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Objective: Unusual clinical course Background: Orbital abscess is a severe infectious condition of the eye that can result in significant complications, including vision loss or fatality. Timely and accurate diagnosis and treatment of this condition are crucial. Case Report: A 45-year-old man with exophthalmos, diplopia, and decreased vision was admitted to our hospital. He had a history of chronic sinusitis. Ultrasonography showed a dark fluid area above the superior rectus muscle of the right eye, measuring approximately 5.7 ml. Orbital MRI revealed short T1 and long T2 signal shadows outside the upper muscle cone of the right orbit, with a size of about 13.2 ml. The right eyeball was compressed and moved forward, and the superior rectus muscle was also compressed. Long T2 signal shadows were observed in the right frontal sinus, maxillary sinus, and bilateral ethmoid sinuses, leading to a diagnosis of orbital subperiosteal abscess and sinusitis. We performed a fine-needle puncture and injection of antibiotics into the abscess cavity using a 5-ml syringe under the guidance of B-ultrasound. On the 7th day after surgery, the patient showed clinical improvement with decreased symptoms. His visual acuity improved from 20/40 to 20/20, and diplopia resolved. His sinusitis was treated with medication, and no recurrence of ocular symptoms was observed during the 3-year follow-up. Conclusions: This report highlights the use of ultrasound-guided fine-needle puncture and injection of antibiotics into the abscess cavity for the treatment of an upper-quadrant orbital subperiosteal abscess. Timely surgical drainage and effective antibiotic therapy can help reduce the complications associated with orbital abscesses. [ABSTRACT FROM AUTHOR]

IntrroductionMethodsResultsConclusionSixth nerve palsy is the most common type of extraocular muscle palsy. The therapy options in sixth nerve palsies include monitoring with or without conservative treatment, botulinum toxin injections or strabismus surgery. The aim of this retrospective study was to compare botulinum toxin (BT) injections into the medial rectus to conservative treatment in sixth nerve palsies. The rate of patients improved after intervention and treatment outcomes for the two treatment options were be evaluated at a German tertiary referral center.A service evaluation was conducted on adult patients with sixth nerve palsy. Patient files were reviewed and data including abduction deficit and size of deviation were collected retrospectively. Patients which presented between January 1987 and April 2022 were considered. Patients were allocated into two treatment groups: BT injected into medial rectus or conservative treatment, which included observation, providing occlusion and Fresnel prisms. Inclusion criteria were attendance of two visits with orthoptic assessment. Exclusion criteria included presence of further oculomotor palsies, strabismus, strabismus surgery and suppression. Non-parametric statistical analysis was conducted using IBM® SPSS Statistics.A total of 606 adult patients with unilateral or bilateral sixth nerve palsy attended during the named period. A total of 137 adult patients met the inclusion criteria. Of which, 36 had a bilateral palsy, 101 had a unilateral palsy. 45.26% (n = 62) were treated with BT injections and 54.75% (n = 75) were treated conservatively. The median initial abduction deficit was greater in the BT group, (−4 to −5 after Scott and Kraft) than in the conservative treatment group (−1). The initial angle of deviation at distance was significantly larger in the BT group than in the conservative treatment group (p =  <0.001). The rate of improvement in the BT group was 24.19% (n = 15) and 20% (n = 15) in the conservative treatment group. When excluding longstanding palsies rates of improvement in both groups increased to 28.85%. The improvement of the angle of deviation at distance in all patients was greater in the BT group (p = <.001). The improvement of abduction in bilateral palsies were greater in the BT group (p = .016), but in unilateral palsies, there was no significant difference in abduction improvement in the two treatment groups (OD p = .3, OS p = .406).This service evaluation found that BT injection into medial rectus in unilateral and bilateral sixth nerve palsies did not increase the rate of improvement compared to conservative treatment. But BT injections reduced the angle of deviation to a greater extent than conservative treatment. Additionally, BT was able to improve abduction in bilateral palsies to a greater extent than conservative treatment. It is recommended a BT injection is considered in symptomatic bilateral sixth nerve palsies to enable fixation and improved ocular motility. More research is needed to verify reliable clinical guidelines for the use of BT in sixth nerve palsies. [ABSTRACT FROM AUTHOR]

Convergence insufficiency (CI) is a frequent clinical condition primarily of idiopathic etiology. Neurological causes are secondary, and in the case of cerebral infarctions, the symptoms do not always correlate with the location. We present a middle-aged man who experienced a left anterior choroidal artery stroke with marked and symptomatic CI. In addition to having multiple cardiovascular risk factors, he also had antiphospholipid syndrome as a possible contributing cause. [ABSTRACT FROM AUTHOR]

