A patient with swelling of the eyelid: ancient schwannoma of the supraorbital nerve (2010:6b)

Unilateral orbital schwannoma arising from the supraorbital nerve: Report of a rare case

Schwannomas are rare tumors in the orbit, typically originating from various nerves and presenting diagnostic challenges. We present a unique case of a unilateral orbital schwannoma arising from the supraorbital nerve. A 55-year-old female presented with a painless, slowly growing mass in the right superior orbit, causing proptosis. Visual acuity remained unimpaired, and clinical examination revealed a well-defined mass in the superior orbit. A provisional diagnosis of an orbital dermoid or cyst was made, leading to excision biopsy. The histopathological examination confirmed a diagnosis of benign schwannoma. Schwannomas in the orbit, particularly those arising from the supraorbital nerve, are uncommon and often challenging to diagnose. Early surgical intervention is crucial to prevent complications associated with tumor growth. This case underscores the need to consider schwannomas as a differential diagnosis for slow-growing orbital masses in adults and emphasizes the importance of timely management to prevent vision-threatening complications.

A Case of Herpes Zoster Ophthalmicus With Multiple Delayed Ocular Complications

Herpes zoster ophthalmicus (HZO) presents a variety of ocular complications, most of which occur simultaneously as skin lesions. We report a case of HZO with delayed onset of multiple ocular complications. A 72-year-old man developed HZO, blepharitis, iritis, and conjunctivitis in the left eye, which resolved after topical ocular treatment and systemic acyclovir administration. However, six weeks after the first onset of the rash, the patient came to our hospital because of recurrent blepharitis, iritis, scleritis, conjunctivitis, eye pain, ptosis, and blurred vision in the left eye. Best corrected visual acuity (BCVA) in the left eye had decreased to hand motion, and the Goldmann visual field test showed only mild residual peripheral vision on the lateral side. Intraocular pressure showed 25 mmHg in the left eye and inflammation in the anterior chamber with paralytic mydriasis. Orbital magnetic resonance imaging (MRI) showed the contrast effects with the lacrimal gland, superior ophthalmic vein, supraorbital nerve, optic nerve, and around optic nerve sheath. The patient was diagnosed with optic neuritis, optic perineuritis, ptosis, paralytic mydriasis, trigeminal neuralgia, lacrimal gland inflammation, blepharitis, iritis, scleritis, and ocular hypertension after HZO, and three courses of steroid pulse therapy were administered. Thereafter, BCVA improved to 0.3 in the left eye, with improvement in central vision, and MRI lesions and other symptoms also improved. The patient has had no complications or recurrence of HZO. HZO can cause a variety of ocular complications. Since autoimmune mechanisms might be involved, combined immunotherapy should be considered.

Isolated eyelid Schwannoma: A rare differential diagnosis of lid tumor

Primary Schwannomas of the eyelid are extremely uncommon. It accounts for one percent of orbital tumors. We present a case of isolated eyelid Schwannoma in the lateral canthus of the left eye with no systemic diseases associated. Surgical excisional biopsy was done. In two years follow up, no recurrence or malignant conversion was detected.

An Unusual Differential Diagnosis of Orbital Cavernous Hemangioma: Ancient Schwannoma

Schwannomas are rare lesions of the orbit that can be confused with cavernous hemangioma on imaging studies. We report the case of an 84-year-old woman with a 9-year history of a tumoral lesion in the inferolateral left orbit. The imaging studies did not reveal specific characteristics, only bone remodeling due to the long evolution of the tumor. The patient underwent complete excision of the tumor by anterior orbitotomy via the inferior conjunctival fornix. The histopathological examination revealed an ancient schwannoma, a variant of schwannoma with uncommon histological features. The follow-up was uneventful. The present case emphasizes the importance of considering neural tumors in the differential diagnosis of orbital masses with bone changes and degenerative alterations such as hemorrhagic areas, cysts, and/or calcifications.

A bilobed schwannoma in roof of orbit: a rare case report

In this paper, we report a case of bilobed schwannoma, presented in the roof of orbit arising from supraorbital nerve. A 62-year male presented with a nontender mass in superior part of orbit and eccentric proptosis. Visual acuity and rest of ocular examination were normal. CT scan and MRI orbit revealed an extraconal homogenous bilobed mass, of size 3.5 to 2.5 cms in roof of orbit. Fine needle aspiration cytology was done, which was suggestive of schwannoma a peripheral nerve tumor. Successful surgical excision of intact bilobed schwannoma was done with careful separation and preservation of supraorbital nerve from which it was originated. Postoperative period was uneventful though rare, less than 1%, schwannoma can present as painless mass in the orbit and proptosis. Treatment of choice is surgical excision of intact tumor to prevent recurrence and preservation of peripheral nerve from which it arises.