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Surgical Timing and Fracture Type on the Outcome of Diplopia After Orbital Fracture Repair

Yu DY, Chen CH, Tsay PK, Leow AM, Pan CH, Chen CT

Ann Plast Surg, 2016 Mar;76 Suppl 1:S91-5.
PMID: 26808744 DOI: 10.1097/SAP.0000000000000726

Orbital fractures and the concomitant soft tissue injuries within the bony orbit result in well-recognized complications such as diplopia and enophthalmos. Guidelines for timing and indications for surgery for achieving an optimal outcome remain elusive. This study examined the effects of timing and fracture type on the outcome of orbital fracture repair.

Matched MeSH terms: Diplopia
Recurrent bilateral orbital myositis: case report and review of the literature

Abd-Rashid R, Hussein A, Yunus R, Naik VR, Shatriah I

Ann Trop Paediatr, 2011;31(2):173-80.
PMID: 21575325 DOI: 10.1179/1465328111Y.0000000004

Orbital myositis in children is uncommon. Recurrence is a major challenge in management. An 11-year-old Malay girl who presented with bilateral orbital myositis with recurrent attacks of diplopia is reported.

Matched MeSH terms: Diplopia/diagnosis; Diplopia/etiology
Silent sinus syndrome due to a maxillary mucocele

Tan TY, Shashinder S, Subrayan V, Krishnan G

Auris Nasus Larynx, 2008 Jun;35(2):285-7.
PMID: 18024042

Silent sinus syndrome is a rare clinical condition in which patients present with spontaneous enophthalmos and hypoglobus secondary to collapse of orbital floor due to chronic subclinical maxillary sinusitis. It is postulated that obstruction of the osteomeatal complex lead to negative antrum pressure which causes the maxillary sinus atelectasis.

Matched MeSH terms: Diplopia/etiology*
Orbital multiple myeloma: a diagnostic challenge

Tai E, Sim SK, Haron J, Wan Hitam WH

BMJ Case Rep, 2017 Aug 07;2017.
PMID: 28790098 DOI: 10.1136/bcr-2017-220895

Orbital involvement in multiple myeloma is unusual. We describe the case of an 85-year-old woman who presented with right eye proptosis, reduced visual acuity and diplopia. Computed tomography showed a lobulated, enhancing soft tissue mass arising from the right greater wing of the sphenoid with intraconal, lacrimal gland and ocular muscle involvement. Histopathology revealed predominantly atypical plasma cells in a background of reactive lymphocytes, with monoclonality towards kappa light chain protein, suggestive of multiple myeloma. This case illustrates the diagnostic imaging challenge of orbital multiple myeloma.

Matched MeSH terms: Diplopia
Fulltext "Why do I always see double?" A misdiagnosed case of ocular myasthenia gravis for 10 years

Yousuf UA, Yashodhara BM, Thanigasalam T, Ting HS

BMJ Case Rep, 2014 May 02;2014.
PMID: 24792021 DOI: 10.1136/bcr-2013-203488

A 58-year-old man presented with diplopia and partial ptosis for 10 years. It was non-progressive in nature, despite inadequate medical attention the patient received from non-specialists/general practitioners. He did not have fatigability or diurnal variation in weakness and was clinically stable without exacerbations of disease for a decade. He did not have features of Graves's disease, oculopharyngeal dystrophy, cranial nerve paralysis, polymyositis and stroke. The possibility of an atypical presentation of myasthenia gravis (MG) was considered and the patient was evaluated. Ice pack test was negative, Cogan's lid twitch (CLT) test was positive and high titres of acetylcholine receptor antibodies (AChR Ab) suggestive of MG were found. He was treated accordingly with a very good response.