To review the efficacy and safety of the use of intraoperative image guidance (IIG) in orbital and lacrimal surgery. A literature search of the PubMed database was last conducted in November 2023 for English-language original research that assessed the use of any image guidance system in orbital and lacrimal surgery that included at least 5 patients. The search identified 524 articles; 94 were selected for full-text analysis by the panel. A total of 32 studies met inclusion criteria. The panel methodologist assigned a level II rating to 2 studies and a level III rating to 30 studies. No study met the criteria for level I evidence. Procedures reported on were as follows: fracture repair (n = 14), neoplasm and infiltrate biopsy or excision (n = 6), orbital decompression for Graves ophthalmopathy (n = 3), dacryocystorhinostomy (n = 1), and mixed etiology and procedures (n = 8). Four studies used more than one IIG system. One study that met level II evidence criteria compared the outcomes of orbital fracture repair with IIG (n = 29) and without IIG (n = 29). Borderline better outcomes were reported in the IIG group: 2% versus 10% with diplopia (P = 0.039) and 3% versus 10% with enophthalmos (P = 0.065). The other level II study compared the repair of fractures with navigation (n = 20) and without (n = 20). The group in which navigation was used had a measured mean volume reduction of 3.82 cm3 compared with 3.33 cm3 (P = 0.02), and there was a greater measured reduction in enophthalmos in the navigation group of 0.72 mm (P = 0.001). Although the remaining 30 assessed articles failed to meet level II criteria, all alleged a benefit from IIG. No complications were reported. A small number of comparative studies suggest that there are improved outcomes when IIG is used in orbital fracture repair, but each study suffers from various limitations. No high-quality comparative studies exist for the management of lacrimal surgery, neoplastic disease, or decompression. Complications attributable to the use of IIG have not been identified, and IIG has not been analyzed for cost savings. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Introduction: Reduction in visual acuity and glare are common indications for cataract surgery in patients with strabismus. The amblyopic eye is particularly sensitive to blur, despite reduced visual acuity and contrast sensitivity. However, the impact of cataracts on visual functions in strabismus patients is not well documented. Aim: To evaluate the Vision-related Quality of Life (VRQoL) after cataract surgery in strabismus patients. Materials and Methods: The present quasi-experimental study was conducted in the Department of Ophthalmology, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India, from August 2023 to September 2023. Study included 44 strabismus patients, which was assessed by Hirschberg and alternate cover tests. All patients underwent unilateral manual small incision cataract surgery on the worse eye. VRQoL was assessed using the Indian Vision-related Quality of Life Functioning Questionnaire-33 (IND-VFQ-33) questionnaire preoperatively and postoperatively. Statistical significance was determined using paired t-tests (p-value<0.05). Results: In the present study, the mean±Standard Deviation (SD) age of patients was 64.34±8.09 years (range: 42-79 years), with a predominance of females, 29 (66%). All patients underwent unilateral manual small incision cataract surgery on their worse eye. The degree of strabismus among the patients varied: 27 (61.36%) exhibited a 15° deviation, 12 (27.27%) had a 30° deviation and 5 (11.36%) exhibited a 45° deviation. A total of 41 (93.1%) patients presented with exotropia, while 3 (6.9%) exhibited esotropia. The results demonstrated significant improvements in Corrected Distance Visual Acuity (CDVA) from the preoperative to postoperative period. The IND-VFQ-33 questionnaire revealed substantial reductions in scores for general functioning, mobility, activity limitation, psychosocial impact and visual symptoms across the entire study population and in all strabismus groups (15°, 30° and 45° deviations), with a p-value of <0.05. Overall, 84.09% of patients had no to mild visual impairment postoperatively, with 27 (100%) patients with 15° strabismus, 7 (58.3%) patients with 30° strabismus, and 3 (60%) patients with 45° strabismus reporting no to mild visual impairment. 3 (25%) patients with 30° strabismus and 1 (20%) patient with 45° strabismus had moderate vision impairment postoperatively. Two (16.66%) patients with 30° strabismus and one patient with 45° strabismus had severe vision impairment postoperatively. Conclusion: A significant proportion of strabismus patients with cataracts were elderly, predominantly females. Exotropia and 15° strabismus were the most common findings. Cataract surgery significantly improved VRQoL, with the most substantial benefits observed in patients with a 15° deviation and the least in those with a 45° deviation. [ABSTRACT FROM AUTHOR]

Pineal tumors are rare, and the pineal region is a challenging surgical location for neurosurgeons. The present study aimed to investigate the effects of microsurgical management in patients with pineal region tumors and explore probable factors associated with preoperative hydrocephalus, postoperative hydrocephalus remission, and prolonged hospital length of stay (LoS). A retrospective study of patients with pineal region tumors who underwent microsurgical management at the First Affiliated Hospital of Soochow University (Jiangsu, China) between 1 January 2010 and 31 October 2022 was conducted. Data from 36 patients were included in this study. The top 5 common symptoms included headache (58%), dizziness (44%), double vision (22%), vomiting (19%), and nausea (14%). Patients with a lower Karnofsky Performance Score (KPS), younger age, and larger maximum tumor diameters were more vulnerable to preoperative hydrocephalus. Preoperative hydrocephalus also led to a prolonged postoperative LoS (P = 0.021). Patients with a lower KPS score (P = 0.020) or larger maximum tumor diameters (P = 0.045) were more likely to achieve postoperative remission of hydrocephalus. Most postoperative complications led to increased hospital LoS. Microsurgical resection of pineal tumors yielded favorable long-term outcomes. Patients with a lower KPS score, younger age, and larger maximum tumor diameters were more vulnerable to preoperative hydrocephalus and prolonged LoS. Patients with a lower KPS score or larger tumor diameter were likely to achieve significant remission of hydrocephalus after tumor resection. [ABSTRACT FROM AUTHOR]

Nasal Extranodal NK/T Cell Lymphoma is an aggressive tumour affecting the nasal and midline structures, causing surrounding tissue destruction as the result of its progression. The initial presentations are similar to symptoms of benign nasal polyps, such as nasal obstruction, hyposmia and nasal discharge. As the disease progresses, the involvement of the palate, paranasal sinuses, orbit and skin become alarming symptoms. We report a case of a young male with Nasal ENKTL who presented with symptoms similar to acute on chronic rhinosinusitis with orbital complications. The challenges of diagnosing and getting to the correct management pathway are discussed. [ABSTRACT FROM AUTHOR]

This is a case report describing an unusual presentation of acute painful diplopia that led to the diagnosis of VEXAS syndrome. VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is an adult-onset monogenic auto-inflammatory disease due to somatic UBA1 gene mutation in haematopoietic progenitor cells. Our patient was a 67-year-old diabetic male who presented with painful eye movements associated with diplopia, left periorbital pain and swelling. Imaging revealed an inflammatory process involving multiple intra- and extra-orbital structures. The patient improved initially with a short course of intravenous steroids. However, two months later he re-presented with right facial swelling. Bone marrow biopsy demonstrated UBA1 gene mutation supporting the diagnosis of VEXAS syndrome. This case highlights a unique ocular presentation of VEXAS. [ABSTRACT FROM AUTHOR]

One of the authors (K-H. Y.) convened a panel of seven aesthetic experts from South Korea and Australia to create guidelines for treating facial lines of the upper face with letibotulinumtoxinA. The panel members provided recommendations for injection sites, dosage, and injection techniques for using letibotulinumtoxinA and also considered relevant anatomy, patient assessment and selection, and individual variations to evaluate clinical strategies for minimizing complications. The panelists provided recommendations for treating forehead horizontal lines, glabellar frown lines, and lateral canthal lines. The guidelines developed by the panel will support clinical practitioners of all skill levels in providing safe and effective aesthetic treatments of the forehead, glabellar complex, and lateral canthal lines with letibotulinumtoxinA. [ABSTRACT FROM AUTHOR]

