Bilateral recurrent painful ophthalmoplegic neuropathy in an adolescent female

Recurrent painful ophthalmoplegic neuropathy (RPON) is a rare condition characterised by recurrent episodes of headache followed by ophthalmoplegia.An adolescent female presented with a throbbing unilateral headache associated with photophobia and phonophobia, progressing to binocular diplopia after 10-12 hours. She had two prior episodes that resolved spontaneously over 2-3 weeks. On examination, she exhibited binocular diplopia with restricted abduction in both eyes but no ptosis or abnormal reflexes. Neurological examination was otherwise normal. Investigations, including blood tests, cerebrospinal fluid analysis, MRI brain and nerve conduction studies, were all unremarkable. The case was diagnosed as RPON, given the absence of other pathologies and the clinical presentation.