THS is a self-limited illness. A dramatic improvement in painful ophthalmoplegia of THS after administration of steroids for 48 hours is a hallmark feature that differentiates THS from other causes of painful ophthalmoplegia. The usual regimen is a course of steroids tapered over weeks to months. However, some cases may necessitate prolonged therapy. THS still causes significant morbidity, and in some patients residual cranial nerve palsies persist.
The onset of THS is usually acute, with an unpredictable clinical course. Although spontaneous remissions do occur, recurrences are common. For refractory cases, azathioprine (Imuran), methotrexate, or radiation therapy has been instituted. Surgical intervention is reserved for cases in which histopathologic evidence is required. The patient in this case made a full recovery and regained complete ocular motility.
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