Background: Idiopathic intracranial hypertension (IIH) is a cause of chronic headaches that are probably driven by raised intracranial pressure (ICP). Cerebral venous sinus pressure is thought to play a role in the underlying pathology, but its relation with intracranial pressure requires further investigation. We aimed to evaluate the concordance between lumbar puncture opening pressure (LPOP) as indicator of the ICP and cerebral venous sinus pressure in patients investigated for IIH. Methods: In this case-series replication study, all patients with IIH suspicion and who underwent cerebral venous sinus pressure measurement followed immediately by LP opening pressure (LPOP) measurement were retrospectively included. Pearson's correlation and measurement agreement (Bland-Altman plots) between venous pressure and LPOP were analyzed. Results: 52 consecutive patients (46 women; median age, 31 years [IQR = 25–42]) were included. The mean pressure in the superior sagittal sinus (SSS) and in the torcular were 20.9mmHg (SD ± 7.3) and 20.8 mmHg (SD ± 6.8), respectively. The mean LPOP was 22mmHg (SD ± 6.4). Pressure measured in the transverse venous sinus, the torcular, and the SSS correlated with LPOP (p < 0.001). Bland-Altman plots showed that torcular pressure strongly agreed with LPOP (mean difference of 1.7mmHg). The limit of agreement (LOA) (mean difference ± 1.96SD) contained 98.1% of the differences between the two methods, confirming the concordance between the two measures. Torcular pressure and LPOP were consistent in patients with a trans-stenotic pressure gradient ≥ or < to 8 mmHg (mean difference: 1mmHg and 2.4mmHg, respectively), and for those with a LP OP ≥ or < to 18mmHg (mean difference: 1.8mmHg and 1.95mmHg, respectively). Conclusions: In patients investigated for IIH, the ICP measured at the LP is correlated and concordant with the torcular pressure. These results confirm previous findings and further corroborate the hypothesis that cerebral venous system plays a major role in CSF dynamics and ICP. [ABSTRACT FROM AUTHOR]

Legal pluralism scholarship has argued that co‐existing legal orders interact. Individuals draw on exogenous norms to strategically resist social and legal constraints. Integrating the concepts of ‘situated legal consciousness’ and ‘interlegality’, I explore how identities within intersecting legal orders influence legal consciousness. To this end, I draw on a case study of the plurality in marriage laws among British Muslim communities in England, where Islamic nikah ceremonies are not by themselves recognized as marriage. My analysis shows that marginalized individuals routinely rely on interlegality to make sense of their realities and choices. This engenders a ‘double vision’, as individuals perceive their identities, social arrangements, and the law through an integrated lens of intersecting laws. They resist the social locations to which they are relegated in plural legal orders and reposition themselves within these with the aid of a composite identity that allows them to see their lifeworlds through a double vision of the law. [ABSTRACT FROM AUTHOR]

Purpose: To compare the surgical outcomes of One- versus Two-vertical muscle surgery in patients with unilateral superior oblique muscle palsy (SOP) with primary position hypertropia (HT) over 20 PD. Patients in Group 1 underwent inferior oblique anterior transposition plus resection (IOATR), while patients in Group 2 underwent inferior oblique anterior transposition (IOAT) along with contralateral inferior rectus (IR) recession. Methods: Medical data of all SOP patients treated by either procedure from 2000 to 2023 in our strabismus center were recruited. We compared surgical outcomes between Group 1 and Group 2 by analyzing HT correction, rate of under-correction, and over-correction. Results: The study included 33 patients in Group 1 and 23 in Group 2. Both groups were similar in age, sex, etiology, affected side, diplopia, and head tilt. Group 2 achieved higher HT correction in all measured gazes. Group 1 had a higher risk of under-correction (18.18% in Group 1 vs 8.69% in Group 2) while Group 2 had a higher rate of over-correction (21.73% vs 0% in Group 1). Conclusion: In patients with severe unilateral SOP, Two-vertical muscle surgery achieved higher amounts of HT correction in all gazes despite a significantly higher risk of over-correction. [ABSTRACT FROM AUTHOR]

Background: Extracranial internal carotid artery (ICA) pseudoaneurysm is a rare condition that can be caused either by penetrating or blunt trauma, including dog bites, which is an uncommon occurrence. Together with the possibility of no symptoms or nonspecific ones such as cervical pain, hematoma, swelling, or mass, considering ICA pseudoaneurysm following a dog attack is of paramount importance to avoid life-threatening complications. Case presentation: We present a rare case of a 17-year-old male with a history of dog bites three months prior, who presented to the emergency department with left-sided neck pain, dizziness, and several episodes of blurred vision and diplopia. On physical examination, a palpable mass measuring approximately 20 × 30 millimeters was identified in the left neck region and multiple superficial lacerations were observed in this area. Laboratory tests yielded normal results. Doppler ultrasound revealed a pseudoaneurysm in the left internal carotid artery. Because the great saphenous veins were insufficient, the patient was successfully treated with synthetic graft patch arterioplasty, and no complications were seen in his one-year follow-up with computed tomography (CT) angiography. Conclusions: This report emphasizes the significance of thorough initial evaluation and imaging in cases of dog attacks, even without apparent significant trauma, to rule out hidden arterial injuries. [ABSTRACT FROM AUTHOR]

Telemedicine is now being used more frequently to evaluate patients with myasthenia gravis (MG). Assessing this condition involves clinical outcome measures, such as the standardized MG-ADL scale or the more complex MG-CE score obtained during clinical exams. However, human subjectivity limits the reliability of these examinations. We propose a set of AI-powered digital tools to improve scoring efficiency and quality using computer vision, deep learning, and natural language processing. This paper focuses on automating a standard telemedicine video by segmenting it into clips corresponding to the MG-CE assessment. This AI-powered solution offers a quantitative assessment of neurological deficits, improving upon subjective evaluations prone to examiner variability. It has the potential to enhance efficiency, patient participation in MG clinical trials, and broader applicability to various neurological diseases. [ABSTRACT FROM AUTHOR]

• Ophthalmoparesis has not been previously described in anti-HMGCR antibody-associated myopathies and two cases are presented. • Other causes of ophthalmoparesis and proximal weakness were extensively ruled out. • Consider anti-HMGCR antibody-associated myopathies in patients with proximal weakness, elevated creatine kinase, and ophthalmoparesis. We describe two anti-3‑hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) antibody-positive patients with treatment-responsive ophthalmoparesis. Patient 1 was a 53-year-old male with progressive proximal limb weakness, dysphagia, ptosis, and diplopia over 6 weeks and creatine kinase (CK) of 3,512 units/L. Patient 2 was a 55-year-old female with progressive proximal weakness, dysarthria, ptosis, diplopia, and dyspnea over 2 weeks with CK of 31,998 units/L. Both patients had normal thyroid studies and repetitive nerve stimulation, myopathic electromyography with fibrillation potentials, magnetic resonance imaging demonstrating abnormal enhancement of extraocular muscles, muscle biopsy showing necrotic myofibers, and positive anti-HMGCR antibodies. Patient 1 also had weakly positive anti-PM/Scl antibodies. Immunomodulatory therapies led to resolution of oculobulbar weakness and normalization of CK levels in both patients, while limb weakness resolved completely in patient 1 and partially in patient 2. These cases expand the phenotypic spectrum of anti-HMGCR antibody-associated myopathies to include subacute ophthalmoparesis with limb-girdle weakness and markedly elevated CK. [ABSTRACT FROM AUTHOR]

