Abstract
We present a case with recurrent orbital myositis sequentially affecting both lateral rectus muscles separately. In the first episode, the absence of the required symptoms for the diagnosis of orbital myositis led to the erroneous diagnosis of sixth nerve palsy. Eventually, the correct diagnosis was established with cerebral MR imaging. Orbital myositis should be included in the differential diagnosis of what appears clinically to be abducens palsy, and MR imaging with a focus on the orbita is mandatory in such patients.
Highlights
Orbital myositis implies orbital inflammation confined to Ն1 extraocular muscle and usually begins acutely with unilateral periorbital pain, with eye movement, and diplopia due to restriction of extraocular muscle movement
We report a young patient with 2 asynchronous bilateral orbital myositis episodes, separated by 18 months, presenting without any clinical signs of inflammation
This case emphasizes the notion that orbital myositis should be considered in the differential diagnosis of clinically apparent abducens nerve palsy
Summary
Orbital myositis implies orbital inflammation confined to Ն1 extraocular muscle and usually begins acutely with unilateral periorbital pain, with eye movement, and diplopia due to restriction of extraocular muscle movement. Eyelid swelling and conjunctival injection usually are present.[1] These may be related to specific inflammatory processes associated with systemic disease or restricted to the orbit.[2] Typically, inflammation is unilateral and can be recurrent. Recurrences can involve different muscles and, occasionally, the other eye.[2] Diagnosis can usually be made clinically due to the characteristic pain and signs of inflammation.
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