PMC4144941_01
The Hess chart examination at the initial visit.. Notes: (A) The Hess chart examination at the first clinic visit showed substantially limited abducent of the left eye. (B) The Hess chart examination 2 weeks later shows that the limited abduction of the left eye was fully recovered. Each arrow indicates the direction of action on each extraocular muscles.. Abbreviations: Sup., superior; Inf., inferior; Lat., lateral; Med., medial; Rect., rectus muscle; Obl., oblique muscle.
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The Hess chart examination showed an abducent disorder of her left eye (Figure 1A). A Hess chart examination and a forced duction test were normal that day (Figure 1B).
The orbital imaging with CT and MRI at initial visit.. Notes: (A) Orbital computed tomography (CT) images (horizontal section and a constructed image) and magnetic resonance imaging (frontal section) at the first clinic visit showed no apparent orbital fracture or transposition. As well, maxillary sinuses were intact, with no fluid or fractures. (B) Short tau inversion recovery (ST1R) magnetic resonance imaging (MRI) of the orbit at the first clinic visit improved visualization of bodily tissues by providing enhanced contrast with fat suppression. There was no enhanced region in the extraocular muscles or surrounding tissue, indicating there was no orbital edema and/or inflammation.
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However, the thin slice (1 mm) computed tomography (CT) scans were negative, and maxillary sinuses were intact with no fluid or fractures (Figure 2A). The scan was negative for edema and inflammation and other abnormalities (Figure 2B).