Purpose: To study the clinical spectrum and recovery patterns in patients of acquired isolated ocular motor nerve palsies (OMNPs). Methods: Patients above 5 years of age with various etiologies of OMNPs were included. Demographic and ocular details were recorded, and a squint assessment was performed. Recovery patterns at 3 and 6 months were noted. Results: OMNP was more common in adults, in the order VI > III > IV nerve. Ischemic cause (35%) was followed by idiopathic (26.3%). III nerve palsies were all unilateral, of which all ischemic palsies were pupil-sparing. By 6 months, >50 patients showing complete recovery had ischemic and idiopathic palsies. Smaller baseline deviation correlated with better recovery. Conclusion: Acquired isolated OMNPs are mostly ischemia-related, with >80% of cases fully recovering by 6 months. VI nerve palsy of ischemic or idiopathic etiology and small baseline deviation were associated with self-recovery. [ABSTRACT FROM AUTHOR]

(1) Background: Defining the optimum center for laser refractive corrections is difficult, with many of the available approaches having pros and cons. Decentered ablations result in undesirable side effects like halos, glare, monocular diplopia, and a reduction in visual acuity; (2) Methods: The ideal centration in refractive corrections should fulfil three requirements: covering a scotopic pupil; respecting the visual axis; and minimizing tissue removal. The implications of different centration strategies are discussed and shown graphically; (3) Results: Oversized asymmetric offset ablation faces fewer difficulties in registering static cyclotorsion, features less tissue wastage compared to a symmetric offset, and includes a certain amount of coma (and trefoil) in the profile, benefiting eyes with a pupil offset, which typically present with relevant amounts of coma and trefoil corneal aberrations due to decentered optics; (4) Conclusions: There is a need for a flexible choice of centration in refractive procedures to design customized and non-customized treatments optimally. An ideal optical zone covering the pupil with the widest entrance may be as important as a centration reference. [ABSTRACT FROM AUTHOR]

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Sinonasal teratocarcinosarcoma (SNTCS) is a rare malignancy characterized by a highly aggressive nature. It mainly arises in the ethmoidal or maxillary sinus. SNTCS has a poor prognosis, with a mean survival rate of 55% at 2 years. Herein, we presented a case of advanced SNTCS successfully treated with surgery followed by chemoradiotherapy plus targeted therapy and reviewed the published literature on this rare entity. [ABSTRACT FROM AUTHOR]

Purpose To analyze the correlation between orbital computed tomography (CT) scan measurements including the fracture area (FA), the fracture location, the soft-tissue herniation volume (HV), the fractured orbital volume ratio (OVR) to the normal orbit, and the clinical enophthalmos in acute isolated orbital floor fractures. Methods We enrolled 100 patients with acute isolated unilateral orbital floor fractures from May 2017 to January 2021. Based on the CT scan findings, we measured the FA, HV, OVR, and fracture site. We assessed enophthalmos using both clinical (CE) and radiographic (RE) measurements. Additionally, we investigated the correlation between CE and the measured parameters, along with the relationship between the pattern of diplopia and the fracture site. Results We identified enophthalmos in 81% and diplopia in 78% of the patients with an acute blowout orbital floor fracture. CE was moderately correlated with the FA (R2 = 0.4341, P < 0.001). CE was weakly correlated with the HV (R2 = 0.2861, P = 0.04). Anterior fractures caused diplopia in both vertical gazes, but posterior fractures were mostly associated with diplopia in the up gaze. OVR was strongly associated with RE (R2 = 0.663, P < 0.0001) and moderately associated with CE (R2 = 0.4378, P < 0.0001). The univariate regression analysis also showed that OVR could significantly predict CE and RE. Conclusions OVR surpasses other CT scan measurements such as FA and HV in the prediction of clinical enophthalmos. Thus, OVR could be utilized to estimate clinical enophthalmos at the time of presentation, especially when the acute clinical setting prohibits the proper clinical evaluation.

A 31-year-old male with a history of right zygomaticomaxillary complex (ZMC) fracture presented with aesthetic concerns, continuous tearing, and double vision. The patient had undergone multiple surgeries post accident, resulting in an asymmetrical cheek bulge, persistent diplopia, and epiphora. Investigations revealed abnormal placement of an orbital mesh and damage to the lacrimal sac. A surgical plan was devised to remove the plates, reposition the muscles, secure the floor, correct the epiphora, and provide the desired aesthetics. The surgery involved removal of the mesh and a long plate, refracturing of the zygoma, approximation and securing of the fractured zygoma with plates, and creation of an osteum on the lateral wall of the nose. Post-operatively, the patient’s healing was uneventful and he was satisfied with the outcome. This case underscores the importance of a proper surgical technique and patient-centered care in managing complex facial fractures.

Introduction: Reduction in visual acuity and glare are common indications for cataract surgery in patients with strabismus. The amblyopic eye is particularly sensitive to blur, despite reduced visual acuity and contrast sensitivity. However, the impact of cataracts on visual functions in strabismus patients is not well documented. Aim: To evaluate the Vision-related Quality of Life (VRQoL) after cataract surgery in strabismus patients. Materials and Methods: The present quasi-experimental study was conducted in the Department of Ophthalmology, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India, from August 2023 to September 2023. Study included 44 strabismus patients, which was assessed by Hirschberg and alternate cover tests. All patients underwent unilateral manual small incision cataract surgery on the worse eye. VRQoL was assessed using the Indian Vision-related Quality of Life Functioning Questionnaire-33 (IND-VFQ-33) questionnaire preoperatively and postoperatively. Statistical significance was determined using paired t-tests (p-value

Abstract This case report presents the clinical findings of a female patient diagnosed with Wernicke’s encephalopathy, characterized by pinpoint pupils. While pupillary changes can occur in Wernicke’s encephalopathy, the presence of pinpoint pupils is exceedingly rare. In this report, we aim to document and discuss this unusual presentation, as well as speculate on the potential mechanisms underlying this atypical manifestation of the disease.

