EYE

A 33-year-old woman who you began treating for depression 2 weeks earlier with amitriptyline comes to the emergency department because of a "migraine headache", "fuzzy vision", nausea, and one episode of vomiting. She was seen 4 days ago in the emergency department for similar complaints and states that "the doctor couldn't find anything wrong with me." Review of her records shows a normal physical examination, normal CBC, and normal CT of the head. She was given oxycodone/acetaminophen for her headaches and sent home. Now, the visual acuity is 20/20 in the right eye and 20/200 in the left eye. Examination of the right eye is normal, however examination of the left eye reveals a non-reactive pupil to light or accommodation. The left pupil is fixed at 5 mm and there is redness of the conjunctiva. The optic nerves appear normal in both eyes. The most appropriate next step in the management of this patient is to


A. begin a trial of sumatriptan therapy
B. counsel her about depression
C. obtain a STAT ophthalmology consult
D. order an MRI of the brain and orbits
E. send VDRL and FTA-ABS studies