Restrictive extraocular myopathy: A presenting feature of acromegaly

• Main Authors: Steven Heireman, Christophe Delaey, Ilse Claerhout, Christian E Decock
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2011-01-01
• Series: Indian Journal of Ophthalmology
• Subjects: Myopia; prethreshold retinopathy of prematurity; retinopathy of prematurity; Retinopathy of prematurity; screening; survey; Anthrax; community-acquired methicillin-resistant Staphyloccus aureus; orbital cellulitis; preseptal cellulitis; Intrastromal corneal ring segments; keraring; post-LASIK ectasia; Blebitis; bleb leak; microbiology; ocular surface diseases; risk factors; Early glaucoma; retinal nerve fiber layer thickness; spectral optical coherence tomography / scanning laser ophthalmoscope; Blowout; diplopia; prism; strabismus; Ocular trauma; open globe injury; preoperative visual acuity; prognostic factors; relative afferent pupillary defect; Anterior chamber depth; axial length; lens thickness; phacomorphic glaucoma; risk factor; Refractive errors; Schoolgirls; visual impairments; Cataract; intraocular lens; monovision; presbyopia; pseudophakic; Accommodative esotropia; atropine; cycloplegia; esotropia; Optic disc cupping; optic disc pallor; suprasellar tumor; glaucoma; neuroimaging; Dislocated nucleus; iris claw lens; pars plana vitrectomy; Retinoblastoma; Foveal hypoplasia; microperimetry; spectral domain optical coherence tomography; Beta-tracer protein; cerebrospinal fluid leakage; three-dimensional computed tomography; X linked retinoschisis; macular hole; Hutchinson-Guilford progeria syndrome; ocular manifestations; premature aging syndrome; progeria; Keratomycosis; minimum inhibitory concentration; natamycin; susceptibility; treatment outcome; Cyclopentolate; cycloplegic refraction; hypermetropia; Acromegaly; extraocular myopathy; pituitary adenoma; restrictive myopathy
• Online Access: http://www.ijo.in/article.asp?issn=0301-4738;year=2011;volume=59;issue=6;spage=517;epage=519;aulast=Heireman

A 45-year-old man presented with binocular diplopia in primary gaze for 1 year. Orthoptic evaluation showed 10-prism diopter right eye hypotropia and 6-prism diopter right eye esotropia. The elevation and abduction of the right eye were mechanically restricted. This was associated with systemic features suggestive of acromegaly. Magnetic resonance imaging (MRI) of the brain demonstrated a pituitary macroadenoma. An elevated serum insulin-like growth factor I level and the failure of growth hormone suppression after an oral glucose load biochemically confirmed the diagnosis of acromegaly. Computed tomography (CT) of the orbit demonstrated bilateral symmetrical enlargement of the medial rectus and inferior rectus muscle bellies. All tests regarding Graves-Basedow disease were negative. Although rare, diplopia due to a restrictive extraocular myopathy could be the presenting symptom of acromegaly.