckmanuals.com/professional/eye-disorders/symptoms-of-ophthalmologic-disorders/anisocoria?query=anisocoria), (https://www.statpearls.com/ArticleLibrary/viewarticle/17592), Visitation, mask requirements and COVID-19 information. Another name for miosis is pinpoint pupil. Facebook: http://www.facebook.com/geekymedics Thiele EA, Riviello JJ. Are you in search of a Neuro-Ophthalmology fellowship? Anisocoria is greater in the dark due to a defect in the pupillary dilator response secondary to lesions along the sympathetic trunk. This may suggest Adie tonic pupil, pharmacologic dilation, oculomotor nerve palsy, or damaged iris. A diagnosis of Horners can be confirmed by administering 0.5% apraclonidine (alpha-2 agonist) eye drops which will dilate the miotic pupil and correct the anisocoria.5. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Visit your provider or the emergency room as soon as you notice any irregularity in your pupils. suffix-al-pertaining to A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. There also may be loss of sweating, especially on the forehead on the same side. root-opt-eye Ophthalmol 2014; 25:519-523. Diagnosis and suffix-us-structure 74 terms. We do not endorse non-Cleveland Clinic products or services. It was named in 1909 for the Austro-Hungarian neurologist and psychiatrist . https://www.aao.org/eye-health/diseases/anisocoria-5, https://collections.lib.utah.edu/ark:/87278/s6cc5cm7, Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0), https://eyewiki.org/w/index.php?title=Anisocoria&oldid=89277. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! If you have no other symptoms and your provider rules out any serious underlying conditions you probably wont need any treatment. If you grind the stump yourself it may cost you as little as $75 to rent a stump grinder for half a day, or $250 to $400 for a full day. Check out our other awesome clinical skills resources including: The nerves controlling the muscles that constrict the pupil are part of the parasympathetic nervous system. While small differences in pupil size are normal and can even come and go (physiologic anisocoria), constant and significant differences in pupil sizes may be a sign of damage to the nerves that control the pupils or to the brain. If a person's pupils are symmetric there is said to be isocoria. In the mirror, the pupil of the eye appears as a black circle in the middle of the iris (the colored part of the eye). This phenomenon results due to disturbances in the efferent pathway dynamics. Aberrant reinnervation and upregulation of postsynaptic receptors lead to the clinical presentation of a tonically dilated pupil with near stimulation and poor reactivity to light. Please write a single word answer in lowercase (this is an anti-spam measure). Curr Opin Ophthalmol. Chronic anisocoria without associated symptoms may point to a benign process such as physiologic anisocoria, whereas sudden-onset anisocoria in the setting of other symptoms may be more worrisome. Thus, thorough clinical evaluation is important for the appropriate diagnosis and management of the underlying cause. While small differences in pupil size are normal and can even come and go ( physiologic anisocoria ), constant and significant differences in pupil sizes may be a sign of damage to the nerves that control the pupils or to the brain. The purpose of this process is to remove diseased or damaged cells from the body without causing harm to other cells. A finger is holding the right eyelid up because it cannot open. Anisocoria is sometimes the first sign people notice of a life-threatening underlying condition like a stroke or aneurysm. Cremer SA, Thompson HS, In apoptosis, the damaged or diseased cell initiates self-destruction. In this position, she presents the maximum cross-sectional area and thus maximizes the air-drag force on her. The right pupil is bigger (arrow) and the right eye is positioned down and out. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. The etiology of anisocoria is complex, ranging from benign to potentially life-threatening causes. Sympathomimetics, such as adrenaline, clonidine, and phenylephrine, cause mydriasis through their actions at -1 receptors of the pupillary dilator muscle. - Introduction 00:00 Gaines LA. korbell plus refill apotea; jake hess death; lithonia shop light model 1233 Epidemiology. This distinction isnt as important as getting your symptoms evaluated right away. Cornpickers This article will cover the causes and assessment ofanisocoria. Place the correct number of electrons in each shell of (a) Sodium (Na), (b) Rubidium (Rb), (c)(c)(c) Krypton Kr and (d) Chlorine Cl. Normally our pupils are relatively the same size. Voice box ______________________________________. anisocoria [ an-ahy-s uh- kawr-ee- uh, - kohr-, an-ahy- ] noun Ophthalmology. Anisocoria cannot make you go blind. Clinical features of autoimmune autonomic ganglionopathy and the Usually, one of your pupils will be different enough from the other that you can notice it in a mirror. The right pupil is larger (arrow) and does not react to light. (4) is incorrect. Clinicians: Download as PDF. Gastro - stomach Enter - intestines Itis - Inflammation Through this breakdown, we can understand that Gastroenteritis means inflammation of the stomach and small intestine. A flow chart for sorting out the anisocorias. By . Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 'Ultra-' means 'beyond . Mechanical anisocoria secondary to trauma may require surgery to correct the structural defect. root-scler-hardening Considerations Slight differences in pupil sizes are found in up to 1 in 5 healthy people. normal or perfect vision, prefix-en-in The first-order neuron originates from the posterolateral hypothalamus and travels caudally down the brainstem to the ciliospinal center of Budge (C8-T2). An eye doctor will be able to rule out any life-threatening conditions and perform a diagnosis. Apraclonidine, a strong -2 and weak -1 agonist, is a more readily available alternative to cocaine. Isolated anisocoria is often asymptomatic, though mydriasis may cause glare, photosensitivity, and impaired accommodation. A thorough pupillary exam is crucial, and it is best done in dim light with the patients eyes fixed on a distant object to eliminate the near reaction. Lumbar punctures for VDRL, FTA-ABS, and total protein and cell count may be indicated in the evaluation of neurosyphilis. While some of these medications are intentionally used in the eye, sometimes these medications or chemicals are accidentally rubbed into the eye from your skin, usually by your finger. Patients can note increased light sensitivity and blurriness when reading, but overall no specific treatment is needed. Visit Us 4201 Wilson Blvd, Suite 300, Arlington, VA 22203 glentunnel to christchurch FREE QUOTE. Your pupils are the black circles in the center of your eyes. Anisocoria can also be caused by serious, life-threatening conditions, including: Your healthcare provider will classify your anisocoria as either pathological (caused by a disease) or physiological (caused by something malfunctioning inside your body). Other important causes of anisocoria include: DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! The third-order neuron ascends along the carotid artery into the cavernous sinus to ultimately synapse at the pupillary dilator muscle, the Muller muscle of the upper eyelid, and the smooth muscle of the lower eyelid. Home. - Examples 05:45 root-metr-measure This information is produced and made available as is without warranty and for informational and educational purposes only and do not constitute, and should not be used as a substitute for, medical advice, diagnosis, or treatment. When a patient presents with anisocoria, the fear of a serious condition, such as an intracranial aneurysm, often leads clinicians to obtain numerous tests, which are not always necessary. The clinical picture of Adies tonic pupil under slit-lamp examination shows iris sector palsy and vermiform iris movement [18]. June 12, 2022 . Pupillary Disorders Including Anisocoria. diabetes, syphilis) or accidental drug instillation into the eye (if the drug or substance has anticholinergic properties the A thorough review of medications, especially topical eye drops, may provide explanations for pharmacologic anisocoria. It naturally changes size without you noticing or controlling it. Localization of Horners syndrome. Tell your healthcare provider about any changes in your eyes or vision. Unequal pupils. Common ocular effects reported to a poison control center after Ophthalmologe 2000; 97:396-401. The effect of latanoprost 0.005% on pupillary Visit your healthcare provider or go to the emergency room right away if you notice any changes in your eyes or vision, including if your pupils are irregularly sized. Differentiate prefixes that deal with body parts, color, and direction. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ . In the season 10 Big Bang Theory Comic-Con special, Steve Molaro told a story about how he first met actor. However, careful clinical examination is required to rule out more serious pathological causes.1. A detailed neurologic exam is important to localize lesions, look for accompanying signs of cranial nerve involvement, and assess for focal neurologic deficits in the sensory, motor, and deep tendon reflex pathways. Complaints of pain, headaches, ptosis, diplopia, blurred vision, numbness, weakness or ataxia may warrant further evaluation for more life-threatening conditions including traumatic injury, intracranial mass, aneurysm or carotid dissection. Monsieur deux chapeaux allemands s il vous plait. J Emerg Med 2007; This allows them to see how your pupils respond to light. Friedman NJ. [2] Anisocoria has various causes: [3] Physiological anisocoria: About 20% of population has a slight difference in pupil size which is known as physiological anisocoria. J