Complete ophthalmoplegia secondary to amyloidosis associated with multiple myeloma

Total ophthalmoplegia associated with biopsy-proven amyloid infiltration of the extraocular muscles developed in a 60-year-old man with multiple myeloma. Amyloid was also found in biopsy specimens of the conjunctiva and eyelid papules. The patient also had eyelid purpura, keratitis sicca, and pupillary abnormalities. Treating the multiple myeloma had no effect on the ophthalmoplegia. Physicians should be aware that ophthalmoplegia associated with amyloidosis may indicate an underlying myeloma rather than primary systemic amyloidosis.