Radiologic evaluation in the diagnosis of diplopia due to unilateral accessory extraocular muscle

This case report details a case of a 52-year-old female with a history of diplopia and an elevation deficit in her right eye. Initially misdiagnosed as an atavistic retractor bulbi muscle in 2005 via MRI, symptoms persisted despite surgical excision. Follow-up MRI in 2023 confirmed no changes, ruling out other causes like nerve palsy or schwannoma, and ultimately guiding diagnosis towards an accessory extraocular muscle. This case underscores the importance of imaging in diagnosing rare anatomical variations that may present with symptoms similar to more common conditions. Increased awareness of accessory extraocular muscles can enhance diagnostic accuracy and patient outcomes.