The Case Of The Enlarged Eye

A young lady of 21 came to see me today. Her major complaint was that her right eye was bigger than her left. I asked her how long ago she first noticed this and her reply was one month. She was seeking a second opinion from me as the previous ophthalmologist could not help her.
I will call her Susan. Susan had no prior medical history, worked in the retail business, and was quite concerned about her right eye. She denied any pain or change in vision. I looked at her and did not notice a difference in the size of her two eyes. Sometimes an eyelid can be drooping and make that eye look smaller than the other. However her lids were symmetrically positioned. I measured he protrusion of her eyes from the bony orbits and did not find any asymmetry either.
I explained to Susan that there was no obvious difference in her eye size. She became quite animated and surprised. Her first response was "Are you serious?" I had her look in the mirror and she said the difference was obvious. Perhaps she was noting her pupil size, but she denied this. I asked one of my partners to look and he did not see a problem either. At this point Susan took out her cellphone and took a picture of her face. She promptly and emphatically held the camera's picture up to me to view and said "Do you now see the difference?"
Clearly some patients present challenges that my med school psychiatry rotations did not fully prepare me for. Though I tried to reassure her that whatever she saw was within the normal range , she would have none of that. I did what most doctors do in situations where the patient is no longer trusting our opinion: offered her another opinion with another ophthalmologist. That would be the third eye surgeon she would be seeing. I wish her well. Perhaps you might ask why I did not investigate further, for example, by getting a CT Scan of her eyes. Then I could show her there is no tumor or abnormality behind her eye. The problem is there is a cost associated with the scan which I could not justify. Even more importantly she would be exposed to unnecessary radiation. Sometimes as physicians the best we can do is try to reassure patients that their fears are not going to come to fruition.