PMC7768007_01
Changes of patient's eyes' appearance. (A) Eyes' appearance before therapy of orbital myositis. (B) After 3 weeks of treatment, the eye signs improved. (C) After 7 weeks of treatment, the eyes' appearance almost got back to normal. (D) New symptoms of left ptosis presented with MG. (E) The patient rapidly progressed to obvious bilateral ptosis when MG was diagnosed. (F) The patient got a great improvement after one month treatment of pyridostigmine bromide, tacrolimus and prednisone. (Informed consent was obtained).
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His corneas, fundi, and visual acuity were normal ( Figure 1A ), though his eyeball mobility was limited bilaterally. The patient's proptosis, diplopia, and limited ocular movements improved considerably ( Figures 1B, C ) with an MRI of the extraocular muscles showing reduced swelling ( Figures 2G-I ). Three months later, when tapering the prednisone, the patient presented with left ptosis, followed immediately by bilateral ptosis and diplopia ( Figures 1D, E ). One month later, the patient showed considerable improvement ( Figure 1F ); facial and upper limb muscle weakness improved more rapidly than the ptosis.
The changes of imaging of extra-ocular muscles. (A-C) Orbital CT scan before therapy showed the bilateral ophthalmic muscles including superior rectus, medial and lateral rectus, inferior rectus were obviously thickened. (D-F) Enhanced MRI revealed thickened and enhanced multiple extra-ocular muscles including tendinous insertion. (G-I) After 3 months of treatment, orbital CT showed bilateral extra-ocular muscles were not thickened.
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The extraocular muscles, especially the superior and inferior recti, were enlarged bilaterally ( Figures 2A-C ). Both eyelids and lateral soft tissues showed diffuse swelling, without the lacrimal gland and periorbital fat involvement ( Figures 2D-F ). The patient's proptosis, diplopia, and limited ocular movements improved considerably ( Figures 1B, C ) with an MRI of the extraocular muscles showing reduced swelling ( Figures 2G-I ).