Non-traumatic extraocular muscle haemorrhage associated with anticoagulation use.

We present a case of a unilateral extraocular muscle haematoma in an adult female patient who was compliant with life-long oral anticoagulation for recurrent deep vein thrombosis. The patient presented with symptoms of sudden-onset left-sided headache radiating to the temporal region, which started 2 days prior. No obvious triggering factors were identified. Cranial and ocular examinations were within normal limits. Imaging revealed a haemorrhage related to the lateral rectus muscle of the left eye. Conservative management was employed with abstinence from anticoagulation for 2 weeks and a weaning regime of oral steroids. Under the clinical review of ophthalmology and interval radiological monitoring, symptoms were reduced with reduction of haemorrhage size. Anticoagulation was reinstated after 2 weeks. To our knowledge, this is the first case of a non-traumatic extraocular muscle haematoma to be reported in a patient on anticoagulation.

Suspected orbital myositis associated with COVID-19.

A 44-year-old male patient developed proptosis, edema, and erythema progressing to complete ptosis and supraduction deficit 2 days after positive COVID-19 test. He failed to improve on systemic antibiotics. MRI showed thickening and T2 enhancement of the superior rectus/levator complex consistent with orbital myositis. He improved on intravenous corticosteroids and experienced continued gradual improvement on oral steroids.

New Onset of Unilateral Orbital Myositis following Mild COVID-19 Infection.

Purpose: The authors present a case of unilateral orbital myositis of new onset following COVID-19 without a severe course.Methods: The patient had been received topical treatment with a preliminary diagnosis of conjunctivitis but no recovery had been noticed. The history revealed that the ocular signs had started 1 week after the COVID-19.Results: The examination revealed sectoral hyperemia of the temporal region in the bulbar conjunctiva together with marked limitation of right inward gaze. MRI of the orbits demonstrated diffuse fusiform enhancing enlargement of the right lateral rectus and superior rectus. The results of the laboratory tests and examination findings were normal. Systemic corticosteroids were started for the orbital myositis.Conclusions: Although conjunctivitis is the more common ocular disease following COVID-19, the possibility of orbital myositis should be considered in cases with resistance to topical treatment and/or gaze limitation. The possible role of orbital myositis as a trigger for COVID-19 could be explained with an immune-mediated mechanism.

Acute abducens nerve palsy in a patient with the novel coronavirus disease (COVID-19).

We present a case of an abducens nerve palsy in a previously healthy young man in the setting of SARS-CoV-2 infection. Magnetic resonance imaging obtained 5 weeks after the onset of diplopia demonstrated an atrophic left lateral rectus muscle, which was hyperintense on T2 weighting, consistent with denervation. Although the mechanism of the nerve palsy remains unclear, it is suspected to be related to his viral illness, because the patient had no preexisting vascular risk factors or evidence of other neurologic disease on neuroimaging. Cranial nerve palsies may represent part of the neurologic spectrum of COVID-19.