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70 yo WM presents to the emergency department with a history of double vision for the past 3 hours.  He describes the double vision as horizontal and improving in left gaze.  He has no complaints of pain.

Past ocular history: "told had cataracts", glasses

Ocular meds: none

PMH: Diabetes mellitus type 2, hypertension, high cholesterol, no history of cancer.

Meds: insulin, metoprolol, lisinopril, simvastatin

All: none

SH: quit smoking 20 years ago.

FH: no glaucoma, no blindness

PSH: none

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