1/10. mucormycosis manifesting as proptosis and unilateral blindness.A 51-year-old woman presented to the emergency department (ED) of another institution with sudden onset of blindness in the left eye. The patient was found to have no light perception in the left eye and a marked chemosis occurring several days after a fall. She was transferred to the hospital for ophthalmologic evaluation. Upon careful history and physical examination, the diagnosis of rhinocerebral mucormycosis was considered and urgent ophthalmology and otolaryngology consults were obtained. The patient underwent extensive surgical debridement and pharmacologic treatment. The diagnosis was confirmed by pathological specimens. In this case report, the clinical presentation, pathogenesis, diagnostic workup, and ED management of mucormycosis are discussed, highlighting the possible diagnostic and therapeutic pitfalls that are most pertinent to the emergency physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Orbital lymphoma misdiagnosed as Graves' ophthalmopathy.OBJECTIVE: To describe a case of bilateral orbital lymphoma mistakenly diagnosed as Graves' ophthalmopathy. methods: We present a case report, with laboratory data and photographic documentation, and discuss the differential diagnosis in patients with orbital masses. RESULTS: A 65-year-old man with bilateral exophthalmos and substantial weight loss was referred to the Endocrine Clinic for evaluation of possible Graves' disease. A 6-cm mass was detected in the left axilla. biopsy of this mass revealed the histopathologic diagnosis of anaplastic B-cell lymphoma. Treatment with intrathecally administered methotrexate and orally administered dexamethasone promptly resulted in decreased proptosis. CONCLUSION: The most frequent cause of bilateral proptosis is Graves' ophthalmopathy, and when it is associated with weight loss in an elderly patient, the initial diagnostic consideration is thyrotoxic Graves' disease. This case should remind physicians that bilateral orbital lymphoma, although uncommon, may mimic Graves' ophthalmopathy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Spontaneous globe luxation associated with contact lens placement.PURPOSE: Globe luxation, characterized as the anterior dislocation of the eyeball beyond retracted lids, presents a dramatic clinical picture. It is an uncommon event and can produce anxiety in both the patient and the physician. The purpose of this article is to present a case of spontaneous globe luxation which occurred with attempted contact lens placement. methods: A case report and literature review are presented. RESULTS: Manual reduction of the globe required conscious sedation in the emergency room. Diffuse superficial punctate keratitis resolved completely with no visual sequelae. DISCUSSION: The clinical features, epidemiology, risk factors, complications and treatments of globe luxation are presented. eye care specialists who fit and dispense contact lenses should be aware of risk factors associated with globe luxation. A step-wise plan for management is presented, in hope of limiting patient discomfort, recurrence, and perhaps long-term visual impairment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Granulomatous idiopathic orbital inflammation.One category of idiopathic orbital inflammation (IOI) displays a granulomatous inflammatory pattern that mimics sarcoidosis, although this has not been extensively addressed in most published series of IOI. We analyzed the clinicopathologic features of patients with biopsy-proven noninfectious granulomatous inflammation of the orbit. review of surgical pathology records from January 1988 to May 1992 identified 12 patients with a diagnosis of sarcoidosis or other noninfectious granulomatous process involving the orbit. Clinical records were reviewed, and the patients' physicians contacted to determine if the diagnosis of sarcoidosis was confirmed. Five cases in which the systemic diagnosis was not established despite thorough evaluation are reported here. We report five cases of noninfectious IOI in which sarcoidosis was suspected clinically and histologically. In these, however, further systemic evaluation at 15 to 32 months (mean 22.4) failed to reveal evidence of systemic involvement. A spectrum of histopathologic patterns was seen, including non-necrotizing foreign body type granulomas, lipogranulomatous inflammation, and variable sclerosis. patients with solitary orbital noncaseating granulomatous inflammation should be thoroughly evaluated before a diagnosis of sarcoidosis is made. Practitioners should be aware of the existence of granulomatous IOI not associated with systemic sarcoidosis as a distinct clinicopathologic entity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. Bilateral ethmoid sinusitis with unilateral proptosis as an initial manifestation of metastatic prostate carcinoma.This article presents a case of bilateral ethmoid sinusitis with unilateral proptosis as a presenting sign of an unsuspected prostate carcinoma. A 59-year-old Hispanic male presented to his primary care physician