AbstractEpithelial carcinoma of the nasopharynx originates from the mucosal lining of this region. The etiology of the disease involves a complex interplay of environmental factors, genetic predisposition, and infection with the Epstein Barr virus. In this article, we present a case of nasopharyngeal carcinoma (NPC) that presented with right orbital proptosis and ocular symptoms, without any of the typical signs of nasopharyngeal carcinoma. However, imaging studies revealed subtle findings of NPC. Isolated neuro-ophthalmologic symptoms are not a common manifestation in NPC patients. Proptosis is a rarer finding among ophthalmologic symptoms, usually associated with tumor invasion into the orbit. However, in the presented case, unilateral proptosis was observed without orbital tumor invasion.

Ibuprofen, a commonly used over-the-counter medication, is widely recognized for its effective pain relief properties but is also associated with various adverse effects, including rare ocular and neurological manifestations. We report a case of a 27-year-old male who experienced transient vertical diplopia following a standard ibuprofen dosage for back pain. Symptoms resolved promptly upon discontinuation of the drug, with normal findings on extensive clinical and laboratory evaluations. The clinical presentation, suggestive of skew deviation, implies central toxicity. This case underscores the potential for diplopia associated with NSAIDs like ibuprofen to be underdiagnosed and offers valuable insights into the central toxicity of ibuprofen. Further research is warranted to elucidate the underlying mechanisms and optimize patient care in similar scenarios. [ABSTRACT FROM AUTHOR]

Neurologically isolated trochlear nerve (TN) injury is uncommon. We describe the case of acute vertical diplopia development in a 64-year-old man who considered himself healthy. The cause of diplopia was neuropathy of TN. The diagnostic search gave reason to assume that TN damage was associated with microangiopathy caused by arterial hypertension and dyslipidemia newly diagnosed in the patient. A diagnostic algorithm for acute vertical diplopia and the range of diseases for differentiation with isolated TN neuropathy are discussed, as well as the prognosis and patient’s management. The association of isolated TN neuropathy with migraine and the risk of ischemic stroke is considered.

Multiple oculomotor palsies are a rare condition. They typically present with ptosis, diplopia and preserved pupillary function. We present the case of a 65-year-old woman with a history of diabetes and arterial hypertension, initially presenting with headache and later developing diplopia, progressive left palpebral ptosis and fluctuating pupillary response. She was diagnosed with unilateral paralysis of cranial nerves III and IV. Extension studies were performed and, ultimately, the Neurology Department diagnosed microvascular ischemia due to diabetes. Metabolic and blood pressure therapy was adjusted; two months later, complete recovery was achieved. Multiple oculomotor palsy is a diagnostic challenge in the general medical practice. Fluctuating pupillary response, or anisocoria, may be caused by neoplasms or aneurysms in the posterior communicating artery, with potentially devastating consequences. Therefore, judicious clinical evaluation is crucial for etiological diagnosis and appropriate treatment.

Purpose: This 13-year consecutive case series aims to provide a comprehensive overview of all patients operated for clival chordomas and clival chondrosarcomas in Denmark since the centralization of treatment in 2010, comparing outcomes to international series. Methods: This was a retrospective review of 33 patients with clival tumors, comprising 22 chordomas and 11 chondrosarcomas, who were treated at Copenhagen University Hospital between years 2010 and 2023. Data were collected from digital patient records and pathology reports. Results: The symptoms leading to diagnosis primarily included double vision, headaches, and dizziness. In general, patients were in good health, with a mean Charlson Comorbidity Index score of 1.6. The complication rate of the index surgery was 51.5%. Adjuvant radiotherapy was applied in 51.5% of the cases. In patients with clival chordomas, the mean age was 51.1 years, ranging from 16 to 83 years. At the time of diagnosis, the mean tumor volume was 20.9 cm3 and the five-year overall survival rates were 79.1% (95% confidence interval (CI): 62.4–100). In patients with chondrosarcomas, the mean age was 48.2 years, ranging from 15 to 76 years. At the time of diagnosis, the mean tumor volume was 22.3 cm3 and the five-year overall survival 90% (95% CI: 73.2–100). Conclusion: The centralized treatment of clival tumors in Denmark demonstrates incidence, survival, and complication rates comparable to those found in other international series. Given the variations in treatment strategies, tumor localizations across series, and small sample sizes, the further analysis of larger compiled multicenter datasets for clival tumors could provide more solid evidence regarding the management of these rare tumors. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of slanted bilateral lateral rectus recession (BLR-rec) for treating convergence insufficiency-type intermittent exotropia (CI-IXT) in children. Methods: In this retrospective cohort study, 26 patients aged < 16 years with CI-IXT who underwent BLR-rec between August 2016 and July 2021 with six months of follow-up data post-surgery were classified into slanted BLR-rec group (n = 14) and standard BLR-rec group (n = 12; equal-length recession of the upper and lower horns of the LR muscle). Surgical outcomes were compared between the groups. Results: In the slanted and standard groups, the preoperative distance exodeviation was 27.9 ± 5.5 and 30.8 ± 10.0 prism diopter (PD) (p = 0.63), near exodeviation was 41.1 ± 5.6 and 42.9 ± 9.2 PD (p = 0.75), and difference between near and distance deviation (N-D deviation difference) was 13.2 ± 3.2 and 12.1 ± 3.3 PD (p = 0.30), respectively. The ratio of postoperative and preoperative N-D deviation difference was compared between the slanted BLR and standard BLR groups at six months postoperatively. The results revealed that the ratio for slanted-BLR was 0.44 ± 0.19, and for standard-BLR was 0.84 ± 0.24. In the standard group, stereoacuity remained unchanged post-surgery compared to that pre-surgery, while the slanted group showed significant improvement (p < 0.05, Wilcoxon signed-rank test). Conclusion: Compared with the standard BLR-rec procedure, the slanted BLR-rec procedure reduced N-D deviation differences in CI-IXT, positively impacting gross stereopsis. [ABSTRACT FROM AUTHOR]

A 62-year-old woman had 6 months of proximal weakness, fatigue and occasional diplopia, symptoms normally suggesting myasthenia gravis or inflammatory myopathy. Postexercise reflex facilitation is a bedside clinical sign that points to a diagnosis of the rarer alternative, Lambert-Eaton myasthenic syndrome (LEMS). We confirmed this diagnosis using electrodiagnostic short exercise testing and serum assay for voltage-gated calcium channel antibodies. Further investigation identified a small cell neuroendocrine carcinoma of the gallbladder, not previously associated with LEMS. Postexercise reflex facilitation is an important bedside clinical finding that helps clinicians to distinguish LEMS from its mimics. [ABSTRACT FROM AUTHOR]

A 41-year-old man developed rapidly progressive cranial neuropathies and muscle weakness followed by respiratory failure, requiring ventilation support. On examination, there was marked bilateral ptosis and ophthalmoplegia with bulbar, neck and proximal upper limb weakness. He had a recent open left humeral fracture that eventually required amputation. Despite immunoglobulin therapy, his progressive weakness continued. Multiple investigation results were inconclusive. Eventually, botulinum type A toxin was found positive, by which time the therapeutic window for antitoxin had passed. He continued on supportive management and was treated for concomitant infections and nosocomial illnesses. He was subsequently weaned from respiratory support and has made a good neurological recovery. [ABSTRACT FROM AUTHOR]

Background: The eyes are the central aesthetic unit of the face. Maxillofacial trauma can alter facial proportions and affect visual function with varying degrees of severity. Conventional approaches to reconstruction have numerous limitations, making the process challenging. The primary objective of this study was to evaluate the application of three-dimensional (3D) navigation in complex unilateral orbital reconstruction. Methods: A prospective cohort study was conducted over 19 months (January 2020 to July 2021), with consecutive enrollment of 12 patients who met the inclusion criteria. Each patient was followed for a minimum period of 6 months. The principal investigator carried out a comparative analysis of several factors, including fracture morphology, orbital volume, globe projection, diplopia, facial morphic changes, lid retraction, and infraorbital nerve hypoesthesia. Results: Nine patients had impure orbital fractures, while the remainder had pure fractures. The median orbital volume on the normal side (30.12 cm3 ; interquartile range [IQR], 28.45–30.64) was comparable to that of the reconstructed orbit (29.67 cm3 ; IQR, 27.92–31.52). Diplopia improved significantly (T(10)= 2.667, p= 0.02), although there was no statistically significant improvement in globe projection. Gross symmetry of facial landmarks was achieved, with comparable facial width-to-height ratio and palpebral fissure lengths. Two patients reported infraorbital hypoesthesia at presentation, which persisted at the 6-month follow-up. Additionally, five patients developed lower lid retraction (1–2 mm), and one experienced implant impingement at the infraorbital border. Conclusion: Our study provides level II evidence supporting the use of 3D navigation to improve surgical outcomes in complex orbital reconstruction. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the presence of structural and functional changes in extraocular muscles (EMs) among patients with inactive Graves' orbitopathy (GO) classified according to the Clinical Activity Score (CAS). Sixty-seven patients with Graves' disease (GD) and inactive GO were included. The data collected included clinical parameters, thyroid function, autoantibody levels, EOM morphology via orbital ultrasound (US), and ocular motility. Patients were stratified into Red Filter Test (RFT)-positive or RFT-negative groups based on the presence or absence of latent diplopia during the RFT examination. Thirty-three patients (49.25%) exhibited latent diplopia on the RFT, despite not reporting double vision during standard ocular motility tests. Significant differences were observed between the two groups in terms of age, disease duration, intraocular pressure (IOP) elevation in up-gaze, and medial rectus muscle thickness (p < 0.05). No significant differences were found in thyroid status, TRAb and ATA levels, CASs, exophthalmos, or lateral rectus thickness between the two groups. This study revealed that in inactive GO, subclinical EM dysfunction and morphological changes may be present, which might not be apparent through routine ocular examinations. The RFT is effective in detecting latent diplopia, highlighting its utility in identifying subtle ocular motility issues and subclinical muscle involvement. Comprehensive evaluations combining functional tests like the RFT and imaging are essential for early detection of GO-related abnormalities, enabling tailored and prompt management and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Isolated paresis of the inferior rectus muscle (IRM) represents a rare occurrence. This case report involves a young adult male who, abruptly during a Valsalva maneuver, encountered acute vertical diplopia due to right IRM paresis, resolving spontaneously within a few hours. The patient presented without identifiable risk factors, and magnetic resonance imaging revealed a minor left thalamic ischemic lesion. A cardiac study identified the presence of a patent foramen ovale, potentially associated with a paradoxical embolism, indicating its likely role in this transient ischemic event. [ABSTRACT FROM AUTHOR]

A 37-year-old scuba diver developed sudden severe headache, mid-facial pressure/pain and diplopia while diving. Upon examination, he had signs and symptoms consistent with silent sinus syndrome (SSS), including bilateral enophthalmos, hypoglobus, and diplopia/strabismus in conjunction with CT findings of occluded maxillary sinus ostia, atrophic/collapsed maxillary sinuses, and bilateral orbital floor fractures with fat herniation. As there was no history of trauma or chronic sinusitis, this rare case of bilateral SSS was deemed the cause of the spontaneous fractures (i.e. barotrauma secondary to a lack of equalization to ambient surrounding pressure). Transconjunctival repair of the fractures was successful and maxillary sinus antrostomies re-established aeration of the sinuses. We present this case and its management, as well as review the literature concerning sinus barotrauma as a result of diving and SSS. There have been no reports of orbital fractures primarily caused by scuba diving, nor secondarily from diving with the rare entity, SSS. [ABSTRACT FROM AUTHOR]

Purpose: Evaluate and analyze the efficacy of inferior oblique belly transposition (IOBT) in treating adult patients with diplopia and small-angle hypertropia caused by mild to moderate inferior oblique overaction (IOOA) secondary to acquired superior oblique palsy (SOP). Methods: Nine adult patients with diplopia and small-angle hypertropia associated with mild to moderate IOOA secondary to unilateral acquired SOP were included in the current retrospective study. All patients received the IOBT procedure between February 2019 and May 2023 at The Second People's Hospital of Jinan and were followed up for more than 6 months after the surgery. During the procedure, the belly of the inferior oblique muscle was fixed to the sclera at 5 mm posterior to the temporal insertion of the inferior rectus muscle. The following indicators were reviewed pre- and post-surgery: the vertical deviation (VD) in the primary position and in the Bielschowsky test, the fovea disc angle (FDA) of the affected eye, changes in IOOA, and diplopia. Results: After IOBT, the VD in the primary position decreased from 7.22△ ± 1.72△ (range 4△–10△) to 1.22△ ± 1.30△ (range 0△–3△). The VD in the Bielschowsky test decreased from 13.00△ ± 1.80△ to 3.22△ ± 1.09△. The FDA decreased from 10.02° ± 3.34° to 6.26° ± 1.91°. The grade of IOOA was reduced from 2.00 (1.00, 2.00) to 0.00 (0.00, 1.00). All changes were statistically significant (P < 0.001 or P = 0.006). Diplopia was resolved completely for all patients. Conclusions: IOBT can effectively treat adults with diplopia and small-angle hypertropia caused by mild to moderate IOOA secondary to acquired SOP. [ABSTRACT FROM AUTHOR]

