An unusual case of painful ophthalmoplegia in a patient with rheumatoid arthritis

Abstract

A 43-year-old woman with long-standing rheumatoid arthritis and systemic lupus erythematosus had pain and horizontal diplopia. Clinical symptoms were consistent with inflammation of the right superior oblique tendon sheath, but a computed tomographic scan showed no pathology. Treatment with systemic corticosteroids reduced the symptoms, but the patient was left with a persistent muscle imbalance.