Impairment of the superior rectus, medial rectus
, and inferior oblique muscles was observed upon neuro-ophthalmological examination.
The neoplasm was confirmed by computed tomography (CT) scan, and the image disclosed a muscle density, well-defined, ovoid retrobulbar nodule measuring 2.8 cm x 1.9 cm between the optic nerve and medial rectus
. The boundary between the lesion and medial recuts was obscure, and the optic nerve was squeezed outward by the neoplasm [Figure 1]c.
For recession surgery, medial rectus
muscle was detached from the sclera (Figure 2) after used suspensory suture with Vicryl 7-0 (polyglactin 910, Ethicon, USA).
The thickness of the fatty tissue was defined as the maximum thickness from the medial wall of the eyeball (or the lateral margin of the medial rectus
) to the medial wall of the orbit [17, 18] (Figure 1(d)).
We observed a thickened and contrast-enhanced right medial rectus
muscle in the orbital MRI (Figure 4b).
The pseudo CN III palsy in our patient was likely attributable to mechanical factors (e.g., muscle restriction and compressive effects) that caused maldevelopment of the medial rectus
muscle and secondary strabismus.
* involvement of the paired medial rectus
subnuclei causes a wall-eyed bilateral internuclear ophthalmoplegia (WEBINO), characterised by exotropia, and defective convergence and adduction.
A case of bilateral medial rectus
paresis following bite by a viper.
Due to lesion in the MLF, ipsilateral medial rectus
fails to receive the signal to contract when paramedian pontine reticular formation (PPRF) and sixth nerve nucleus act to intiate lateral gaze.
Erosions were noted in the right inferior orbital wall and the disease was noted to involve the inferior oblique and medial rectus
muscles, pushing right optic nerve superiorly.
A CT scan of the head showed no abnormalities, so the right medial rectus
muscle was treated with Botox injection.
The muscles most commonly affected by thyroid eye disease are the inferior and medial rectus