PMC3373229_01
Patient photograph before edrophonium chloride administration.
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Although both eyes had exophthalmos (20 mm OD, 19 mm OS; normal range, <17 mm), he demonstrated a normal left eyelid height and right ptosis, ie, margin reflex distance-1, 3.5 mm OS and 0.5 mm OD, respectively (Figure 1).
Patient's eye positions in nine directions of gaze before edrophonium chloride administration.
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His primary eye position was exotropic, dominantly on his right side, and the upward gaze of the right eye was severely restricted (Figure 2).
Coronal computed tomography of the orbits shows bilateral enlargement of the inferior rectus muscle, medial rectus muscle, superior oblique muscle, and superior rectus muscle-levator muscle complex.
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Coronal computed tomography of the orbits showed bilateral enlargement of the inferior rectus muscle, medial rectus muscle, superior oblique muscle, and superior rectus muscle-levator muscle complex (Figure 3A). Axial computed tomography demonstrated bilateral medial and lateral recti muscle enlargement (Figure 3B). Localization of these muscle involvements did not match the characteristics of the eye movement disorder (Figure 3C).
Axial computed tomography demonstrates bilateral medial and lateral recti muscle enlargement.
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The margin reflex distance-1 had improved to 2.5 mm OD and 8.0 mm OS (Figure 4), although the eye movement had not clearly improved.