Matched MeSH terms: Diplopia/drug therapy; Diplopia/etiology
Fulltext Cerebral venous thrombosis: an unusual cause of complex ophthalmoplegia in an elderly man

Ng, Benjamin Han Sim, Prakash Supahiah, Goh, Siew Yuen

Borneo Journal of Medical Sciences, 2021;15(1):45-48.
MyJurnal

Cerebral venous thrombosis (CVT) is a neurological condition occurring because of thrombosis involving the cerebral venous sinuses. This case report is an unusual clinical manifestation of cerebral venous thrombosis in a 76-year-old Chinese man who presented with restricted eye movement and double vision. Despite extensive investigation, there was no better explanation for his clinical symptom and sign apart from cerebral venous thrombosis which was confirmed by magnetic resonance venography (MRV) of the brain. Once cerebral venous thrombosis was diagnosed, he was initiated on anticoagulation and discharged with oral warfarin. This case emphasizes the need to consider cerebral venous thrombosis as one of the rare causes of complex ophthalmoplegia especially when typical cardiovascular risk factors are lacking in an individual.

Matched MeSH terms: Diplopia
Nystagmus and diplopia in a patient with positive aquaporin-4 antibody

Koh KL, Sonny Teo KS, Halim SA, Wan Hitam WH

Can J Ophthalmol, 2019 04;54(2):e66-e69.
PMID: 30975364 DOI: 10.1016/j.jcjo.2018.06.022
Matched MeSH terms: Diplopia/diagnosis*; Diplopia/etiology; Diplopia/immunology
Fulltext Arteriovenous malformation in temporal lobe presenting as contralateral ocular symptoms mimicking carotid-cavernous fistula

Mohd-Tahir F, Siti-Raihan I, Wan Hazabbah WH

Case Rep Ophthalmol Med, 2013;2013:158961.
PMID: 23533876 DOI: 10.1155/2013/158961

Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

Matched MeSH terms: Diplopia
Fulltext Corticosteroid Therapy in Optic Neuropathy Secondary to Nasopharyngeal Carcinoma

Wahab Z, Tai E, Wan Hitam WH, Sonny Teo KS

Cureus, 2021 Mar 06;13(3):e13735.
PMID: 33842113 DOI: 10.7759/cureus.13735

INTRODUCTION: Nasopharyngeal carcinoma (NPC) is a tumor arising from the epithelial cells of the nasopharynx. NPC can spread and invade the base of skull, nasal cavity, paranasal sinuses, pterygopalatine fossa, and apex of the orbit. However, the involvement of the optic nerve in NPC is rare. The purpose of this case report is to report the efficacy of corticosteroid therapy in optic neuropathy secondary to NPC.
CLINICAL CASE: A 56-year-old Chinese woman, an active smoker, presented with a hearing deficit, persistent tinnitus and nasal congestion. Examination and investigations revealed the presence of a mass in the nasopharynx. Tissue biopsy revealed nasopharyngeal carcinoma. However, the Epstein-Barr virus was not tested. She was counseled for chemotherapy, but refused and was subsequently lost to follow up. She presented one year later with right eye ptosis associated with progressive worsening of diplopia and blurring of vision. Examination revealed multiple (second, third, fourth and sixth) cranial nerve involvement. Systemic examination and investigations revealed cervical lymphadenopathy and liver metastasis. Repeated imaging showed that the mass had invaded the base of the skull, cavernous sinus and orbital apices. Pulse dosing of corticosteroid therapy was commenced, resulting in dramatic improvement of vision.
CONCLUSION: Optic neuropathy may be the presenting sign of NPC. Corticosteroid therapy can offer immediate visual improvement.

Matched MeSH terms: Diplopia
Fulltext Leptomeningeal Carcinomatosis With Optic Nerve Metastasis Secondary to Breast Cancer

