Clinical findings, orbital imaging, and intraoperative findings in patients with isolated inferior rectus muscle paresis or underaction

ABSTRACT The diagnosis of Graves’ orbitopathy is usually straightforward. However, orbital diseases that mimick some clinical signs of Graves’ orbitopathy may cause diagnostic confusion, particularly when associated to some form of thyroid dysfunction. This report describes the rare occurrence of localized inferior rectus muscle amyloidosis in a patient with autoimmune hypothyroidism, who was misdiagnosed as Graves’ orbitopathy. A 48-year-old man complained of painless progressive proptosis on the left side and intermittent vertical diplopia for 6 months. The diagnosis of Graves’ orbitopathy was entertained after magnetic resonance imaging revealing a markedly enlarged, tendon-sparing inferior rectus enlargement on the left side, and an autoimmune hypothyroidism was disclosed on systemic medical workup. After no clinical improvement with treatment, the patient was referred to an ophthalmologist and further investigation was performed. The presence of calcification in the inferior rectus muscle on computed tomography, associated with the clinical findings led to a diagnostic biopsy, which revealed amyloid deposition. This report emphasizes that a careful evaluation of atypical forms of Graves’ orbitopathy may be crucial and should include, yet with rare occurrence, amyloidosis in its differential diagnosis.

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Clinical findings and surgical outcomes of patients with traumatic isolated inferior rectus muscle paresis

Journal of American Association for Pediatric Ophthalmology and Strabismus ◽

10.1016/j.jaapos.2019.07.008 ◽

2019 ◽

Vol 23 (6) ◽

pp. 315.e1-315.e5

Author(s):

Mohammad Reza Akbari ◽

Mohammad Mehrpour ◽

Mohsen Karimian ◽

Arash Mirmohammadsadeghi

Keyword(s):

Surgical Outcomes ◽

Rectus Muscle ◽

Clinical Findings ◽

Inferior Rectus ◽

Inferior Rectus Muscle

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Incidence and Risk Factors of Inferior Rectus Muscle Palsy in Pediatric Orbital Blowout Fractures

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1601884 ◽

2018 ◽

Vol 11 (1) ◽

pp. 028-034 ◽

Cited By ~ 1

Author(s):

Stephanie M. Young ◽

Yan Tong Koh ◽

Errol W. Chan ◽

Shantha Amrith

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Pediatric Patients ◽

Rectus Muscle ◽

Orbital Floor ◽

Case Review ◽

Inferior Rectus ◽

Retrospective Case ◽

Orbital Blowout Fractures ◽

Inferior Rectus Muscle

The aim of this study was to evaluate the incidence, clinical features, and risk factors of sustaining inferior rectus (IR) palsy in a group of pediatric patients with orbital floor blowout fractures. We performed a retrospective case review of sequential cases of pediatric orbital floor blowout fractures (<18 years old) from 2000 to 2013 in a tertiary ophthalmic center in Singapore. A total of 48 patients were included in our study, of whom 5 had IR palsy (10.4%). Patients with IR palsy had a higher mean age (16.4 ± 1.5 years) compared with patients without IR palsy (12.4 ± 3.3 years), had significantly ( p < 0.05) worse preoperative motility, and had significantly greater proportion developing postoperative hypertropia (100%) compared with patients without IR palsy (4.7%). Our series of pediatric blowout fractures demonstrated IR palsy prevalence and clinical features for IR palsy which may be distinct to the pediatric group.

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