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Ptosis due to ocular myasthenia is often variable, and it may improve on awakening and worsen at the end of the day. Clinical signs of ocular myasthenia may include worsening [...]

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Four cases of gaze paresis occurred in association with vital disease. In three cases the viral prodrome preceded the oculomotor disturbance. In one, gaze palsy was followed several days later by a viral syndrome. One had isolated bilateral horizontal ophthalmoplegia; another patient had motility disturbance with blepharoptosis and peripheral areflexia. Two patients had clinical evidence of brain-stem involvement: unilateral gaze paresis and gaze-evoked nystagmus in one and Parinaud's syndrome in the other. No accompanying long-tract signs or changes in mental status were present in any case. Recovery was complete in all four patients.

• Orbital cellulitis secondary to adjacent paranasal sinusitis presents with marked proptosis, ophthalmoplegia, eyelid edema, chemosis, and/or conjunctival hyperemia. These conditions often precede visual dysfunction. "Posterior" orbital cellulitis secondary to sphenoethmoidal sinusitis may be defined as the clinical syndrome in which early severe visual loss overshadows or precedes accompanying inflammatory orbital signs. The visual loss may be attributed to involvement of the intracanalicular or orbital apical segment of the optic nerve. Total irreversible unilateral visual loss developed in three patients with this syndrome. Severe visual loss was preceded by diplopia in one patient and by bilateral eyelid edema in another. One patient with chronic panparanasal sinusitis with acute visual loss presented with isolated optic disc edema. Proptosis and ductional restriction subsequently developed. The irreversible blindness in these cases may be due to a combination of intracanalicular edema and vasculitis causing optic nerve infarction.

• Idiopathic orbital myositis, a subgroup of inflammatory orbital pseudotumor, occurred in six patients with acuteonset periorbital pain, diplopia, and, in most cases, eyelid swelling. Proptosis, ductional restrictions, and responsiveness to oral prednisone administration were characteristic. Computed tomography and orbital ultrasonography showed enlargement of one or more extraocular muscles, with sparing of other orbital soft tissues. One patient had involvement of all recti muscles in both orbits. The distinction of orbital myositis from Graves' ophthalmopathy is made on clinical grounds, with acute orbital pain and corticosteroid responsiveness being uncharacteristic of the latter. The possibility of orbital myositis being an immune-mediated process is discussed.

Two cases of pituitary apoplexy were detected in the immediate postoperative period after cardiac surgery with extracorporeal bypass. Both patients had pituitary adenomas that were asymptomatic and previously undiagnosed. One patient, a 57-year-old man, had unilateral total ophthalmoplegia and blepharoptosis with sparing of the visual system. The second patient, a 55-year-old man, had headache, marked bilateral visual loss, and ophthalmoplegia with subsequent development of a hemiparesis. Pituitary apoplexy was confirmed pathologically in both cases.