Chew C, Wan Hitam WH, Ahmad Tajudin LS

Cureus, 2021 Mar 31;13(3):e14200.
PMID: 33936906 DOI: 10.7759/cureus.14200

Leptomeningeal carcinomatosis (LC) and optic nerve metastasis are uncommon occurrences in breast cancer. We report a rare case of LC with optic nerve infiltration secondary to breast cancer. A 45-year-old lady who was a known case of treated right breast carcinoma six years ago presented with a blurring of vision in both eyes, floaters, and diplopia for one month. She also had recurrent attacks of seizure-like episodes, headache, and vomiting. Examination revealed high blood pressure with tachycardia. Her right eye visual acuity was counting fingers at two feet and 6/36 in the left eye. She had right abducens nerve palsy. Fundoscopy showed bilateral optic disc swelling with pre-retinal, flame-shaped haemorrhages and macular oedema. CT scan of brain and orbit was normal. She was admitted for further investigations. While in the ward, her vision deteriorated further. Her visual acuity in both eyes was at the level of no perception to light. She also developed bilateral abducens nerve palsy and right facial nerve palsy. Subsequently, she started having bilateral hearing loss. There were few episodes of fluctuations in conscious awareness. MRI brain showed mild hydrocephalus. Both optic nerves were thickened and enhanced on T1-weighted and post-gadolinium. Lumbar puncture was performed. There was high opening pressure. Cerebrospinal fluid cytology showed the presence of malignant cells. Family members opted for palliative care in view of poor prognosis. Unfortunately, she succumbed after a month's stay in hospital. Diagnosis of LC and optic nerve infiltration presents a formidable challenge to clinicians especially in the early stages where neuroimaging appears normal and lumbar puncture has high false negatives. Multiple high-volume taps are advised if clinical suspicion of LC is high.

Matched MeSH terms: Diplopia
Co-occurrence of acute ophthalmoplegia (without ataxia) and idiopathic intracranial hypertension

Yeak J, Zahari M, Singh S, Mohamad NF

Eur J Ophthalmol, 2019 Jul;29(4):NP1-NP4.
PMID: 30280587 DOI: 10.1177/1120672118803532

BACKGROUND: Acute ophthalmoparesis without ataxia was designated as 'atypical Miller Fisher syndrome' as it presents with progressive, relatively symmetrical ophthalmoplegia, but without ataxia nor limb weakness, in the presence of anti-GQ1b antibody. Idiopathic intracranial hypertension is characterized by signs of raised intracranial pressure occurring in the absence of cerebral pathology, with normal composition of cerebrospinal fluid and a raised opening pressure of more than 20 cmH2O during lumbar puncture. We aim to report a rare case of acute ophthalmoplegia with co-occurrence of raised intracranial pressure.
CASE DESCRIPTION: A 28-year-old gentleman with body mass index of 34.3 was referred to us for management of double vision of 2 weeks duration. His symptom started after a brief episode of upper respiratory tract infection. His best corrected visual acuity was 6/6 OU. He had bilateral sixth nerve palsy worse on the left eye and bilateral hypometric saccade. His deep tendon reflexes were found to be hyporeflexic in all four limbs. No sensory or motor power deficit was detected, and his gait was normal. Plantar reflexes were downwards bilaterally and cerebellar examination was normal. Both optic discs developed hyperaemia and swelling. Magnetic resonance imaging of brain was normal and lumbar puncture revealed an opening pressure of 50 cmH2O. Anti-GQ1b IgG and anti-GT1a IgG antibody were tested positive.
CONCLUSION: Acute ophthalmoparesis without ataxia can present with co-occurrence of raised intracranial pressure. It is important to have a full fundoscopic assessment to look for papilloedema in patients presenting with Miller Fisher syndrome or acute ophthalmoparesis without ataxia.

Matched MeSH terms: Diplopia/diagnosis
Solitary Extramedullary Plasmacytoma of the Sphenoid Sinus: A Case Report

Loong SP, Afandi AN, Lum CL, Ong CA

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1692-1694.
PMID: 31763226 DOI: 10.1007/s12070-015-0945-1

Solitary extramedullary plasmacytomas are rare, discrete mass of neoplastic monoclonal plasma cells in the soft tissue with no evidence of multiple myeloma. They constitute 3 % of all plasma cell tumors and less than 1 % of head and neck malignancies. A 43 year old lady presented to our clinic with complains of diplopia and headache for 4 weeks. Computed Tomography scan showed a mass lesion in the sphenoid sinus eroding the sinus floor, right wall, basisphenoid and parasellar area. A biopsy of the mass reported as plasmacytoma. Systemic examination revealed no evidence of dissemination of the disease confirming the diagnosis of a solitary extramedullary plasmacytoma. The patient was subjected to 25 fractions of radiotherapy. Here, we report a rare case of solitary extramedullary plasmacytoma of the sphenoid sinus.

Matched MeSH terms: Diplopia
White-eyed blowout fracture: Diagnostic pitfalls and review of literature

Yew CC, Shaari R, Rahman SA, Alam MK

Injury, 2015 Sep;46(9):1856-9.
PMID: 25986667 DOI: 10.1016/j.injury.2015.04.025

White-eyed blowout fracture was first termed by Jordan et al. in individuals sustaining a blow to the periocular area and presenting with ocular symptoms, although with minimal soft tissue signs of trauma. It is often found in pure orbital floor blowout fractures among paediatric patients, and it could manifest as a linear or hinge-like trapdoor deformity. Unlike the more common open orbital blowout fractures with distinct diagnostic clinical signs, white-eyed blowout fractures are rarer and their diagnoses can be easily missed, subsequently costing an optimal time window for surgical intervention. This is critical as better outcomes are found with earlier release of entrapments. This report describes a case of a white-eyed blowout fracture in a 10-year-old child faced with its diagnostic challenges. The current literature review discusses the types of fracture pattern, signs and symptoms, mechanism of action, as well as timing of surgery. In view of the common complication of persistent diplopia, clinical pitfalls in achieving this diagnosis are emphasized to prevent any delay of treatment. Current literature evidences are weighted towards urgent surgical intervention, as positive outcomes are found to correlate with earlier release of entrapments.

Matched MeSH terms: Diplopia
Fulltext Outcome of Various Pterygium Excision Techniques in Tertiary Ophthalmic Centre in East Coast Malaysia

Khairidzan, M.K., Fatimah, S.S., Thangasamy, V.K.

International Medical Journal Malaysia, 2006;5(1):1-2.
MyJurnal

Pterygium is a common external eye problem. It is more frequently seen in tropical areas regions where exposure to ultraviolet sunlight is high. Clinically, a pterygium is a wing shaped fibrovascular growth arising from the bulbar conjunctiva onto the superficial cornea. Complications of pterygium include decreased in visual acuity, dryness, foreign body sensation and persistent redness. Surgical management is the mainstay of treatment for this condition. Numerous surgical techniques have been described in the treatment of pterygium. They include the bare sclera technique, simple direct conjunctival closure, rotational conjunctival graft and conjunctival autograft. Additional treatment to some of these techniques may include the use of beta particle therapy and antimetabolite therapy. Despite the wide range of surgical procedures described for its treatment, the main concern from these procedures has been the recurrence, which could be as high as 30% to 70%. Recurrent pterygium is often accompanied by increased conjunctival inflammation and accelerated corneal involvement. Repeated surgical procedures often only worsen the situation, as loss of conjunctival tissue and scarring can result in obliteration of the fornices and mechanical restriction of extraocular movements, with clinically significant diplopia. In Hospital Tengku Ampuan Afzan, pterygium excision is the most common surgical procedure after cataract extraction. We reviewed patients who had undergone pterygium surgery in HTAA in order to determine the most effective surgical method that could minimize recurrence. PURPOSE: To compare success rates of various excision techniques performed for primary and recurrent pterygium in Hospital Tengku Ampuan Afzan, Kuantan, Pahang.
METHODS: The outcome of 47 cases of pterygia (44 primary and 3 recurrent) excised with various techniques between January 2004 to September 2004 was retrospectively reviewed. Six clinical specialists and four trainees performed the surgical procedures. Outcome was evaluated in terms of recurrence of pterygia onto the cornea. RESULTS: The mean follow up was 3.04 months (range, 1-7 months). All pterygia were morphologically graded as intermediate or fleshy type except one. Four types of pterygium excision techniques were performed. Twenty-four cases had bare sclera, seventeen cases had conjunctival autograft transplantation, six cases had direct conjunctival closure and one had amniotic membrane transplantation done. Recurrence of pterygia occurred in thirteen eyes. Twelve cases from primary pterygia group and one case from recurrent group recurred. Recurrence rate was noted to be higher in direct conjunctival closure (4 out of 6 cases) and lowest in conjunctival autograft transplantation (2 out of 17 cases). Recurrence rate for bare sclera technique was noted to rank second in this study (6 out of 24 cases). In five cases of recurrence, subconjunctival tissue invasions were more than 1 mm but further surgical interventions were not needed at the time of this review was done. CONCLUSIONS: Conjunctival autografting was found to have less recurrent rate when compared with other techniques. The bare sclera technique was quoted to be associated with higher recurrence rate in other literatures. Interestingly in our series, recurrence rate for direct conjunctival closure technique was higher when compared to the former technique. This may be related to inadequate excision of pterygia tissue, which led to direct apposition of abnormal tissue to the cornea in the direct conjunctival closure technique. Even though the bare sclera technique is associated with a higher recurrence rate, it is still the preferred excision technique. This could be because it is less time consuming and technically easier to perform. Based on this study, conjunctival autografting should be the surgical procedure of choice for pteryigum in order to minimise the risk of recurrence.

