Central Retinal Artery Occlusion by Orbital Pseudotumor-A Case Report

Abstract

Purpose: To report a case of central retinal artery occlusion (CRAO) by orbital pseudotumor.Method: A case report.Results: A healthy 35-year-old man noticed vision loss, severe eye pain, and horizontal diplopia in his left eye at our emergency room (ER). The ophthalmologic examination disclosed intraocular pressure elevated to 29 mm Hg, deep anterior chamber without inflammatory cells, and exophthalmos of the left eye. His best spectacle corrected visual acuity (BSCVA) was 20/20 in the right eye and no light perception in the left. Relative afferent pupillary defect (RAPD) is positive in the left eye and negative in the right eye. Fundus examination of the left eye showed superficial retinal whitening with cherry-red spots, which indicated CRAO. Ultrasonographic examination of his left eye revealed a space-occupying lesion at nasal portion. Fluorescein angiography showed delayed perfusion in the arterial circulation surrounding optic nerve in the left eye. Orbital computerized tomography (CT) and magnetic resonance imaging displayed hyperdense and hypovascular mass in the left retrobulbar region with clear paranasal sinuses, and the orbital bony structure was intact. After treatment with high-dose corticosteroids and anti-glaucoma agents, his CT imaging showed no obvious enhanced mass lesion in the left orbital cavity. At 4- month follow-up, his BSCVA was counting fingers at 15 cm in the left eye.Conclusion: Pseudotumor with involvement of the orbital and optic nerve can cause CRAO. The mechanisms of retinal vascular obstruction in eyes with orbital pseudotumor are multifactorial. The evaluation of retinal vascular perfusion is as important as orbital imaging for the diagnosis and management of CRAO by orbital pseudotumor.