with nasal congestion and rhinitis. He was treated with antibiotics and antihistamine decongestants for 3 weeks without improvement. A trial of steroids resulted in brief improvement followed by a rapid onset of nasal obstruction with proptosis. A computed tomography scan revealed opacification of the ethmoid sinus with right proptosis. The presumptive diagnosis was orbital cellulitis secondary to chronic ethmoid sinusitis. Endoscopic sinusotomy and bilateral ethmoidectomies were performed. biopsy results returned as metastatic adenocarcinoma, probably of prostate origin. Urological work-up and evaluation with biopsy confirmed the diagnosis of prostatic carcinoma. The patient was treated with chemotherapy and radiation therapy. He died 7 months later with disseminated disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. exophthalmos and iatrogenic Cushing's syndrome.A 38-year-old physician presented with a 9-month history of progressive self-administration of oral prednisone < or = 160 mg per day for Addison's disease. Examination demonstrated typical Cushingoid features and bilateral proptosis with elevated intraocular pressure. Computed tomography disclosed increased intraorbital adipose tissue. We hypothesize that the increased intraorbital adipose deposition was due to the differential binding of glucocorticoids to adipose tissue receptors and an enhancement of lipoprotein lipase activity. We conclude that the findings in this case may be related to glucocorticoid-induced changes in the ocular and periorbital structures. Cushing's syndrome should be considered in the differential diagnosis of acquired exophthalmos and elevated intraocular pressure and findings of increased orbital fat on orbital imaging.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Luxation of the globe.Emergency physicians encounter globe luxation, anterior dislocation of the eyeball beyond retracted lids, in a limited number of clinical circumstances. The authors present a case of spontaneous luxation followed by a general discussion of luxation. An understanding of the pathophysiology of various causes of luxation and the appropriate method and timing of reduction allows appropriate evaluation, treatment, and follow-up, thereby limiting patient discomfort, recurrence, and perhaps long-term visual impairment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. Pourfour du Petit syndrome: a case following a traffic accident with severe cranioencephalic trauma.Poufour du Petit syndrome is an extraordinarily unusual clinical condition produced by hyperactivity of the sympathetic cervical chain as a consequence of irritation of these nerves. It causes an ipsilateral mydriasis, which, in patients suffering a head injury as in the case reported here, can confuse the diagnosis and disconcert physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Unusual penetrating faciocranial injury caused by a knife: a case report.Penetrating head and neck trauma in children is uncommon and are potentially life-threatening injuries. Penetrating trauma to the head in children is a challenging problem for both the initial evaluating physicians and surgeons. We report upon a patient who had fallen from a tree while cutting vegetables and sustained a penetrating faciocranial injury caused by his knife. Clinical examination showed a knife which had entered his face in the right preauricular, pre-temporomandibular joint area below the zygomatic arch. His left bulbus oculi was exophthalmic and a complete ptosis was present. He was fully conscious. The only abnormal finding was complete left visual loss. The other neurological ophthalmological and systemic physical evaluations were normal. The Glasgow coma scale score was 14. The modalities of treatment and the outcome of the operation are described and the management of similar injuries is discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. Percutaneous treatment of an orbital hydatid cyst: a new therapeutic approach.PURPOSE: To describe the percutaneous treatment of an orbital hydatid cyst as an alternative approach to conventional surgery. methods: In a 21-year-old man with diplopia and right proptosis, radiologic studies disclosed a 25 x 25 x 20-mm purely cystic mass in the right retrobulbar area. Based on the presumptive diagnosis of hydatid cyst, the cyst was treated percutaneously under ultrasonographic guidance with aspiration, 15% hypertonic saline injection, and reaspiration without any complication. RESULTS: A substantial decrease in the size of the cyst was observed in the 3 months after treatment. Nine months after treatment, the shrunken cyst had a volume of only 0.5 ml, and the patient was asymptomatic. Twenty-one months after the procedure, the findings were consistent with those at 9 months of follow-up. CONCLUSION: Percutaneous treatment of orbital hydatid cysts, which is more satisfactory to both the patient and the physician, may be a safe and effective alternative to surgical extirpation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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