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Teoh RJJ, Ain Masnon N, Bahari NA, Ch'ng LS. Acquired proptosis and progressive abducens nerve palsy due to overpacked coiling material: rare sequelae of endovascular treatment for carotid cavernous fistula. BMJ Case Rep 2023; 16:e255406. [PMID: 37816571 PMCID: PMC10565337 DOI: 10.1136/bcr-2023-255406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Affiliation(s)
| | - Nurul Ain Masnon
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nor Akmal Bahari
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Li Shyan Ch'ng
- Department of Radiology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Department of Radiology, Faculty of Medicine, UiTM Sungai Buloh, Selangor, Malaysia
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Steinberg JA, Brandel MG, Wali AR, Mahata S, Rennert RC, Santiago Dieppa DR, Pannell JS, Khalessi AA, Olson SE. Direct Transorbital Approach for Treatment of Carotid Cavernous Fistula: An Illustrative Case Series. Oper Neurosurg (Hagerstown) 2023; 25:324-333. [PMID: 37345917 DOI: 10.1227/ons.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/03/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Endovascular techniques have become the first-line treatment for carotid-cavernous fistulas (CCFs). Direct transorbital venous access may be used if anatomic constraints limit standard transarterial or transvenous access. We describe our institutional experience with the transorbital approach for Barrow Type A-D CCFs. METHODS Patients with CCFs undergoing transorbital endovascular treatment at our institution between 2017 and 2019 were retrospectively reviewed. Demographic, treatment, and outcome data were collected. RESULTS Eight patients met inclusion criteria, 4 female and 4 male patients. The mean age was 43 years, with 6 right-sided CCF and 2 left-sided CCFs. Symptoms were present for an average of 1.5 months before treatment. All patients presented with eye pain and subjective visual changes. Seven (87.5%) patients presented with proptosis, 6 (75%) patients had elevated intraocular pressure (IOP), and 3 (37.5%) patients had ophthalmoplegia. Six CCFs (75%) were spontaneous, and 2 CCFs (25%) were traumatic. Barrow types were A (n = 1), B (n = 1), C (n = 1), and D (n = 5). All patients underwent direct percutaneous transorbital embolization with coils followed by Onyx. Three patients had undergone prior transarterial and/or transvenous treatment. A radiographic cure was obtained in all patients after direct transorbital embolization. After CCF cure, cranial nerve palsies resolved in 66.7% of patients, visual acuity in the affected eye was improved or stable in 75% of patients, and IOP had normalized in 85.7% of patients. Proptosis improved in all patients, with complete resolution in 75%. CONCLUSION Direct transorbital embolization is a safe and potentially curative treatment for all 4 Barrow types of CCFs.
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Affiliation(s)
- Jeffrey A Steinberg
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Michael G Brandel
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Sumana Mahata
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | | | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Alexander A Khalessi
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Scott E Olson
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
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Lai YF, Lee LC, Chen YH, Chien KH. "Pulsating proptosis and heavy eye syndrome precipitated by neurofibromatosis type 1: A case report". Medicine (Baltimore) 2021; 100:e27575. [PMID: 34678901 PMCID: PMC8542118 DOI: 10.1097/md.0000000000027575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Neurofibromatosis type 1 (NF1) is a hereditary disease characterized by café-au-lait spots, peripheral neurofibromas, Lisch nodules, optic nerve glioma, and sphenoid wing dysplasia. Pulsating proptosis is associated with a sphenoid bony defect. Heavy eye syndrome is characterized by acquired esohypotropia in patients with high myopia. This study aimed to describe the presentation of pulsating proptosis and heavy eye syndrome precipitated by NF1 and its management. PATIENT CONCERNS A 41-year-old woman presented with progressive pulsating proptosis and hypodeviation of the right eye over the past 2 years. The axial length of the right eye was 36.81 mm. The right eye presented with esohypotropia and hypoglobus. The ocular motility examination showed limitations in all directions, especially in supraduction. Brain computed tomography revealed sphenoid wing dysplasia of the right orbit. The meningocele protruded through the orbital defect, lifting the globe. Brain magnetic resonance imaging demonstrated superior rectus muscle (SR) medial displacement and lateral rectus muscle inferior displacement. Physical examination revealed café-au-lait macules and neurofibromas on the trunk. DIAGNOSIS NF1 with pulsating proptosis and heavy eye syndrome. INTERVENTIONS The patient declined neurosurgery due to risk and economic reasons. To manage her main concern regarding cosmetics, we performed orbital floor decompression, SR resection with advancement, maximal hang-back recession of the inferior rectus muscle, and a partial Jensen's procedure. OUTCOMES Proptosis was reduced. The eye position became more symmetrical. The range of eye movements was also increased. LESSONS This case describes a rare synchronous presentation of pulsating proptosis and heavy eye syndrome precipitated by NF1. Adult-onset presentation implied a progressive process in NF1. The case also showed a different etiology from that of typical heavy eye syndrome. It reminds ophthalmologists that orbital imaging should be performed in high myopia patients with strabismus to evaluate the extraocular muscle pathway. Furthermore, the case demonstrated a management that avoided the risk and expensive cost of neurosurgery, which has not been reported.
