Unstable Strabismus Secondary to Amyloid Infiltration of the Extraocular Muscles Preceeding a Diagnosis of Primary Amyloidosis

Amyloid infiltration of the extraocular muscles is a rarely reported finding in the literature with eleven total cases reported in the last twenty-five years. In approximately half of the reported cases, patients had an associated systemic hematologic abnormality. We present a patient with a history of unstable strabismus, found to have biopsy-proven amyloid infiltration of the extraocular muscles as an initial presentation of systemic amyloidosis with extraocular involvement. We discuss the appropriate systemic evaluation for patients with extraocular muscle amyloid infiltration, as well as the pathology and prognosis for amyloidosis.