DR. RITU GUPTA

DR.HARPAL SINGH

Abstract

A 32yr female with drooping of right upper eyelid since 8 days & periorbital pain. Recently diagnosed with Type2 DM. BCVA was CF 1ft in RE & 6/9 in LE. Chin elevation present, RE had exotropia of 15 degrees on hirshberg test, severe ptosis, restricted eyeball movements in all directions, lid edema, chemosis & mild conjunctival congestion, absent pupillary reaction to light. Posterior segment & Fundus was grossly normal. Blood sugars were raised, routine blood investigations WNL. MRI brain orbit with contrast revealed enhancement of right nerve sheath from orbital apex to cavernous sinus s/o acute inflammatory etiology in T1W images. Other causes like IOID, orbital myosistis, acute dacryoadenitis, Wagener polyangitis, multiple sclerosis, sarcoidosis, tumors, thyroid eye disisease were ruled out. Received I/V methyl prednisolone 1g OD for three days then tapered orally over 2 months. Patient improved symptomatically with resolution of ocular signs, followed up weekly till full recovery.