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Meling TR, Steffen H. [Cavernous hemangioma of the orbit: diagnosis and management]. Rev Med Suisse 2020; 16:2135-2139. [PMID: 33146966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The cavernous hemangioma (or angioma) of the orbit (HCO) is a benign, encapsulated venous malformation and the most common primary lesion of the orbit in adults. It occurs more often in women. These lesions can cause a unilateral proptosis (exophthalmos), optic nerve damage and other signs of orbital pathology, with varying degrees of visual impairment.When an HCO is suspected, ultrasound, scanner or magnetic resonance imaging (MRI) are a valuable aid to its definitive diagnosis. When HCO is symptomatic, multidisciplinary surgical management by a trained specialist in orbital surgery should be considered.This article aims to present the surgical management of HCO. Topographic classifications and surgical approaches are also discussed.
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Affiliation(s)
| | - Heimo Steffen
- Service d'ophtalmologie, Département des neurosciences cliniques, HUG, 1211 Genève 14
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Goin P, Charpentier H, Delattre M, Delbosc B, Gauthier AS. [Acute angle closure attack secondary to a cavernous sinus dural fistula]. J Fr Ophtalmol 2020; 43:e393-e396. [PMID: 33071006 DOI: 10.1016/j.jfo.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 11/18/2022]
Affiliation(s)
- P Goin
- CHU de Besançon, Besançon, France.
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Henderson SE, Boylan SM. Trauma-induced exophthalmia in vermilion snapper, Rhomboplites aurorubens (Cuvier 1829): Treatment and prevention. J Fish Dis 2020; 43:295-300. [PMID: 31752047 DOI: 10.1111/jfd.13117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
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Wang GA, Ning RX. [Acupoint selection rules of hyperthyroidism and related exophthalmos treated with acupuncture]. Zhongguo Zhen Jiu 2019; 39:667-672. [PMID: 31190507 DOI: 10.13703/j.0255-2930.2019.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To explore the clinical acupoint selection rules for hyperthyroidism and related exophthalmos treated with acupuncture. By taking "hyperthyroidism" "acupuncture and moxibustion" as keywords,literature regarding acupuncture for hyperthyroidism and related exophthalmos published was collected in the Chinese Journal Full-text Database (CNKI), VIP Database (VIP) and WANFANG database. The literature was organized, the database of acupuncture prescription was established and the characteristics and rules of acupoint selection were analyzed. A total of 46 papers were included, involving 89 acupoints, the frequency of acupoint application was 449 times. The most commonly used 6 acupoints for hyperthyroidism treated with acupuncture were Sanyinjiao (SP 6), Neiguan (PC 6), Zusanli (ST 36), Shuitu (ST 10), Hegu (LI 4), Taichong (LR 3). And the most meridians of acupoints were the stomach meridian and the pericardium meridian. The most commonly used 6 acupoints for hyperthyroidism related exophthalmos treated with acupuncture were Fengchi (GB 20), Shangtianzhu (Extra), Hegu (LI 4), Sanyinjiao (SP 6), Cuanzhu (BL 2), Yangbai (GB 14). And the most meridian of acupoints was the gallbladder meridian. The most commonly used specific acupoints for hyperthyroidism treated with acupuncture were crossing points, yuan-source points and five-shu points. The most commonly used specific acupoints for hyperthyroidism related exophthalmos treated with acupuncture were crossing points, yuan-source points and five-shu points. Acupuncture masters in modern times have achieved significant therapeutic effect in the treatment of hyperthyroidism,which has showed the principles of searching for the primary cause of disease in treatment and giving consideration to both the root cause and symptoms. But there is a lack of simple and effective treatment methods that can be rapidly promoted in clinical practice.