Matched MeSH terms: Diplopia
Fulltext Managing Subacute Subperiosteal Hematoma with High Intraocular Pressure: A case report

Hashim SE, Fatisha A, Nazri MN

International Medical Journal Malaysia, 2017;16(1):135-138.
MyJurnal

Subperiosteal haematoma of the orbit is an uncommon complication of maxillofacial trauma, hence easily missed. It usually presents subacutely with proptosis and diplopia. In our case, the subperiosteal haematoma is complicated with high intraocular pressure, necessisating measures to reduce the intraocular pressure. Unresponsive to only medical treatment, surgical evacuation was carried out in this patient. Removal of the clot finally relieved the intraocular pressure and simultaneously improved the proptosis and the cumbersome diplopia.

Matched MeSH terms: Diplopia
Delay and misdiagnosis in adult myasthenia gravis: A case report

Kwa, Siew Kim, Zainab Abdul Majeed, Tan, Kah Nian

International e-Journal of Science, Medicine & Education, 2016;10(3):37-39.
MyJurnal

Myasthenia gravis (MG) is a rare autoimmune disorder
characterised by fluctuating and variable combination
of muscle weakness and fatigue. Most cases are due to
T-cell mediated autoantibodies against post-synaptic
acetylcholine receptors (AChR-Ab), thus preventing
acetylcholine from binding and signalling skeletal
muscle to contract.1
The annual incidence is 7-23 new cases per million.1
It can occur at any age but with two peaks; an earlyonset
(20-40 years) female-predominant and a late-onset
(60-80 years) male-predominant peak. MG is classified
into ocular and generalised (80%). More than half the
patients initially present with ptosis and diplopia but half
will progress to generalised disease with involvement of
bulbar, limb and respiratory weakness. Those presenting
as generalised MG can also develop eye signs later.1
It is important to recognise MG early because it is
highly treatable. Untreated disease leads to permanent
weakness.2 Treatment reduces mortality from lifethreatening
myasthenic crisis.1,3 Misdiagnosis leads to
potentially harmful interventions and inappropriate
management.4,5 Diagnosis in late-onset MG is easily
missed2,3,4,5 because of overlapping symptoms with
other diseases common in the elderly. We report a case
of delay and misdiagnosis in an elderly patient with
co-morbidities. (Copied from article).

Matched MeSH terms: Diplopia
Fulltext Diplopia in a post-splenectomy Thalassemic patient

Neoh, Pei Fang, Tai, Evelyn L.M., Liza Sharmini A.T.

Journal of Biomedical and Clinical Sciences, 2017;2(2):26-28.
MyJurnal

We report a case of cavernous sinus thrombosis in a post-splenectomy male with underlying Haemoglobin E Thalassemia major. A 35-year-old man presented with a first episode of sudden onset of diplopia on lateral gaze for 1 week. He had no other ocular and systemic symptoms. There was no history of trauma or recent infection. However, he admitted that he was not compliant to his oral penicillin V and aspirin, which was prescribed to all post splenectomy patients. Unaided visual acuity in both eyes was 6/6. On examination, there was limited abduction over the left eye, suggestive of left lateral rectus palsy. Full blood count revealed leucocytosis with thrombocytosis. Magnetic resonance imaging, magnetic resonance angiography and magnetic resonance venography of the brain showed bulging of the left cavernous sinus, with a persistent focal filling defect, in keeping with left cavernous sinus thrombosis (CST). He was diagnosed with left isolated sixth nerve palsy secondary to aseptic cavernous sinus thrombosis with pro-thrombotic state post-splenectomy. He was started on subcutaneous fondaparinux and oral warfarin. His diplopia fully resolved after 1 month of treatment with complete resolution of CST on computed tomography venogram.

