Mydriasis and Ophthalmoplegia in a 10-Year-Old Girl: A Diagnostic Predicament
Michael Horley
St.George’s University of London, London, England.
Karthikayini Gomathinayagam
University of Nicosia Medical School, Nicosia, Cyprus.
Antigoni Koukkoulli *
Pantheo Eye Centre, Limassol, Cyprus.
*Author to whom correspondence should be addressed.
Abstract
This case reports a 10-year-old girl who presented with sudden-onset diplopia and bilateral mydriasis following a recent upper respiratory infection. Ocular examination showed poor light response and mild abduction deficits. Initial low-resolution MRI was normal, but a high-resolution MRI revealed bilateral enhancement of the abducens and oculomotor nerves. Viral-induced cranial nerve palsies were suspected. The use of systemic steroids was considered but concerns about side effects in children led to a conservative approach. Patient achieved full recovery four months later. This case highlights the importance of high-resolution imaging in diagnosing cranial nerve palsies in children and raises questions about the role of corticosteroids in managing viral-induced neuropathies. Further research is needed to determine optimal treatment strategies for such cases.
Keywords: Mydriasis, ophthalmoplegia, lateral rectus palsy, viral-induced, paediatrics, paediatric ophthalmology, neuro-ophthalmology