First, I performed a blink reflex in my office. This is an electrical test in which I stimulate the trigeminal nerve and force an individual to blink. I record how long it takes for a person to blink. In this situation, there was a clear prolongation for blinking for the left lower eyelid relative to the right lower eyelid. I then sent him for a detailed high-resolution MRI of the left eye.
This MRI scan shows a subtle lesion just under the left eyeball. A biopsy of this tumor showed lymphoma.