"Bitemporal occlusion, especially in elderly patients with medial rectus
impairment is not recommended as the partial patch may reduce the patient's peripheral vision and increase the risk of a fall.
Gadolinium-enhanced [T.sub.1] and [T.sub.2]-weighted MRI of the orbit revealed inflammation in bilateral extraocular muscles which was more pronounced in the left medial rectus
suggesting orbital myositis (Figures 3 and 4).
Given her atypical presentation, we got MRI of orbit with contrast done that revealed ill-defined mixed signal intensity lesion in the intraconal compartment of the left orbit involving Medial Rectus
, Inferior Rectus and posterior part of the Superior Rectus muscles.
Symptomatic excyclotorsion following inferior transposition of both medial rectus
muscles in patients with bilateral trochlear nerve palsy.
The levator palpebrae superioris, pupillary sphincter muscle, and four extraocular muscles (the superior rectus, inferior rectus, medial rectus
, and inferior oblique muscles) are innervated by the oculomotor nerve.
(3) have demonstrated a case of orbital metastasis of PTC to the medial rectus
muscle, similar to our case, in which muscles were involved.
Right medial rectus
muscle was hypertrophic and iso-hyperintense in T2, and contrast-enhanced, fat-suppressed T1-weighted images (Figure 1A, 1B, 1C, 1D).
In the second case, medial rectus
muscle swelling, lid retraction, and proptosis of the right eye and diplopia were observed .
The mass was located in the lateral orbit cavity extending to the ethmoid and maxillary sinuses, with bony destruction, encasing and displacing the medial rectus
and superior oblique muscles, optic nerve, ocular globe, and vascular structures (Figure 1).
Orbital computed tomography revealed a 1.5 x 2.9 x 1.5 cm rim-enhancing hypodense lesion at the right orbital apex abutting to the optic nerve sheath complex and right medial rectus
muscle (Figure 1).
It exists in complex with multiple independent subnuclei, controlling the superior, inferior, and medial rectus
muscle, inferior oblique muscle, levator palpebrae superioris muscle, and sphincter pupillae, respectively.
Most involve injury to the medial rectus
muscle via violation of the lamina papyracea, while the orbital floor and adjacent inferior rectus muscle is generally not considered a high-risk area .