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A 64-year-old woman with a past medical history of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and osteoporosis presents with a 2-week history of binocular horizontal diplopia. Her past ocular history includes diabetic retinopathy and cataract extraction. She admits to a 75-pack-year smoking history. She has no other neurologic symptoms and no history of cancer. On examination, visual acuity, pupillary testing, intraocular pressure, and slit-lamp examination results are all within normal limits. Fundus examination reveals nonproliferative diabetic retinopathy. Extraocular muscle testing reveals the above images.
Answer on page 1027