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Affiliation(s)
- Guang-An Wang
- Third Affiliated Hospital of Henan University of CM, Zhengzhou 450008, China
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Bouladi M, Bouraoui R, Zerei N, Dhouib N, Limaiem R, Mghaieth F, El Matri L. Association of carotido-cavernous fistula and controlateral optic neuropathy secondary to cranial trauma. Tunis Med 2019; 97:145-148. [PMID: 31535707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE to report a case of a woman who had a severe cranial trauma complicated by two ophalmologic potentially cecitating complications: right carotido-cavernous fistula and left traumatic optic neuropathy. OBSERVATION A 56 years-old woman, without any medical history, referred, one month after fall from a height of 3 meters, for right exophthalmos. Ophthalmic examination of the right eye completed by retinal angiography suspected carotid-cavernous fistula which was confirmed by angio-MRI. In the left eye, the visual acuity was decreased to no light perception and fundus examination showed optic nerve head palor secondary to traumatic optic neuropathy. Arterial embolization was performed and allowed closing of the fistula. CONCLUSION Optic neuropathy and carotido-cavernous fistula are two severe complications that can occur simultaneously in the same patient. The prognosis of the optic neuropathy may be compromised, and the treatment of carotido-cavernous fistula benefited from progress in interventional neuro-radiology.
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Abstract
Purpose To evaluate eye signs, proptosis and ocular movements in patients with endocrine ophthalmopathy under the influence of pulsed electromagnetic field therapy. Methods We examined 14 patients (9 women, 5 men) with endocrine ophthalmopathy and evaluated eye signs, proptosis and ocular movements before and after the course of pulsed electromagnetic field therapy, and 12 controls. Their age ranged from 29 to 57 years. Visual sensitivity was investigated with a static automatic perimeter (Allergan Humphrey Field Analyzer). The score was calculated by rating the severity of involvement of soft tissue, proptosis, extraocular movements, corneal state and optic nerve function on a scale from 0 to 3. The pulsed electromagnetic field procedures were carried out with the help of electromagnetic spectacles. Results Pulsed electromagnetic field therapy reduced the score for soft tissue and proptosis in patients who suffered from endocrine ophthalmopathy. There was fall in the mean score for ocular movements, corneal and optic nerve function but it did not reach significance after treatment. Electromagnetic field therapy has no useful effect on visual signs and eye movements in two patients who had had the illness more than two years. Conclusions Localised pulsed electromagnetic field procedures can be recommended, together with other methods of conservative treatment of endocrine ophthalmopathy.
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Affiliation(s)
- J Jankauskiene
- Department of Ophthalmology, Kaunas Medical Academy, Lithuania
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10
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Stanzel S, Gyürüs P, Kresnik E, Aigner R. A rare case of Marine-Lenhart syndrome with unilateral endocrine orbitopathy and Hürthle cell carcinoma. Nuklearmedizin 2017; 56:N28-N30. [PMID: 28488725 DOI: 10.3413/nukmed-0862-16-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/07/2017] [Indexed: 11/20/2022]
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Rath EZ, Rumelt S. [COEXISTENCE OF ORBITAL VARICOSE VEIN AND THYROID ORBITOPATHY]. Harefuah 2016; 155:302-321. [PMID: 27526560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To describe a thyroid orbitopathy patient who had asymmetric progression of exophthalmos due to orbital varicose vein. PATIENT A 55-year-old patient with thyroid orbitopathy had asymmetric progression of exophthalmos without complaints over 4 years of follow-up. RESULTS In repeated computerized tomography (CT) of the orbit, a dilation of the superior ophthalmic vein was noted on the more proptotic eye, in addition to bilateral excessive orbital fat. This finding was also confirmed on color Doppler imaging in valsalva manoeuver. CONCLUSIONS In patients with thyroid orbitopathy who have atypical progression course of their exophthalmos, repeated orbital CT scan is advocated to rule out other concurrent orbital disorders such as varicose veins.