Thyroid-associated ophthalmopathy (TAO) is an autoimmune condition affecting the eyes, characterized by proptosis, extraocular muscle involvement, and in severe cases, vision impairment including diplopia, optic neuropathy, and potential blindness. The exact etiology of TAO remains elusive; however, increased oxidative stress and decreased antioxidant capacity are pivotal in its pathogenesis. Elevated oxidative stress not only directly damages orbital tissues but also influences thyroid function and autoimmune responses, exacerbating tissue destruction. This review explores the role of oxidative stress in TAO, elucidates its mechanisms, and evaluates the efficacy and limitations of antioxidant therapies in managing TAO. The findings aim to enhance understanding of oxidative stress mechanisms in TAO and propose potential antioxidant strategies for future therapeutic development. [ABSTRACT FROM AUTHOR]

Binocular diplopia limits quality of life by hampering visual function. There are several treatment options with individual advantages and drawbacks. Contact lenses have recently emerged as an attractive treatment delivery mechanism due to advances in lens manufacturing and imaging modalities. Contact lenses can offer better comfort, efficacy, and cosmetic appeal compared to alternative treatments such as spectacles. They also present unique challenges due to risks of inflammation, infection, and intolerability. This review will explore the management of binocular diplopia using several types of contact lenses including base down prism in contact lenses, scleral lenses, occlusive lenses, and monovision lenses. Increased awareness of differing contact lens will help providers and patients make better informed decisions about diplopia management. [ABSTRACT FROM AUTHOR]

Acute acquired comitant esotropia (AACE) is mainly characterized by sudden onset, accompanied by diplopia, without extraocular muscles paralysis or ocular motility disorders. In recent years, the incidence of AACE has been increasing, researchers have found that this phenomenon may be related to the widespread use of electronic devices and the increase in the number of people working from home during the COVID-19 pandemic. However, its neural mechanisms have not been fully elucidated. This article primarily reviews the latest developments in the diagnosis and treatment of AACE from the perspectives of etiology and treatment methods, aiming to provide direction for future in-depth exploration of the pathogenesis and treatment approaches of this disease. [ABSTRACT FROM AUTHOR]

This article proposes an examination of the white woman's positionings within the French postcolonial structures of race and gender in two of Claire Denis's films: Chocolat (1988) and White Material (2009). Using an intersectional frame of reference which combines postcolonial theory, Third World feminism and geography/spatiality, this article demonstrates that these two films unearth structures of power and inequality that situate the white female of the colony not as subjugated by the patriarchal order, as has been argued, but as an agent of imperialism in herself. This analysis shows that Denis's films anchor their aesthetic sensibility and narrative discourse within pictorial and narrative practices specific to, or appropriated by, imperialism, such as mapping, landscape painting and cinema. These films reveal a rhetorical and visual inventory of colonial tropes that ineluctably structure Denis's cinematic Africa as a space which, through racial privilege, the white woman claims as her own. [ABSTRACT FROM AUTHOR]

Sports performance is relatively robust under high levels of binocular blur. However, the limited research studies investigating monocular impairments has shown it has a larger impact on sport performance. This research study is relevant for classification in sports for athletes with vision impairment (VI), where visual acuity (VA) from the better eye is used during classification. Across two experiments, we aimed to establish the point at which binocular and monocular impairments affected performance in a football penalty kick (PK) through simulating varying severities of degraded VA and contrast sensitivity (CS) in active football players. In experiment one, 25 footballers performed PKs as VA and CS were systematically decreased in both eyes, and in one condition, visual field (VF) was reduced. The most severe VA/CS condition and reduced VF significantly impacted outcome, ball velocity and placement (ball kicked closer to the centre of the goal) (p < 0.05). In experiment two, 29 different footballers performed PKs as VA and CS of only the dominant eye were systematically decreased and in one condition the dominant eye was occluded, and participants viewed their environment through the non‐dominant eye (monocular viewing). No differences were observed when assessing monocular impairments influence on outcome, velocity and ball placement. PKs have a high resilience to VI, but binocular impairment has a more immediate effect, suggesting binocular measures should be used in classification processes in football. Highlights: Penalty kick (PK) performance was relatively robust to severe artificial binocular visual impairment. Performance reduced at 1.96 logMAR, causing the ball to be kicked slower (lower velocity) and closer to the centre of the goal.Monocular viewing or impairment did not influence the velocity at which the ball was kicked or where the ball was placed. Therefore, PK performance was maintained at the habitual level.The evidence suggests that PK performance is more sensitive to binocular impairments than monocular impairments. Therefore, it may be beneficial for footballers with vision impairment to be classified using binocular assessments. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid eye disease (TED) is an autoimmune process characterized by extraocular muscle and orbital fat remodeling/expansion resulting in swelling, pain, redness, proptosis, and diplopia. Teprotumumab, an insulin-like growth factor-I receptor inhibitor, demonstrated improvements in TED signs and symptoms in three adequately powered clinical trials of 24 weeks duration. Here we analyze the long-term maintenance of responses with teprotumumab from these trials. Methods: A total of 112 patients who received 7 or 8 infusions of teprotumumab in the Phase 2, Phase 3 (OPTIC study), and OPTIC Extension (OPTIC-X) studies were included in this analysis. Responses, including clinical activity score (CAS ≥2-point improvement), the European Group of Graves' Orbitopathy ophthalmic composite outcome, diplopia (≥1 Gorman grade improvement), proptosis (≥2 mm improvement), Overall (improvement in proptosis + CAS), and disease inactivation (CAS ≤1), were assessed and pooled from study baseline to week 24 (formal study) and up to week 72 (formal follow-up). Graves' Ophthalmopathy quality-of-life (GO-QoL) scores were also assessed. Outcomes included the percentages of observed patient responses from the study baseline. Additional alternative treatments for TED were assessed as a surrogate of persistent benefit from week 24 through week 120 (extended follow-up). Studies differed in the timing of follow-up visits, and data from some visits were unavailable. Results: At week 72, 52/57 (91.2%), 51/57 (89.5%), 35/48 (72.9%), 38/56 (67.9%), and 37/56 (66.1%) of patients were responders for CAS, composite outcome, diplopia, proptosis, and Overall response, respectively. The mean reduction in proptosis was 2.68 mm (SD 1.92, n = 56), mean GO-QoL improvement was 15.22 (SE 2.82, n = 56), and disease inactivation (CAS ≤1) was detected in 40/57 (70.2%). Over 99 weeks following teprotumumab therapy, 19/106 (17.9%) patients reported additional TED therapy during formal and extended follow-up. Conclusion: The long-term response to teprotumumab as observed 51 weeks after therapy was similar to week 24 results in the controlled clinical trials. Inflammatory and ophthalmic composite outcome improvements were seen in 90% of patients with nearly 70% reporting improvement in diplopia and proptosis. Further, 82% of patients in this analysis did not report additional TED treatment (including surgery) over 99 weeks following the final teprotumumab dose. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Although a forehead lift is generally a safe surgery, it has well‐known complications. Iatrogenic SO paresis is one of the rare complications following forehead lifting procedures which almost resolves spontaneously. This report aims to introduce a woman with superior oblique (SO) muscle paresis following the brow and forehead lift procedure. A 30‐year‐old woman with a history of brow and forehead lift surgery was referred to the ophthalmic emergency department complaining of vertical diplopia. A right eye hypertropia was obvious at the left gaze. A Park's three‐step test showed right eye superior oblique paresis. Other ophthalmic examinations including slit‐lamp examination, tonometry, and dilated fundoscopy were unremarkable for both eyes. After a 3‐month follow‐up period, she had no diplopia. No sign of SO paresis was apparent in her ocular motility examinations. Iatrogenic SO paresis is one of the rare complications following forehead lifting procedures which almost resolves spontaneously. [ABSTRACT FROM AUTHOR]