Ophthalmol 1990; 110:71-76. Scopolamine patch-induced unilateral mydriasis. Some people develop anisocoria with no long-term complications, but it can also be a sign of a much more dangerous issue in your body. coiling of the aneurysm). In bright light (such as sunlight), the pupil constricts to make the pupils smaller, which decreases the amount of light getting into the eye. ED Concerns: apical lung lesion, carotid artery dissection, cerebral aneurysm, intracranial mass lesion ED Evaluation: Determine if the anisocoria is more pronounced in the light or in the dark by measuring the pupil diameters under these 2 conditions. - Site 01:12 Accommodation to near stimuli should also be examined as light-near dissociation. anisocoria medical terminology breakdownwhat is a male beaver called. You might also still need imaging tests to rule out one of the causes of anisocoria that can be life threatening. For example, hypothermia has the prefix hypo- (meaning below normal), the root therm (heat or warmth), and the suffix -ia (condition). The pupil may or may not be dilated, but if it is, it requires urgent evaluation. "Stedman's Medical Dictionary, 27th ed." Congenital, traumatic and surgical causes of anisocoria will often be associated with other structural defects. anisocoria medical terminology breakdown. May A. This page was last edited on February 3, 2023, at 08:32. Suffixes can modify the meaning of the word, often in very important ways. Professional Stump Grinding Prices Our research shows that the average cost to grind a stump ranges from $100 to $400 per stump with an average price per diameter of $3. Pp 647. The prevalence of simple anisocoria. suffix-ia-condition The swallows flew swiftly into the old barn where they vigilantly guarded their nests. anisocoria medical terminology breakdown June 26, 2022 by disadvantages of historical sites / Sunday, 26 June 2022 / Published in kobalt lk20175 air compressor manual Major revisions are performed on a periodic basis. Here, the abnormal pupil will be unable to constrict in the light and will appear dilated (mydriatic). 2022 North American Neuro-Ophthalmology Society. Pupillary function is autonomic, largely occurring in response to light stimulation and adrenergic tone. Moreover, sympathetic, and parasympathetic . Please note we have made every effort to ensure the content of this is correct at time of publication, but remember that information about the condition and drugs may change. Subjects. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Patients with isolated traumatic brain injury (iTBI) are known to have coagulopathy, but no previous studies have examined the gender differences in detail. conclusions have been reached. June 12, 2022 Thats why you should talk to your provider as soon as you notice any changes in your eyes or vision. Root: central part of a word. Depending on the specific chemical, this can take hours or days. Expert solutions. Pupillary constriction suggests an oculomotor nerve palsy, whereas no response indicates a pharmacologic cause to the anisocoria. 1978;96(9):1615-1620. hydroxyamphetamine test. Koc F, Kavuncu S, Kansu T. The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis, Br J Ophthalmol 2005; 89(11):1442-1444. turning inward of the margin of the lower eyelid, prefix-eso-inward Pharmacologic anisocoria can present as mydriasis or miosis following administration of agents that act on the pupillary dilator or sphincter muscles. If you experience symptoms alongside anisocoria, you should seek medical care. Pay attention to spelling! I'm bad at making friends, and I don't have any close friends that I could talk to about being trans. Anisocoria is the medical term for asymmetric (different sized) pupils. Talk to your provider about what you should expect if your childs pupils are different sizes at birth. Segmental palsy of the iris sphincter in Adies syndrome. anisocoria inequality of pupil size. Policy. Mechanical anisocoria is an acquired defect that results from damage to the iris or its supporting structures. Use and limitations of the to the iris sphincter muscle), inflammation (e.g. recording of intraocular pressure used in detecting glaucoma, root-trich-hair Anisocoria is a common condition, defined by a difference of 0.4mm or more between the sizes of the pupils of the eyes.[2]. aqueous watery fluid filling the front chamber. Horners syndrome (oculosympathetic palsy) is classically described by the triad of ptosis, miosis, and anhidrosis, although clinical presentations may vary. 3 Pathological anisocoria - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Goldstein JE. anisocoria medical terminology breakdownliu athletics staff directory. Anisocoria can occur as a result of injury (e.g. Create . 52:386391. Ptosis and gaze deviation may suggest an oculomotor nerve palsy, whereas proptosis may indicate and underlying space-occupying lesion within the orbit.
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