A 64-year-old woman complained of insidious onset of binocular vertical diplopia for 4 weeks. The diplopia was present in upgaze and downgaze and was worse in the morning and improved as the day progressed. She denied pain with eye movements, eyelid droop, generalized weakness, or difficulty swallowing. Her medical history was significant for colon cancer that was treated with surgery and chemotherapy 4 years previously and cardiac arrhythmia. She had a history of narrow anterior chamber angles treated with laser peripheral iridotomies. She worked as a dog groomer.
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