TR was a 6-year-old child who had been treated with glasses and patching for anisometropic amblyopia and accommodative esotropia over several years. His vision in the right eye was 20/25 on the most recent examination and the left had improved with therapy to 20/50. His family had changed their health insurance and because their ophthalmologist was not on the plan they elected to seek consultation with a different doctor. He noted that the patient’s left eye appeared prominent under amplification by the high plus spectacle lenses the child was wearing. Hertel exophthalmometry was performed and showed a measurement of the right eye of 15 mm and the left of 18. He also documented the presence of a subtle afferent pupil defect on the left side.
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