344 - A rare case of Idiopathic Bilateral Ocular Myositis associated with Uncontrolled Diabetes: A Case Report

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

EC

Emiliano Curia, MD

Chief Resident
Larkin Community Hospital, Palm Springs Campus
Miami, Florida, United States
NJ

Neel Jingar, MD

Resident Physician/ Chief Resident
Larkin Community Hospital - Palm Springs Campus
Miami, Florida, United States

Corresponding Author(s)

MG

Moises Guevara, MD

Physician
Larkin Community Hospital
Hialeah, Florida, United States

Case Diagnosis: We present a case of severe progressive bilateral ocular myositis, a rare inflammatory eye muscle condition. Ocular myositis typically manifests with symptoms like eye pain, double vision, and limited eye movement. While its exact cause is often unclear, it can be linked to systemic autoimmune diseases, infections, or occur idiopathically.

Case Description: 59-year-old diabetic female presented to neurorehabilitation clinic in August 2023 for evaluation of 6 month worsening diplopia and bilateral ptosis. Symptoms began in 2019 but worsened in 2022 with diplopia and gaze deviation. In 2023, she developed right orbital pain. Initially diagnosed with seronegative myasthenia gravis, steroid therapy proved ineffective after six months. Brain and orbital MRI revealed hyperintensity in bilateral extraocular muscles on T2 imaging but no brain abnormalities. Although Chronic Progressive External Ophthalmoplegia was considered a differential, the progressive pain, swelling, MRI findings made it an unlikely diagnosis. Examination showed bilateral ptosis, limited extraocular movements, conjunctival injection, mild proptosis, reduced visual acuity, and mild to moderate diabetic retinopathy. Neurological examination was unremarkable. Laboratory studies demonstrated elevated HbA1c levels (9%), while inflammatory and autoimmune labs were negative. Electrodiagnostic studies were within normal limits.

Discussions: Ocular myositis is a rare condition and its association with uncontrolled diabetes mellitus is infrequently reported. Glycemic control provided moderate reduction in eye pain, ptosis and improved visual acuity.
This case underscores the importance of comprehensive management, as uncontrolled diabetes may contribute to the development of ocular myositis. Collaboration between specialists in neurology, ophthalmology and endocrinology is crucial for achieving optimal outcomes in such cases.

Conclusions: We present a case of bilateral ocular myositis associated with uncontrolled diabetes mellitus. Timely diagnosis, aggressive treatment, and effective diabetes management led to a favorable clinical outcome. Healthcare providers should be vigilant for ocular complications in patients with poorly controlled diabetes to ensure prompt intervention and prevent long-term morbidity.