title: Idiopathic Enlargement of the Extraocular Muscles in Young Patients: A Case Series.
abstract: OBJECTIVE
  To describe a case series of enlarged extraocular muscles in young patients.
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  Study involves 6 young patients who presented with atypical restrictive strabismus and reduced eye movements. Examination, neuroimaging, biochemistry results, and biopsy results are presented. The surgeries are described, and the follow-up over 1-20 years is presented.
  
  
  RESULTS
  All 6 patients had enlarged extraocular muscles that caused restrictive strabismus. The patients had no significant medical history. There was no identifiable underlying pathology on biochemistry tests or muscle biopsy. Three of the patients required multiple surgeries.
  
  
  CONCLUSIONS
  Atypical presentations of strabismus should be investigated for systemic conditions. Neuroimaging of the orbit and brain and a biopsy of the affected muscles should be considered. The patients should be counseled that multiple surgeries may be necessary to improve the strabismus, and it is unlikely that orthotropia will be attained.
authors.affiliation: Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and the University of Toronto, Toronto, Canada.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Ophthalmology, Stanford University, Stanford, California.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Foster
authors.affiliation: Department of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Donny W
authors.initials: DW
authors.lastname: Suh
authors.affiliation: Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and the University of Toronto, Toronto, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.affiliation: Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and the University of Toronto, Toronto, Canada.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Kraft
authors.affiliation: Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and the University of Toronto, Toronto, Canada. Electronic address: asim.ali@sickkids.ca.
authors.forename: Asim
authors.initials: A
authors.lastname: Ali
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006984:Hypertrophy; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D015835:Ocular Motility Disorders / Q000175:diagnosis*; D009801:Oculomotor Muscles / Q000473:pathology* / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013285:Strabismus / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed