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Something Wrong on the Face of an Old Man

Something Wrong on the Face of an Old Man

This article was originally presented as an independent educational activity under the direction of CME LLC. The ability to receive CME credits has expired. The article is now presented here for your reference. CME LLC is no longer responsible for the presentation of the article.


ImageA 76-year-old man is seen because of redness below the right eye. Has long-standing “lazy eye” on the left, which is chronically deviated outward. Has lived in nursing home for some years due to self-care deficit from memory loss. No recent eye surgery, conjunctivitis, sinus infection, or periocular trauma.


Man who does not effectively communicate how much of his moderate discomfiture is psychological versus physical. Temperature, 37.3°C (99.2°F); heart rate, 84 bpm and regular; BP, 126/84 mm Hg; respirations, 20 per minute and not labored. Face as shown. Visual function seems preserved within limits of his replies. Full ocular range of motion. Each pupil constricts on direct illumination and consensually on shining flashlight beam into opposite eye.

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