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Promelle V, Bennai D, Drimbea A, Milazzo S, Bremond-Gignac D. Cellulites orbitaires atypiques d’origine non sinusienne de l’enfant : à propos de quatre cas. J Fr Ophtalmol 2014; 37:149-54. [PMID: 24239218 DOI: 10.1016/j.jfo.2013.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/26/2013] [Accepted: 08/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- V Promelle
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France.
| | - D Bennai
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
| | - A Drimbea
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
| | - S Milazzo
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
| | - D Bremond-Gignac
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
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Rougeot A, Barnoud R, Ferri J, Béziat JL. [Solitary fibrous tumor of the orbit: Possibly recurrent in the long-run]. ACTA ACUST UNITED AC 2013; 114:366-71. [PMID: 23871565 DOI: 10.1016/j.revsto.2013.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 01/27/2013] [Accepted: 05/16/2013] [Indexed: 11/19/2022]
Abstract
Solitary fibrous tumor (SFT) is a rare etiology of progressive unilateral exophthalmia. The tumor is of mesenchymal origin and it is usually well defined. But recurrences can occur despite of complete surgical resection. Metastases have been observed. Tumors of the SFT spectrum are considered as benign or low-grade malignant. Histological features do not currently allow any prognosis. The most important prognostic factor is complete surgical resection. Craniofacial approaches provide a good view of the tumor extensions and orbital contents. Recurrent tumors must be surgically removed when possible. Complementary treatments have not proved effective. A very long-term follow-up is mandatory.
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Affiliation(s)
- A Rougeot
- Département universitaire de chirurgie maxillo-faciale et stomatologie, hôpital Roger-Salengro, CHRU de Lille, boulevard du Professeur-Émile-Laine, 59037 Lille cedex, France.
| | - R Barnoud
- Service d'anatomie et de cytologie pathologiques, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - J Ferri
- Département universitaire de chirurgie maxillo-faciale et stomatologie, hôpital Roger-Salengro, CHRU de Lille, boulevard du Professeur-Émile-Laine, 59037 Lille cedex, France
| | - J-L Béziat
- Service de chirurgie maxillo-faciale, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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Shahar J, Leibovitch I, Amit S, Zitser J, Neuderfer M, Landsberg R. [Proptosis and ophthalmoplegia after cataract surgery]. Harefuah 2013; 152:292-308. [PMID: 23885454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report a case of a 57 years old female presenting with proptosis, periorbital swelling and ophthalmoplegia, 4 days after an uneventful phacoemucification surgery. Visual acuity was 20/200, biomicroscopy showed mild corneal edema and anterior chamber cells with normal posterior segment. The patient was febrile with leukocytosis and elevated Levels of C-reactive protein. A head computed tomography venography scan showed left eye proptosis, bilateral paranasal sinus hyper-density with massive sinus vein thrombosis extending from the left ophthalmic vein to the left cavernous, transversal and sigmoidal sinuses, the right cavernous and sigmoidal sinuses and internal jugular veins bilaterally. Very mild infiltration was seen around the Left ophthalmic vein, with no other signs of orbital inflammation. Emergency endoscopic sinus surgery was performed followed by anticoagulation and antibiotic treatment, blood and sinus culture later grew streptococci. The therapeutic measures resulted in complete resolution of the ocular and systemic findings.
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Affiliation(s)
- Jonathan Shahar
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv Israel.
