DR. NEHA ARORA

Dr.Saptagirish Rambhatla

Abstract

History: A 42 years old female presented with complaints of diplopia. Examination showed left exotropia and hypertropia with visual acuity (VA) of 6/6 in both the eyes, was advised MRI. Over next 3 days she progressed to limitation of all extraocular muscles movements with associated pain, ptosis and VA of 6/9p in left eye. Clinically she was diagnosed with OAS. MRI was within normal limits. She was given 8 mg of intravenous dexamethasone and followed 60mg/day of oral prednisolone. She improved followed by deterioration over next 2 days with VA of 6/12p. She was started on intravenous steroid therapy. There were frequent recurrences. Therefore, patient was started on 50mg TID dose of azathioprine which was tapered over 30-31 weeks. She recovered completely. She is asymptomatic at 6 months follow up. Conclusion: OAS secondary to NSOI reponds well to steroid therapy, but patients who are intolerant or refractory to steroid therapy azathioprine can be considered as 2nd line of treatment.