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A 63-year-old man had a 13-year history of intermittent vision loss, binocular diplopia, and blepharoptosis of the left eye during bending or straining that had worsened over the previous year. There was no proptosis on examination. A Valsalva maneuver induced 6 mm of proptosis in the left eye, with anterior superior globe displacement and blepharoptosis, which quickly reversed on relaxation.
See the NEJM article: