Article Text

Download PDFPDF
Review of extraocular muscle biopsies and utility of biopsy in extraocular muscle enlargement
  1. Edwina L Eade1,
  2. Thomas G Hardy1,2,
  3. Penelope A McKelvie3,
  4. Alan A McNab1,4,5
  1. 1 Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
  2. 2 Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
  3. 3 Department of Anatomical Pathology, St Vincent’s Hospital, Fitzroy, Victoria, Australia
  4. 4 Department of Ophthalmology, University of Melbourne, Parkville, Victoria, Australia
  5. 5 Centre for Eye Research Australia, East Melbourne, Victoria, Australia
  1. Correspondence to Dr Edwina L Eade, Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia ; edwina.eade{at}


Aims To review the distribution of pathology in extraocular muscle (EOM) biopsies performed at a tertiary orbital centre, identify clinical and imaging features which are associated with benign or malignant diseases and indicate when biopsy is necessary for EOM enlargement.

Methods Retrospective case series including 93 patients with EOM enlargement who underwent an EOM biopsy. Clinical, radiological and histopathological information was recorded from the medical records. Statistical analysis was used to compare variables between patients with malignant and benign biopsies.

Results The median age of subjects was 61.1 years. Forty-eight cases (52%) were benign and 45 (48%) were malignant. Those with malignant pathology were significantly older (P<0.0001). Males were more likely affected by a benign disease and females by a malignancy (P=0.029). A history of malignancy (P<0.0001) and diplopia (P=0.029) were significant factors in predicting a malignancy. Pain (P=0.005) and eyelid erythema (P=0.001) were more likely in benign conditions. Idiopathic orbital inflammation was the most common benign diagnosis and lymphoma the most common malignancy.

Conclusions Biopsy is warranted in those with an atypical presentation of EOM enlargement or suspected of having a malignancy. Some features such as age, gender, pain, diplopia, history of malignancy and eyelid erythema may help indicate a particular diagnosis; however, clinical features and imaging findings are often not pathognomonic of each disease.

  • neoplasia
  • inflammation
  • muscles
  • orbit
  • pathology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors ELE contributed to the collection of data, analysis, writing of the manuscript and revisions. TGH contributed to the collection of the data and writing of the manuscript. PAM contributed to the data collection and writing of the manuscript. AAM contributed to the data collection and the writing of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Royal Victorian Eye & Ear Hospital Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There is no additional unpublished data from this study.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas