PMC3514055_01
(A) Ocular motility in the nine cardinal positions of gaze. There is a complete right upper-eyelid ptosis (center panel, center row). In addition, there is limited elevation of the right eye (upper row). The clinical findings are consistent with a right superior divisional CN III palsy. (Patient consent obtained to present clinical images). (B) Axial, contrast-enhanced, T1-weighted magnetic resonance images with fat suppression show a right orbital apex enhancing mass one month after symptom onset (left, measuring 1.6 cm x 1.0 cm) and 2 months later (right, measuring 3.1 cm x 1.7 cm). (C) Sagittal view of CN III.. Notes: Patient consent obtained to present clinical images. Reprinted from Survey of Ophthalmology, 49, Foroozan R, Bhatti MT, Rhoton AL, Transsphenoidal diplopia, 349-358, copyright (2004), with permission from Elsevier.. Abbreviations: EW, Edinger-Westphal; III, third cranial nerve; IV, fourth cranial nerve; V1, ophthalmic branch of fifth cranial nerve; V2 maxillary branch of fifth cranial nerve; V3, mandibular branch of fifth cranial nerve.
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Ocular and neurological examination results were normal, with the exception of 5 mm of right eye axial proptosis, complete right upper eyelid ptosis, and limitation of supraduction of the right eye (Figure 1A). Cranial and orbital magnetic resonance imaging (MRI) with contrast and fat suppression revealed a well-circumscribed enhancing intraconal mass centered around the superior rectus muscle at the right orbital apex (Figure 1B). Two months later, a follow-up MRI showed the orbital mass had doubled in size (Figure 1B).