1/1142. Periorbital edema as the presenting sign of juvenile dermatomyositis. We report a case of juvenile dermatomyositis that presented with periorbital edema. dermatomyositis is an autoimmune disorder with cutaneous manifestations including heliotrope patches, Gottron's papules, periungual telangiectasisas, and subcutaneous calcifications. Periorbital edema may accompany the classic heliotrope rash and, as in this case, may be the only presenting sign of juvenile dermatomyositis. ( info) |
2/1142. Severe ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy. PURPOSE: To report severe ocular and orbital toxicity after administration of intracarotid etoposide phosphate and carboplatin. METHOD: Case report. RESULTS: A 52-year-old man with glioblastoma multiforme underwent left intracarotid administration of eto poside phosphate and carboplatin inferior to the ophthalmic artery. Within 7 hours, a nonpupillary block angle-closure glaucoma developed secondary to uveal effusion in the ipsilateral eye, which was relieved by cycloplegia. Four days later, severe orbital inflammation resulted in a visual acuity of counting fingers, proptosis, optic neuropathy, and total external ophthalmoplegia in the eye. The patient's condition improved after a lateral cantholysis and administration of high-dose intravenous corticosteroids. Two weeks later, an anterior uveitis occurred in the left eye, which responded to topical corticosteroids. During a 2-month period, the patient recovered to a visual acuity of 20/70, near normal motility, and normal intraocular pressure, and the ocular and orbital inflammation resolved. Preexisting ipsilateral chemotherapy-induced maculopathy became more pronounced. CONCLUSION: Ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy is infrequently reported. ( info) |
3/1142. Sight-threatening acute orbital swelling from peribulbar local anesthesia. Severe allergic reactions to peribulbar local anesthesia are extremely rare. A 70-year-old woman presented with acute orbital swelling and optic nerve dysfunction after a peribulbar local anesthetic injection. The patient was treated with acute orbital decompression as well as intravenous antibiotics and methylprednisolone; she made a good recovery. An allergy, probably to lignocaine, was the most likely cause. Urgent recognition and treatment of this condition may prevent potentially serious visual consequences. ( info) |
4/1142. Orbital dirofilariasis: MR findings. dirofilariasis is a helminthic zoonosis occurring in many parts of the world. We report the findings in a 61-year-old woman who had painless right exophthalmos caused by orbital dirofilariasis. A vivid worm was embedded inside an inflammatory nodule in the right orbit. On T1-weighted MR images, the parasite was visible as a discrete, low-intensity, tubular signal in the center of the nodule surrounded by contrast-enhancing inflammatory tissue. ( info) |
5/1142. An unusual case of orbital hydatid cyst: a surgical emergency. A rare case of a 19-year-old man with an orbital hydatid cyst is presented. The lesion caused rapid deterioration of vision and was not responsive to the systemic use of mebendazole. It was treated successfully with emergency surgery. Early detection, surgical excision, and the systemic use of albendazole are suggested for the treatment of orbital hydatid cysts. ( info) |
6/1142. Endoscopic sinus surgery in the management of mucormycosis. This is a report of the use of endoscopic sinus surgery in the management of three patients diagnosed with rhino-orbital or rhino-orbito-cerebral mucormycosis. A retrospective review was performed of the clinical examinations and imaging studies of three patients who underwent endoscopic sinus surgery as part of their therapy for mucormycosis. In addition to endoscopic surgery, all patients had aggressive control of underlying risk factors (diabetes mellitus, immunosuppression) and prolonged intravenous amphotericin b therapy. All three patients survived and avoided orbital exenteration. In selected patients with rhino-orbito-cerebral mucormycosis, endoscopic techniques can play a valuable role in diagnosis and management. ( info) |
7/1142. Exposure of expanded polytetrafluoroethylene-wrapped hydroxyapatite orbital implant: a report of two patients. PURPOSE: Hydroxyapatite (HA) spheres used to replace volume after an enucleation are often wrapped with autologous tissue before orbital implantation. Man-made materials are less expensive and pose no risk for viral transmission. The use of expanded polytetrafluoroethylene (ePTFE) to wrap HA spheres was evaluated. methods: The medical records of 2 consecutive patients who underwent uncomplicated implantation of an HA sphere wrapped in ePTFE were reviewed. RESULTS: An unusual reaction to the ePTFE material that was nonresponsive to topical or systemic antibiotic therapy developed in these 2 patients. Eventual wound erosion and bacterial infection of the implant necessitated its removal. CONCLUSIONS: Although well tolerated in other surgeries, ePTFE, when used to wrap HA spheres and placed into the orbit, may cause persistent conjunctival discharge, pyogenic granuloma formation, and eventual wound erosion. Therefore, the use of this material to wrap HA spheres is not recommended. ( info) |
8/1142. Pneumatocele of the orbit. PURPOSE: To describe an uncommon sinus condition that can cause proptosis. methods: Intermittent unilateral proptosis and diplopia developed in a 29-year-old man. Computed tomography showed an enlarged frontal sinus with erosion of the floor of the sinus and air in the orbit. RESULTS: Endoscopic ethmoidectomy and frontal sinusotomy corrected an outlet check valve of the nasal frontal duct and eliminated the proptosis. CONCLUSION: Pneumatocele of the orbit is an uncommon cause of proptosis and diplopia and can be corrected with endoscopic sinus surgery. ( info) |
9/1142. Giant cell reparative granuloma of the orbit. PURPOSE: To report a case of giant cell reparative granuloma occurring in the orbit and to discuss its clinical, radiologic, and histopathologic characteristics in contrast with other similar lesions. methods: A 38-year-old man developed pain and mild proptosis of the left eye. Computed tomography and magnetic resonance imaging demonstrated an intraosseous cystic orbital mass. Excisional biopsy disclosed giant cell reparative granuloma of the orbit. RESULT: At 11 months' follow-up, the patient had normal vision, with no tumor recurrence. CONCLUSION: Giant cell reparative granuloma of the orbit is a rare benign fibro-osseous proliferation that is generally seen in young adulthood. It should be considered in the differential diagnosis of orbital fibro-osseous proliferation. Surgical excision and curettage is the therapeutic method of choice. ( info) |
| The term orbital pseudotumor refers to a broad category of non-specific idiopathic inflammations of the orbit. This disease, which may affect any orbital structure, is one of the commonest causes of exophtalmus, occurring with a similar incidence in both sexes. The diagnosis is based on a combination of clinical, radiological and histopathological findings, after careful exclusion of specific systemic and local diseases. Many classification systems have been proposed and a range of therapeutic modalities, including surgery, steroids, immunosuppressive agents, and radiation therapy, have been employed by various authors in heterogeneous series of patients. This slowly proliferating disease, which usually presents with a long clinical history and high variability in clinical manifestations and prognosis, is difficult to manage with any of the available therapeutic options. The difficulties and controversies regarding the diagnostic and therapeutic management of these patients are addressed in an updated review of the literature and exemplified in our case report. ( info) |