Totally One-sided: Painless Unilateral Proptosis

Abstract

PRESENTATION An 88-year-old woman’s startling ophthalmologic symptoms were initially attributed to infection during an outpatient examination. When treatment offered no improvement, she presented to Johns Hopkins Hospital, where she reported progressive left eye swelling of 2 weeks duration. Seven years earlier, she had undergone mastectomy, chemotherapy, and radiation for breast cancer. Her medical history was also significant for a prior stroke, hypertension, and dementia. Initially, the patient noticed the onset of left-eye redness and swelling; she commented that her eye gradually “popped out.” An outside ophthalmology evaluation resulted in a diagnosis of conjunctivitis, and she was prescribed a regimen of tobramycin/dexamethasone ophthalmic suspension and moxifloxacin ophthalmic solution. Yet, her symptoms persisted. Two days prior to her presentation at the hospital, her son noticed ipsilateral cheek swelling. Given the progression of symptoms and her profoundly compromised appearance, the patient and her son sought further evaluation at the hospital. She did not have fever, chills, sweats, headaches, nausea, or vomiting. In addition, she denied having ocular pain, discharge, or visual compromise. She was admitted to the Osler Medical Service.