Acute-onset diplopia in a case of nephrotic syndrome

Description

A 12-year-old boy was evaluated in our emergency services for complaints of diplopia and mild generalised headache since past 4 days. The patient was a known case of frequently relapsing idiopathic nephrotic syndrome and was currently in remission since 5 days. He was normal and oriented on general physical and systemic examination. Urine microscopy had revealed only traces of protein on repeated evaluation, and serum albumin was 2.2 g/dL on presentation. Visual acuity was 6/6 in both eyes, and the pupillary reflexes were brisk. The ocular motility examination revealed an esotropia of 20 prism dioptres (figure 1A) along with limitation of the abduction movements in both eyes (figure 1B,C). However, right eye showed a greater limitation compared with left eye. Anterior segment of both the eyes were normal, but the fundus examination revealed bilateral severe established optic disc oedema (figure 2A,B). The...

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