Case Of Orbital Involvement Research Articles

Orbital Involvement in Bing-Neel Syndrome

Bing-Neel syndrome (BNS) is defined as intracranial involvement of Waldenström macroglobulinemia (WM). Few cases of orbital involvement have been reported. A 51-year-old man with a history of WM developed bilateral orbitopathy and optic neuropathy. Orbital biopsy, cerebrospinal fluid studies, and neuroimaging confirmed the diagnosis of BNS involving the orbital soft tissues, optic nerves, meninges, and cauda equina. The neuro-ophthalmic manifestations resolved after parenteral and intrathecal chemotherapy in addition to autologous stem cell transplantation. The rare neuro-ophthalmic manifestations of BNS may require a multifaceted approach to therapy.

Dirofilariose sous-conjonctivale

Dirofilariasis is a disease rarely seen in humans, occurring commonly in noncarnivorous mammals. The microfilariae are transmitted by a mosquito vector. Ocular dirofilariasis is rarely described in the ophthalmic literature. An 81-year-old woman living in the north of France had a history of sudden pain and swelling of the left orbit. On slit lamp examination, a white worm was seen under the superior bulbar conjunctiva. Excision of the subconjunctival worm was adequate treatment and was important for parasite identification. Dirofilariasis is broad-based and is more common in Italy. Cases in France are found in the south. Ocular symptoms are frequently subconjunctival, but many cases of orbital involvement are found. Treatment is only surgical; systemic medication is not necessary. Ocular dirofilariasis is exceptional. Case reports in ophthalmic literature are rare. This parasite infection is probably underdiagnosed.

Left Eye Proptosis in an 11-Year-Old Child

Aneurysmal bone cysts (ABC) are uncommon non-neoplastic expansile lesions of the bone. They usually affect long bones and vertebrae in childhood and early adulthood. Skull involvement is quite rare. Only a few cases of orbital involvement were described in the literatures. We are presenting a case of ABC that affects the orbit causing proptosis and external ophthalmoplegia.An 11-year-old girl known to have a chronic seizure disorder and school performance difficulties presented with a four month history of rapidly progressing left orbital swelling and redness. This was associated with double vision, occasional throbbing headache and feelings of nausea. The patient and her family denied any history of trauma. Her past medical and family histories were otherwise non-contributory. Physical examination revealed a left eye proptosis with mild conjunctivitis (Figure 1). She had complete left external ophthalmoplegia with pupil sparing. The left orbit was non-tender with no detectable bruit. Visual acuity in both eyes was 20/20 (right) and 20/50 (left). Fundoscopic examination revealed mild papilledema in the left eye. The rest of the physical examination was essentially normal. Computerized tomography scan of the brain revealed a left fronto-orbital expansile bony lesion with multiple cystic compartments, distorting the left orbital roof (Figure 2). The lesion pushed the eye globe laterally and externally. Magnetic resonance imaging of the left orbit confirmed that the lesion was extradural, displacing rather than infiltrating the left frontal dura, causing mass effect on the left frontal lobe.Within the lesion, the cystic components exhibited fluid-fluid levels (Figure 3 a,b,c).

Langerhans Cell Histiocytosis of the Orbit: A Need for Interdisciplinary Dialogue

To explore specialty-related perceptions and treatment strategies in Langerhans cell histiocytosis (LCH) of the orbit. A perspective. We reviewed the reported ophthalmic experience with unifocal LCH of the orbit, analyzed current oncologic clinical trial protocols, and provided a brief summary of contemporary knowledge and theory of LCH pathogenesis. Ophthalmic literature indicates that unifocal LCH of the orbit is usually responsive to local intervention. Current international oncologic protocols identify orbital LCH as a "central nervous system-risk" lesion (at risk for delayed-onset diabetes insipidus) and mandate a 6-month course of chemotherapy. Analysis suggests that the latter strategy is based on cases of orbital involvement in multifocal and multisystem disease. The pathologic Langerhans cell continues to define and unite the LCH variants, but cytokine activation of that cell may be an earlier pathogenetic determinant. Despite a common cellular mediator, LCH may be a heterogeneous process, with severity related to varied "upstream" trigger events. Treatment perspectives in LCH are influenced by dissimilar patient encounters and varied interpretations of the basic disease process. Pending documentation of linkage between unifocal orbital LCH and diabetes insipidus, we recommend local intervention, with systemic treatment reserved for incomplete response or local reactivation or the appearance of lesions elsewhere. LCH underscores the need for close interaction between specialists with intersecting clinical interests.

Erdheim-Chester disease: Two cases of orbital involvement

Erdheim-Chester disease (ECD) is an increasingly recognised form of fibro-inflammatory process characterised by xanthomatous histiocytes containing large amounts of ingested lipid, plasma cells, macrophages and Touton-type giant cells. Ophthalmic involvement in ECD has been reported in only 22 cases. We describe two patients, one presenting with diabetes insipidus and subsequently developing orbital pseudotumours and retroperitoneal fibrosis, the other presenting with exophthalmos and diplopia. The first patient was treated with cladribine and subsequently developed sudden onset of bilateral blindness while the second required radiation therapy for the retro-orbital process and developed radiation retinopathy. These cases typify the variable presentation and course in patients with ECD.

Orbital Involvement in Waldenström’s Macroglobulinemia: Ultrasound, Computed Tomography and Magnetic Resonance Findings

A case of orbital involvement in Waldenström's macroglobulinemia is presented. Orbital echography, computed tomography (CT) and magnetic resonance imaging (MRI) were performed and revealed a retrobulbar mass of the right orbit. Ultrasonography suggested a lymphoid orbital tumor. A CT scan was nonspecific, but helpful in exactly locating the tumor and excluding bony lesions. Signal intensity patterns of MRI were characterized by a low intensity on T1- and T2-weighted images. A marked enhancement of the tumor was evident after intravenous injection of a paramagnetic contrast agent (gadolinium-DTPA). Although the definite diagnosis could only be established by means of an ultrasound-guided fine-needle aspiration biopsy, MRI in connection with the history of our patient strongly suggested a diagnosis of orbital lymphoma in Waldenström's disease.

ORBITAL CHANGES PRODUCED BY RADIUM IN CANCER OF THE UPPER JAW

It is now quite customary to supplement the operative treatment of cancer of the upper jaw by the application of radium. As a result of the radium application, definite changes may occur in the orbit and affect the eyeball. These changes, aside from deleterious action on the eyeball, suggest extension of the malignant growth, and the question then arises whether the orbit and its contents should be exenterated or not. It seemed, therefore, of importance to study the condition in the orbit which radium produces when applied in the treatment of tumors of the upper jaw, and to compare this with the neoplastic involvement of the orbit in the course of tumors of the upper jaw. The following five cases of orbital involvement after radium treatment present certain features which bear on this question. <h3>REPORT OF CASES</h3><h3>Case 1.</h3> —E. J. B., aged 61, had been operated on for carcinoma