We present the case of a seven-year-old girl who came to the emergency department for right palpebral ptosis and periorbital pain of 24 hours' duration, which did not subside with the usual analgesics, being afebrile, with sporadic nausea and vomiting and without intercurrent infectious process.
The patient had no personal or family history of interest, except for an episode similar to the one described in the previous two years, lasting two weeks, which subsided spontaneously without medication. Physical examination revealed paralysis of the supraduction and adduction of the gaze of the right eye, with eyelid ptosis, without pupillary involvement or alteration of other cranial nerves. A complete blood count and general biochemistry, erythrocyte sedimentation rate, C-reactive protein, glycosylated haemoglobin, anti-DNA antibodies, antinuclear antibodies (ANA), extractable nucleus antibodies (ENA), anti-neutrophil cytoplasmic antibodies (ANCA), and cranial magnetic resonance imaging were performed, all results being normal. Tolosa-Hunt syndrome was diagnosed and oral prednisone 1 mg/kg/day for five days was prescribed. Within 48 hours, the patient was re-evaluated and presented complete resolution of ophthalmoplegia and pain, with persistence of mild palpebral ptosis, which was maintained for the next six months.