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Sood V, Rejali D, Stocker J, Pagliarini S, Ahluwalia H, Mehta P. A case report of orbital haemorrhage associated with endoscopic sinus surgery and reversible sight loss: a multidisciplinary approach to management. Orbit 2013; 32:73-75. [PMID: 23387463 DOI: 10.3109/01676830.2012.747214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report a case of intraoperative orbital haemorrhage as a complication of endoscopic sinus surgery performed under general anaesthesia. Initial unilateral complete visual loss occurred, but recovered due to accurate and early diagnosis combined with urgent surgical intervention. This patient's case is reported to illustrate the importance of early recognition of clinical signs and how a stepwise approach to management can result in a favourable visual outcome. Moreover, the mechanisms and pathophysiology of visual loss due to orbital haemorrhage following endoscopic sinus surgery are discussed.
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Affiliation(s)
- Vaneeta Sood
- Department of Ophthalmology, University Hospitals, Coventry & Warwickshire NHS Trust, Coventry, United Kingdom.
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Kelly EW, Fitch MT. Recurrent spontaneous globe subluxation: a case report and review of manual reduction techniques. J Emerg Med 2012; 44:e17-20. [PMID: 22305152 DOI: 10.1016/j.jemermed.2011.06.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 04/28/2011] [Accepted: 06/05/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spontaneous globe subluxation is an uncommon problem that develops acutely and can present with significant patient distress from ocular pain and vision loss. OBJECTIVES To present an unusual case of recurrent spontaneous globe subluxation and describe several methods emergency physicians can use to reduce a subluxation. CASE REPORT We describe a patient with recurrent spontaneous globe subluxation who presented to the Emergency Department with acute ocular pain and vision loss. The subluxation was emergently reduced, resolving the pain and restoring normal vision. Various manual reduction techniques are discussed. CONCLUSION There are a number of manual reduction techniques used for treating spontaneous globe subluxation.
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Affiliation(s)
- Elizabeth W Kelly
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Xu WM, Guo YH, Chen BX. [Efficacy observation on infiltrative exophthalmos treated with acupuncture and acupoint massage]. Zhongguo Zhen Jiu 2011; 31:101-104. [PMID: 21442804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To observe the clinical efficacy of acupuncture combined with massage on infiltrative exophthalmos so as to provide a more effective treatment for infiltrative exophthalmos in hyperthyroidism. METHODS Forty-five cases of infiltrative exophthalmos were randomly divided into an acupuncture massage group (25 cases) and a western medicine group (20 cases). In acupuncture massage group, acupuncture was applied mainly at Jingming (BL 1), Qiuhou (EX-HN 7), Chengqi (ST 1) and Shangming (Extra); and massage was applied in combination on the back of the neck and the local points around the orbit. In western medicine group, Dexamethasone and Methotrexate were used for intravenous infusion, and Prednisone was for oral administration. The exophthalmos extent and clinical efficacy were compared between two groups. RESULTS Before and after the treatment, the exophthalmos extents were (20.27 +/- 1.22) mm and (18.11 +/- 0.87) mm in acupuncture massage group and were (20.34 +/- 1.20) mm and (19.47 +/- 1.11) mm in western medicine group separately, indicating remarkable improvement in two groups (both P < 0.01). The improvement in acupuncture massage group was superior remarkably to that in western medicine group (P < 0.01). The total effective rate (83.3%, 40/48) in acupuncture massage group was superior to that (53.8%, 21/39) in western medicine group, and with less adverse reaction. CONCLUSION Acupuncture combined with acupoint massage is an advanced therapy and has definite efficacy on infiltrative exophthalmos, which is superior to the conventional treatment in western medicine.
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Affiliation(s)
- Wei-Ming Xu
- Rehabilitation Department of Fujian Longhai Hospital of TCM, Longhai 363100, China.
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McCaffrey J, Rawlingson C. Multisystem langerhans cell histiocytosis with advanced orbital involvement: case report. East Afr Med J 2010; 87:430-432. [PMID: 23057277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease occurring most frequently in infancy or early childhood. The aetiology is still not completely understood, although some form of immunologic dysfunction has been implicated. Clinically, the disease may either be localised or present with multisystem involvement. Here we discuss the case of a seven year old boy presenting with advanced proptosis. To the best of our knowledge, proptosis of this extent has not been reported previously in association with LCH.
