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Review of extraocular muscle biopsies and utility of biopsy in extraocular muscle enlargement
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  • Published on: 22 October 2018
    Planning an extra-ocular muscle biopsy: a note of caution.
    • Luke Pratt, Foundation Year 2 Doctor Oxford Eye Hosptial, John Radcliffe Hospital, Oxford
    • Other Contributors:
      • Elizabeth Insull, Oculoplastic Fellow
      • Fintan Sheerin, Consultant Radiologist
      • Jonathan Norris, Consultant Ophthalmologist

    We read the excellent paper ‘Review of extraocular muscle biopsies and utility of biopsy in extraocular muscle enlargement’ by Eade et al.1 with great interest. The authors reviewed the pathology in extraocular muscle biopsies performed over a 25-year period and reported the clinical and radiological features that might distinguish between benign and malignant diseases. As the authors note, it is imperative for the orbital surgeon to consider a muscle biopsy when the diagnosis is in doubt. With this in mind we would like to highlight two relevant cases of simulated extraocular muscle enlargement seen radiologically due to deviated ocular position rather than a pathological process related to the muscle itself. In both cases this confused the clinical picture and nearly resulted in needless surgery.

    In case 1, a 42-year-old woman was referred to the oculoplastic clinic with diplopia, reduced vision in the right eye associated with retro-bulbar pain and facial paraesthesia. On examination, there was evidence of a right esotropia with a reduction of abduction (consistent with a 6th cranial nerve palsy) associated with reduced sensation involving the V1 and V2 distribution. Optic nerve function was normal. Investigations revealed an elevated serum IgG subclass 4 (1.18 g/L) and normal serum ACE. The MRI report confirmed increased girth of the right medial rectus muscle in conjunction with enlargement and pathological enhancement of right cavernous sinus extending into...

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    Conflict of Interest:
    None declared.