 Hello everyone. I myself, Dr. Jay Saitarni, third year PG resident, Department of Radio Diagnosis, Swim's Puducherry. I would like to thank my co-author, Dr. S. Srinivasan, sir, who is an associate professor from the Department of Radio Diagnosis, Swim's Puducherry, for giving me a wonderful opportunity to present a paper on a rare case of painful ophthalmoplegia, introduction. Painful ophthalmoplegia consists of periorpital or hemicranial pain with ipsilateral oculomotor nupalsis. The syndrome involves diverse causes, therefore a comprehensive evaluation is essential. Contrast-enhanced magnetic resonance imaging provides a sensitive detection of structural abnormalities such as trauma, infection, malignancy, or vascular anomalies. Hereby we presented two cases of painful ophthalmoplegia with associated blurring of vision and headache. Case description one, a 67-year-old female came to department with complaints of ptosis, dyplopia, and pain in right eye for three weeks. She also complained of right-sided headache, which was sudden in onset, tricking around the right eye and thrombing in the right frontal region and continuous in nature. This is an image of the 67-year-old female who's presented with right eye ptosis. Figure one, ill-defined T1 isointents and BNC images showing the T2 and flare hyperintense, poorly demarcated area, noted involving the right orbital apex adjacent to the cavernous sinus and superior orbital fissure surrounding the cavernous segment of internal carotid artery. There is no evidence of thrombosis or compression over the right internal carotid artery. Figure two, D and E are post-contrast T1 images of axial and coronal cuts showing a vivid enhancement in the cellar and right paracellar region in the right orbital apex. Case description two, 27-year-old female presented to department with complaints of left retroorbital pain for three weeks. There were episodes of blurring of vision. It is associated with headache in left temporal region. Figure three, A, B and C, these are T1, T2 and flare axial images showing a mildly thickened left optic nerve with surrounding fat stranding of intra-coronal fat extending up to the orbital apex. Figure four, Axial and coronal T1 post-contrast images showing a thickening and enhancement of the left cavernous sinus and mild enhancement of the intracranallicular and intracranial portion of the left optic nerve and orbital apex with associated adjacent perineural fat stranding. With apoclinical features and imaging features, a diagnosis of Tolosa-Hunt syndrome was made. Both the patients received steroid therapy for management. Discussion part, Tolosa-Hunt syndrome is a non-specific granulomatous inflammation characterized by the infiltration of lymphocytes and plasma cells primarily in and around the cavernous sinus with variable extension into and beyond the superior orbital fissure, orbital apex. The estimated annual incidence is one case per million per year. Although the etiology is unknown, there are reports describing it possible autoimmune origin due to positivity for ENCA, anti-epic and anti-peroxidase antibodies in some patients with Tolosa-Hunt syndrome. It presents with unilateral orbital, periorbital pain associated with paralysis of one or more of the third, fourth, sixth cranial nerves. The implication of the image methods lies in excluding other etiologies of cavernous sinus syndrome, showing the typical Tolosa-Hunt syndrome findings and monitoring the post-therapeutic response. The method of choice is MRI, which is 92% sensibility. There is disparity in the literature about the utility of MRI diagnosis criteria. The MRI finding consists of convinced thickening of the cavernous sinus that may extend to the superior orbital fissure and orbit with a variable intensity in T1 and T2 and homogeneous enhancement. The most important differential diagnosis are sarcoidosis, lymphoma, meningioma and metastasis. These are my references and thank you.