A 36-Year-Old Woman With Painful Swelling and Ophthalmoplegia of the Right Eye

Sumaira Nabi, MBBS; Sadaf Khattak, MBBS; Mansoor Iqbal, MBBS, FCPS


June 11, 2014

Editorial Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions.


A 36-year-old Pakistani female presents to the emergency department with a one-month history of painful, rapidly progressive swelling of her right eye. The patient is unable to open her eyelid. She denies any foreign-body sensation, fever, joint pains, rash, heat intolerance, weight loss, or easy fatigability. There is no diurnal variation in her symptoms. She is a housewife with 3 children and belongs to a lower socioeconomic group. The patient is a nonsmoker and denies substance abuse. She has been taking multiple analgesics prescribed by her local general practitioner, with no improvement in her symptoms. Other than that, her drug history is insignificant. The family history is unremarkable as well.


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