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INTRODUCTION
Cysticercosis is the most common ocular platyhelminth infestation, being the larval form of tapeworm Taenia solium.1 Reports of orbital cysticercosis are uncommon despite the high incidence of brain and ocular involvement. Infestation of the extraocular muscles is particularly rare. We encountered two cases of cysticercosis involving the extraocular muscles. The presentation in one patient clinically simulated a double depressor underaction and the second patient presented as an acquired Duane retraction syndrome. The cases were successfully treated with oral albendazole therapy.
CASE REPORTS
Case 1. A 14-year-old girl presented with complaints of headache, right-sided ocular pain, and binocular diplopia, which was initially present only in downgaze but gradually spread to involve all directions of gaze. Her best corrected visual acuity was 6/6 in both eyes. On examination, there was no proptosis and a cover test revealed a right hypertropia, which was greater with the right eye fixating. Ocular motility examination showed an underaction of both the depressors of the right eye (Fig 1). Anterior segment and fundus examination were within normal limits. A complete paralytic workup was consistent with the diagnosis of a double depressor underaction of the right eye. A forced duction test was positive in depression in the right eye. General physical and systemic examinations were normal. The blood cell count was normal, with no eosinophilia and a normal sedimentation rate. A stool examination and x-ray evaluation of the orbit, paranasal sinuses, and the skull revealed no abnormality. Ultrasonography of the orbit showed a well-demarcated cyst in relation to the right superior rectus muscle with a central echodense, highly reflective structure within the sonolucent cyst, corresponding to the scolex (Fig 2). A CT scan confirmed the presence of the cyst in relation to the superior rectus muscle, with an eccentric hyperdense focus located within the central low attenuation of the lesion (Fig 3). However, the cerebral parenchyma did not show any lesion. Based on the presumptive diagnosis of extraocular muscle cysticercosis, the patient was started on a single daily dose of oral albendazole (15 mg/kg of body weight) with the total duration of treatment being 30 days. The patient reported on the third day of treatment with local inflammatory signs in the form of pain and swelling, which were well controlled with...