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A previously healthy 12 year old boy was referred to our unit in May 2000, with a history of persistent ocular pain and recurrent diplopia. The first disease manifestation had started three years before, when the patient suddenly presented with diplopia and painful periorbital and eyelid oedema. Limited abduction of the right eye was present. The treating ophthalmologist, after a thorough investigation that excluded brain tumours, orbital masses, and myasthenia gravis, prescribed naproxen (20 mg/kg/day) and systemic corticosteroid treatment (prednisone 1 mg/kg/day, tapered and withdrawn after 15 days); symptoms recovered completely in two weeks. A first magnetic resonance imaging (MRI) scan of the orbit had shown first degree exophthalmus of the right eye and oedema and thickening of the right rectus lateralis muscle (fig 1). Since then the boy had many episodes of ocular pain and diplopia, lasting from two to four weeks, affecting …