There are not many reports on psychogenic diplopia in children and adolescents which is diagnosed as „Dissociate neurological symptom disorder, with visual disturbance" (DNSD) as per ICD-11 guidelines. Here we present a 12-year-old adolescent's case report along with his responses on Somatic Inkblot Series (SIS-II) projective test along with the interpretation of the responses. The blind analysis of the report validates the known history and indicated the need for further exploration to aid the therapeutic process. The images revealed the client's poor interpersonal relationships with his mother, father and peers, with a low self and aggressive attitude with desire to have power and authority. Clients who undergo these experiences need personal therapy to address their negative attitude and aggressive behavior. More research of SIS-II with children and adolescents may help the clinicians to unravel the „inner cry" and help them to process the unresolved issues during psychotherapy. [ABSTRACT FROM AUTHOR]

COVID-19 can cause a wide range of ocular manifestations. The most common ocular manifestation is conjunctivitis. Neuro-ophthalmic presentations of COVID-19 are rare. Case reports suggest that COVID-19 infection can cause cranial nerve palsy, including nerves that regulate ocular movements. The present studypresented a case of fourth nerve palsy in a healthy and asymptomatic COVID-19-infected child. A healthy 10-year-old boy was referred to our eye clinic with a complaint of recent abnormal head posture and squint. His past medical history was unremarkable, and he had not received any medication or vaccinations within the last few weeks. No history of ocular or head trauma was observed. The patient was afebrile and had no respiratory symptoms. A comprehensive ocular examination was performed. All examinations, including slit-lamp, pupils, eyelids, and optic nerve heads, were normal. In ocular motor evaluations, left eye hyperdeviation was observed. Because of the history of COVID-19 in the mother of the child, he was referred to an infectious disease specialist and was tested for SARS-COV-2 with a nasopharyngeal swab specimen. The test was positive and SARS-COV-2 was detected. In addition, the patient was referred to a pediatric neurology department. Brain and orbital MRI was performed, and it was unremarkable. The post-viral fourth nerve palsy is uncommon, and post-COVID-19 has not been reported before. Clinicians should consider this infection in any recent strabismus in pediatrics. The children rarely complain of diplopia, and a recent abnormal head posture may be a sign of acquired strabismus. [ABSTRACT FROM AUTHOR]

Introduction: The pattern of extraocular muscle involvement in ocular myasthenia gravis varies across different reports, diverging from our own observations. Thus, we employed two novel tools to discern this pattern. Methods: A retrospective analysis was conducted to collect and organize clinical data from 43 patients diagnosed with ocular myasthenia gravis. Each patient underwent both the computerized diplopia test and the Ocular Motor Nerve Palsy Scale assessment to evaluate the involvement of extraocular muscles. Results: Among the patients, there were 30 male and 13 female individuals, with a total of 113 affected extraocular muscles identified. Among all the affected extraocular muscles, the involvement of the levator palpebrae superioris muscle accounted for 35.40%, medial rectus muscle 7.7%, lateral rectus muscle 16.81%, superior rectus muscle 13.27%, inferior rectus muscle 12.39%, superior oblique muscle 1.77%, and inferior oblique muscle 2.65% of the total affected extraocular muscles. The positivity rates of the Neostigmine test were 89.19%, AChR antibody detection was 59.38%, and repetitive nerve stimulation was 34.38%. The AChR antibody positive rate among patients with only diplopia was 100%; among those with only ptosis, it was 80%; and among those with both diplopia and ptosis, it was 86.67%. Conclusion: The involvement of the extraocular muscles is not uniform. The levator palpebrae superioris exhibits the highest incidence rate, followed by the four rectus muscles and two oblique muscles. The inferior oblique involvement typically occurs when four or more EOMs are affected. Moreover, the levator palpebrae superioris and medial rectus show a higher tendency for bilateral involvement compared with other extraocular muscles. [ABSTRACT FROM AUTHOR]

Herpes zoster ophthalmicus (HZO) is a manifestation of the reactivation of the varicella zoster virus, characterised by vesicular rash along the ophthalmic division of the trigeminal nerve. A rare but significant complication of HZO is orbital myositis, marked by painful swelling of extraocular muscles and periorbital tissues. We present the case of a 72-year-old woman initially presenting with ophthalmological symptoms, notably conjunctival congestion and superficial punctate keratitis, preceding the typical vesicular rash of herpes zoster. The subsequent development of diplopia led to the detection of lateral rectus palsy. Neuroimaging revealed orbital myositis, with the patient showing marked improvement following treatment with oral steroids. This case emphasize the importance of recognizing orbital myositis as a complication of HZO. [ABSTRACT FROM AUTHOR]