In this case report, we present the rare occurrence of supernumerary extraocular muscles (SEOM) in a 35-year-old male with hyperthyroidism. SEOMs are unusual anatomical variations involving extraocular muscles that deviate from the typical muscle arrangement in the eye. While SEOMs are rare, they can have diverse clinical manifestations, including restrictive strabismus and lid abnormalities. In this case, the patient displayed right-sided lid retraction and an asymmetrical palpebral aperture, which raised concerns about a potential association with thyroid eye disease. However, imaging revealed that the SEOM was anatomically connected to the superior rectus muscle, possibly contributing to the observed lid retraction. Understanding the complexities of SEOM and its potential interactions with conditions like thyroid ophthalmopathy is crucial for accurate diagnosis and management. Further research is needed to fully comprehend the development and clinical impact of SEOMs due to their rarity and limited knowledge in the medical literature.
Hemolacria is a rare condition that causes a person to produce tears that are partially composed of blood. It can be a presenting feature of certain ocular and systemic conditions. Here, the authors describe an interesting case of a 12-year-old boy with an underlying beta-thalassemia trait, who presented with a 2-day history of bilateral blood-stained tears, and an episode of epistaxis. Ocular examination was normal, and syringing showed no nasolacrimal duct blockage. Systemic examination was unremarkable. Laboratory investigations confirmed type 2 von Willebrand disease. Management of hemolacria remains a clinical challenge given the rare occurrence of the disease. In this case report, the authors discuss the differential diagnosis and management approach to hemolacria.