Abstract
A 56-year-old woman reported a 2-week history of diplopia associated with mild pain and periorbital edema. On examination, the patient had a large exotropia (A). While vertical eye movements were intact, there was limited adduction of each eye on right (B) and left (C) gaze. These findings were consistent with wall-eyed bilateral internuclear ophthalmoplegia. Postcontrast axial T1 fat-suppressed magnetic resonance imaging (D) revealed bilateral enlargement and enhancement of the medial rectus muscles indicative of orbital myositis.
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