A patient with diplopia and upper eyelid edema: a case report

Abstract

Idiopathic orbital inflammatory disease, previously referred to as orbital pseudotumor, is a nonneoplastic, non-infective disease. The inflammatory process can involve one or more orbital sof tissues; extraocular muscles, tear gland, scleralorepiscleral tissue or orbital fat. Orbital myositis typically presents itself with a sudden onset of restricted ocular motility, diplopia, congestive proptosis, eyelid ptosis, periocular swelling and conjunctival hyperemia. A thorough workup is essential for ruling out other entities.This report presents a case of a 47-year old man with a sudden onset of right upper eyelid swelling and diplopia. Until then he had no health problems. Afer initial ophthalmologic workup and ultrasound an orbital mass was suspected. Te MRI and a biopsy of the mass confirmed an isolated superior oblique muscle myositis. We treated him with systemic steroids. A good response and fast regression were observed. In two years of follow-up visits no recurrence was noted.Isolated superior oblique muscle myositis is extremely rare. This is one of eleven cases documented between 1988 and 2015. This case report presents a 47-year old man with a sudden onset of right upper eyelid swelling and diplopia. Until then he had no health problems. After initial ophthalmologic workup and ultrasound an orbital mass was suspected. The MRI and a biopsy of the mass confirmed an isolated superior oblique muscle myositis. We treated him with systemic steroids. A good response and fast regression was observed. In two years of follow-up visits no recurrence was noted.Isolated superior oblique muscle myositis is extremely rare. This is one of eleven documented cases between 1988 and 2015.