Painless Diplopia Caused by Extraocular Muscle Sarcoid

Orbital sarcoid is rare and almost always unilateral when it does not involve the lacrimal glands.1To our knowledge, only two cases of orbital sarcoid limited to extraocular muscle have been verified by biopsy and reported in the literature.2,3We describe the first case of a painless external ophthalmoplegia attributable to extraocular muscle sarcoid. Report of a Case. A 43-year-old black woman, who was referred to the University of Maryland Eye Clinic, Baltimore, had painless horizontal and vertical diplopia for 3 months. Her relevant medical and ocular history were unremarkable. On examination in September 1992, the patient had visual acuity of 20/30 OD and 20/25 OS. Exophthalmometry readings were 20 mm OU, with a Hertel's base of 102 mm. The patient had limitations in supraduction and infraduction of the right eye and in adduction of the left eye (Figure 1). Forced ductions revealed full range of motion, with