title: Systemic Amyloidosis and Extraocular Muscle Deposition.
abstract: Isolated amyloid deposition in an extraocular muscle is a rare event but can be a presenting feature of systemic amyloidosis. A 67-year-old woman with an acquired exotropia and hypertropia was found to have unilateral diffuse extraocular muscle enlargement on magnetic resonance imaging. Owing to the progressive nature of her strabismus and the negative laboratory testing for thyroid disease, she underwent an extraocular muscle biopsy that revealed amyloid deposition. Further workup demonstrated a monoclonal gammopathy consistent with systemic amyloidosis. This case demonstrates the need to consider amyloidosis in the differential diagnosis of patients presenting with an atypical acquired strabismus. We review other reports of isolated amyloid deposition in extraocular muscles and its association with systemic amyloidosis, emphasizing the importance of the ophthalmologist in the early recognition of this disease to prevent irreversible, life-threatening end organ damage.
authors.affiliation: Department of Ophthalmology (VS), Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Ophthalmology (KMC, HC, SFG, SRD, NJS), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Veeral S
authors.initials: VS
authors.lastname: Shah
authors.forename: Kara M
authors.initials: KM
authors.lastname: Cavuoto
authors.forename: Hilda
authors.initials: H
authors.lastname: Capo
authors.forename: Sara F
authors.initials: SF
authors.lastname: Grace
authors.forename: Sander R
authors.initials: SR
authors.lastname: Dubovy
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Schatz
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000175:diagnosis; D001706:Biopsy; D003937:Diagnosis, Differential; D005133:Eye Movements; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009801:Oculomotor Muscles / Q000473:pathology* / Q000503:physiopathology; D013285:Strabismus / Q000175:diagnosis / Q000209:etiology*