Case of the week 24 (
January 2012
)
Acute unilateral proptosis
The
mother of this 10 years old girl noted that the Right
eye of her daughter does not go up , this was noticed
since only two weeks .
The girl has no complaint of diplopia , she is healthy
girl , passing good at school .
VA 6/6 OS 6/6 OD , normal fundus and
refraction
Apart from this ocular motility abnormality , she is
completely fine
See video for this patient
The most striking matter about this young girl is the
acute onset of the orbital pathological condition that
leads to this acute slight unilateral proptosis , ocular
motility restriction to upward gaze and the lower
dystopia of the right eye . By inspection I'm sure this
eye is pushed down by a mysterious space occupying
lesion located somewhere in the upper orbit.
The abrupt onset of proptosis with ocular motility
restriction in a child represents one of the most
important ocular emergencies and must be an alarming
event for the ophthalmologist.
The varied anatomic structures within the orbit allow it
to host numerous disorders, including infectious,
inflammatory, immune mediated, vascular, and neoplastic
diseases.
While some of the diseases producing acute proptosis
(e.g., inflammatory pseudotumor) are labeled benign,
they almost always produce significant morbidity if
diagnosis and treatment are delayed.
Failure to properly diagnose malignant lesions producing
acute proptosis (e.g., lacrimal gland carcinoma) can
lead to both morbidity and mortality. The clinical picture of acute proptosis may evoke the
specter of
Orbital
rhabdomyosarcomain which prompt diagnosis and early therapy can be
lifesaving, still others are relatively benign in every
sense , the
ophthalmologist should be aware of differential
diagnosis of acute proptosis in children
Orbital
rhabdomyosarcoma
should be considered in the differential diagnosis of
any child with a progressive unilateral proptosis
with ocular motility restriction.
Diagnosis consists of a detailed history, ocular
examination, imaging studies including CT or MRI, and
biopsy.
MRI reveals orbital mass in the superior temporal
quadrant pushing the right globe down and in , reported
by the radiologist : this is a picture of orbital
dermoid ?? or orbital inflammatory pseudotumor ??
A huge dose of corticosteroid and antibiotics were
prescribed , this leads to marvellous result for both
motility restriction and globe displacement
see photos and video of this patient after one week of
this therapy
See video for this patient after treatment
الموقع المصري للحول
وامراض الجهاز الحركي للعين
The Egyptian Site of
Strabismus & Oculomotor Disorders
.jpg)
