Idiopathic orbital inflammation: An unusual presentation of benign essential blepharospasm

A case of a 48-year-old man with recurrent twitching of the right eye associated with the drooping of the upper eyelid, ipsilateral periorbital headache and blurring of vision aggravated by direct exposure to strong sunlight. Eye examination revealed intermittent twitching of the right upper eyelid, mild restriction of range of motion (downward gaze) and difficulty reading small prints (presbyopia). Computed tomographic scan showed thickened right superior rectus muscle and tendons. Based on the clinical and neuroimaging abnormalities a diagnosis of right orbital myositic inflammation was made. Patient was given high dose oral corticosteroids and remarkable improvement in his symptoms was recorded after 6 weeks of treatment.