Matched MeSH terms: Diplopia
Fulltext Diagnostic dilemma of dural carotid cavernous fistula

Noorlaila B., Zunaina E., Raja Norliza R.O., Nor Fadzillah A.J., Alice, G.K.C.

Journal of Biomedical and Clinical Sciences, 2017;2(1):38-41.
MyJurnal

We report a case of dural carotid cavernous fistula (CCF) pose a diagnostic dilemma with initial symptoms of the arteriovenous shunt. A 56 year-old man presented with right eye diplopia, thensubsequently developed ptosis, congestion of conjunctiva, dilated episcleral vessels, and gradual rise in intraocular pressure. Initial diagnosis of pseudotumour was made based on negative finding of CCF by computed tomography angiography (CTA). In view of persistent clinical manifestations in spite of steroid therapy, and with the presence of new ocular signs; cock-screw conjunctival vessels, dilated retinal veins, and proptosis, digital subtraction angiography (DSA) was performed and confirmed the diagnosis of dural CCF.The ocular symptoms resolved completely post embolization of the fistula.

Matched MeSH terms: Diplopia
Fulltext Epiphora as the primary initial presentation for a huge sino-nasal osteoma: a rare presentation

Nadia Yaacob, Adil Hussein

Journal of Biomedical and Clinical Sciences, 2018;3(2):26-28.
MyJurnal

Sino-nasal osteoma is a common benign tumour of paranasal
sinuses and usually asymptomatic. Here, we presented a case of a huge sinonasal osteoma. Despite the large size of the tumour, the only presentation
was epiphora. There were no headache, facial pain or diplopia. Nasal
obstruction only occurred after involvement of the nasal cavity. In diagnosing
aetiology of the epiphora, sino-nasal pathology needed to be ruled out after
excluding ocular causes. Multidisciplinary approach between otolaryngology
(ORL) team and ophthalmology team was essential in managing the case.
The tumour was successfully removed surgically via endoscopic approach;
and dacryocystorhinostomy (DCR) was performed to alleviate the epiphora.

Matched MeSH terms: Diplopia
Fulltext Recurrent optic neuritis as early presentation of idiopathic hypertrophic cranial pachymeningitis

Norhayaty Samsudin, Tai, Evelyn Li Min, Chui, Yain Chen, Kumar, Lakana, Azhany Yaakub, Adil Hussein, et al.

Journal of Biomedical and Clinical Sciences, 2017;2(1):23-26.
MyJurnal

44-year-old Malay lady presented with drooping of the right eyelid and worsening of left eye vision for one week duration. There was associated headache, periorbital discomfort and diplopia on left gaze. She previously had a history of recurrent optic neuritis affecting both eyes over a period of 12 years. On examination, there was right-sided partial ptosis and left exotropia. The adduction, abduction, elevation and depression of the right eye was limited. Left eye extraocular movements were full. The right eye visual acuity was 6/9, while the left eye visual acuity was perception to light, with a positive relative afferent papillary defect and a pale optic disc. The right optic disc was normal. There was reduced sensation in the trigeminal nerve distribution over the right side of the face. Neurological examination was otherwise normal. Magnetic resonance imaging of the brain and orbit revealed meningeal thickening with involvement of the right orbital apex and cavernous sinus. Blood investigations for infectious and autoimmune causes were unremarkable. She was diagnosed to have idiopathic hypertrophic cranial pachymeningitis and treated with systemic corticosteroids. The right eye extraocular motility improved, while the left eye visual acuity improved to counting finger. This case demonstrates that idiopathic hypertrophic cranial pachymeningitis may present as recurrent optic neuritis in the early phase, before radiological evidence of the disease is present. A high index of suspicion for the underlying cause is essential to prevent irreversible optic nerve damage due to recurrent optic neuritis.

Matched MeSH terms: Diplopia

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