Three rare causes of unilateral exophthalmos.

Abstract

Unilateral exophthalmos may be caused by a wide variety of intra- and extraorbital diseases (3, 7, 13, 22, 23, 27). We have recently seen 3 unusual cases of unilateral exophthalmos, one due to a papilloma of the frontal sinus, the second to an orbital epidermoid tumor (cholesteatoma), and the third to myeloma. All three are here reported with a brief review of the literature. Case Reports Case I: The patient, a 54-year-old white female, was admitted to Jersey City Medical Center in May 1965 because of progressive proptosis of the right eye, double vision, and bifrontal headache for three years. Eye Examination: There was conspicuous exophthalmos of the right eye. Vision in the right eye was 20/50 and in the left 20/25. Exophthalmometer readings were 28 mm in the right eye and 16 mm in the left. Intraocular tension as measured by a Schiøtz tonometer with 5.5 g weight was 20 mm Hg (right) and 17.3 mm Hg (left). There were striae throughout the fundus, but disk and macula were spared. Roentgen Examination: The skull radiographs showed an expanding lesion arising in the frontal sinus, destroying the superior orbital wall on the right side (Fig. 1). Despite the fact that no mucosal thickening of the sinuses was evident, the lesion was thought to be a mucocele which originated in the frontal sinus and was destroying the orbital roof. A lateral projection air orbitotomogram revealed a 4 × 5-cm oval mass which arose from the frontal sinus and extended to involve the superior portion of the right orbit, causing marked proptosis (Fig. 2). Operative Findings: The orbit contained a gelatinous material and multiple thin bony plaques representing bony debris from the superior orbital wall, which was almost totally destroyed. Further exploration revealed a large granulomatous cauliflower-like tumor, arising from the frontal sinus and extending downward to displace the globe forward and down. There was no direct invasion of the globe. The pathologic diagnosis was papilloma arising in the frontal sinus (Fig. 3). Case II: The patient, an obese, 38-year-old Negro female, was admitted to Jersey City Medical Center in September 1965 with a six-month history of progressive protrusion of the left eye. Eye Examination: In the right eye vision was 20/50; in the left 20/25. The fundi were clear. Exophthalmometer readings were 17 and 27 mm in the right and the left eye, respectively. Intraocular tension with 5.5 g weight was 14.6 mm Hg on the right and 17.3 mm Hg on the left. Roentgen Examination: Routine skull radiographs and tomograms showed considerable sclerosis of the left orbit with a localized bony defect or dehiscence, suggestive of a dermoid or epidermoid tumor (Figs. 4 and 5). During the air orbitotomography, about 6 cc of dark brownish, oily fluid was aspirated from the cystic mass, which was well delineated by air (Fig. 6). The aspirated fluid contained large quantities of cholesterol crystals.