PMID- 27911447
OWN - NLM
STAT- MEDLINE
DCOM- 20180201
LR  - 20181113
IS  - 1476-5454 (Electronic)
IS  - 0950-222X (Print)
IS  - 0950-222X (Linking)
VI  - 31
IP  - 4
DP  - 2017 Apr
TI  - The enlarged extraocular muscle: to relax, reflect or refer?
PG  - 537-544
LID - 10.1038/eye.2016.248 [doi]
AB  - PurposeExtraocular muscle enlargement (EOME) is most commonly associated with 
      thyroid eye disease, but there are other causes. We report our outcomes of 
      investigating and managing non-thyroid-related EOME 
      (NTR-EOME).MethodsRetrospective consecutive case series. Sixteen patients 
      identified by clinical features and orbital imaging. Patient demographics, 
      radiological features, and adjuvant tests including biopsy and final diagnosis 
      were recorded.ResultsMean age at presentation 59.3 years (range 24-89 years). 
      Mean follow-up 3.2 years (range 3 months to 5.5 years). Superior rectus (SR) was 
      most commonly involved muscle (8/16 cases) followed by lateral rectus (4/16). Of 
      the 16 cases, 14 were associated with underlying systemic neoplasia (5 lymphoma, 
      5 metastatic carcinoma, and 4 presumed paraneoplastic syndrome). All SR 
      enlargement was associated with underlying neoplasia. All patients underwent 
      orbital imaging followed by systemic imaging based on clinical index of suspicion 
      (14/16 patients (13 full body CT (FBCT), 1 mammography)). Positive systemic 
      radiological findings were detected in 12/14 cases. Of the remaining 2 patients, 
      1 underwent full body positron emission tomography-computed tomography 
      (FBPET-CT), which detected thyroid carcinoma, and the second patient underwent 
      FBCT for staging following orbital biopsy showing lymphoma. Four patients (25%) 
      died within 3 years of follow-up due to disseminated systemic 
      malignancy.ConclusionsAll cases of NTR-EOME should be viewed with a high level of 
      clinical suspicion for systemic neoplasia, especially when the SR is involved. 
      FBCT can help to identify a primary systemic cause. FBPET-CT is best reserved for 
      cases negative on FBCT or for staging and monitoring systemic disease. NTR-EOME 
      can be associated with significant mortality (25%), hence warrants prompt and 
      thorough systemic investigation.
FAU - Shafi, F
AU  - Shafi F
AD  - Department of Ophthalmology, University Hospital of Coventry and Warwickshire, 
      Coventry, UK.
FAU - Mathewson, P
AU  - Mathewson P
AD  - Department of Ophthalmology, University Hospital of Coventry and Warwickshire, 
      Coventry, UK.
FAU - Mehta, P
AU  - Mehta P
AD  - Department of Ophthalmology, University Hospital of Coventry and Warwickshire, 
      Coventry, UK.
FAU - Ahluwalia, H S
AU  - Ahluwalia HS
AD  - Department of Ophthalmology, University Hospital of Coventry and Warwickshire, 
      Coventry, UK.
LA  - eng
PT  - Journal Article
DEP - 20161202
PL  - England
TA  - Eye (Lond)
JT  - Eye (London, England)
JID - 8703986
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Arteriovenous Malformations/complications/diagnostic imaging/*pathology
MH  - Breast Neoplasms/diagnostic imaging/*pathology
MH  - Carcinoma, Transitional Cell/diagnostic imaging/*pathology
MH  - Carotid-Cavernous Sinus Fistula/complications/diagnostic imaging/*pathology
MH  - Eye Neoplasms/diagnostic imaging/pathology/*secondary
MH  - Female
MH  - Graves Ophthalmopathy/etiology/*pathology/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Oculomotor Muscles/*pathology
MH  - Orbit/*pathology
MH  - Paraneoplastic Syndromes/diagnostic imaging/*pathology
MH  - Positron-Emission Tomography
MH  - Referral and Consultation
MH  - Retrospective Studies
MH  - Tomography, X-Ray Computed
MH  - Whole Body Imaging
MH  - Young Adult
PMC - PMC5395989
COIS- The authors declare no conflict of interest.
EDAT- 2016/12/03 06:00
MHDA- 2018/02/02 06:00
PMCR- 2018/04/01
CRDT- 2016/12/03 06:00
PHST- 2016/05/23 00:00 [received]
PHST- 2016/09/14 00:00 [accepted]
PHST- 2016/12/03 06:00 [pubmed]
PHST- 2018/02/02 06:00 [medline]
PHST- 2016/12/03 06:00 [entrez]
PHST- 2018/04/01 00:00 [pmc-release]
AID - eye2016248 [pii]
AID - 10.1038/eye.2016.248 [doi]
PST - ppublish
SO  - Eye (Lond). 2017 Apr;31(4):537-544. doi: 10.1038/eye.2016.248. Epub 2016 Dec 2.