Painful ophthalmoplaegia secondary to orbital myositis.

A 53-year-old man with rheumatoid arthritis presented with 1 week of progressive right-sided proptosis, diplopia and pain on eye movement, particularly when looking to the left. Examination demonstrated marked lid swelling, limited right elevation and dextroelevation with pain on adduction (figure 1A). The affected eye was injected and chemosed. There was no evidence of optic nerve compromise.Figure 1 (A) Colour photographs demonstrating the eye in the cardinal positions of gaze. Central image showing the eyes in primary position. There is moderate limitation of right eye dextroelevation and elevation, indicating impairment of the right lateral and superior recti muscles. Note: pain was maximal with eye movement in …