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Affiliation(s)
- J McCaffrey
- Department of Paediatrics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, UK, FY3 8NR
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Vasconcelos BCDE, Porto GG, Carneiro SCDAS. Post-trauma exophthalmos caused by a carotid-cavernous fistula. Braz J Otorhinolaryngol 2009. [PMID: 19893951 PMCID: PMC9442218 DOI: 10.1016/s1808-8694(15)30533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Valdes-Socin H, Niaourou V, Vandeva S, Bosquée L, Beckers A. [Paraneoplastic endocrine syndromes: diagnosis and management]. Rev Med Suisse 2009; 5:1668-1674. [PMID: 19772199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Paraneoplastic endocrine syndromes define a group of secondary signs and symptoms associated to a neoplasia, independently from the location of the primary tumor or its metastases. Paraneoplastic or ectopic endocrine syndromes usually result from aberrant hormone precursors or hormone-like substances by tumours. Knowledge of paraneoplastic endocrine complications is important both for the early diagnosis of neoplasia and the prognosis of the patient. In this review we discuss almost all reported paraneoplastic endocrine syndromes. We analyze their prevalence, etiology, laboratory diagnosis and treatment.
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Affiliation(s)
- H Valdes-Socin
- Service d'endocrinologie, CHU Sart Tilman, 4000 Liège, Belgique.
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Abstract
OBJECTIVES To familiarize rheumatologists and internists with the signs, symptoms, and management of orbital inflammatory disease (OID). METHODS A comprehensive literature review related to OID was performed and reported from the perspectives of rheumatology, ophthalmology, and radiology. RESULTS OID is a general term encompassing inflammatory diseases that affect some or all of the structures contained within the orbit external to the globe. Orbital involvement as a part of the initial symptom complex is not uncommon for systemic diseases such as Graves' disease, Wegener's granulomatosis, and sarcoidosis. The management of these and other causes of OID, such as idiopathic orbital inflammation (formerly known as "orbital pseudotumor"), orbital myositis, and Tolosa-Hunt syndrome frequently involves systemic immunosuppression. Before immunosuppression is considered, however, infectious and malignant causes of inflammation must be ruled out. DISCUSSION Rheumatologists should be familiar with the differential diagnosis of OID and often need to assist colleagues in ophthalmology and internal medicine with the management of this group of diseases.
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Affiliation(s)
- Joseph R Lutt
- Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
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22
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Sandhu M, Allen V, Krishnadev N, Detsky AS. In the eye of the storm. J Hosp Med 2007; 2:439-41. [PMID: 18081177 DOI: 10.1002/jhm.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manindar Sandhu
- Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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23
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Paza AO, Farah GJ, Passeri LA. Traumatic carotid cavernous fistula associated with a mandibular fracture. Int J Oral Maxillofac Surg 2007; 37:86-9. [PMID: 17822873 DOI: 10.1016/j.ijom.2007.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 05/04/2007] [Accepted: 06/14/2007] [Indexed: 10/22/2022]
Abstract
Carotid cavernous sinus fistula is an abnormal vascular interconnection between a branch of the carotid artery and the cavernous sinus. This is an uncommon complication of craniofacial injuries, as it occurs in only 0.17-0.27% of cases, according to the literature. The differential diagnosis should include superior orbital fissure syndrome, orbital apex syndrome, orbital haematoma and cavernous sinus thrombosis. The case is reported of an 18-year-old white woman who was involved in a motor vehicle accident. Clinical examination revealed only mandibular fractures, with the absence of skull-base, mid-face or any other fractures. Two days after the trauma, her condition deteriorated, and extraocular movements were totally absent. Magnetic resonance angiographic scanning was performed, and a carotid cavernous sinus fistula was found. This was treated by embolization resulting in restoration of eye movement and vision.
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Affiliation(s)
- A O Paza
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Campinas, São Paulo, Brazil
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24
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Abstract
BACKGROUND There can be many differences between the clinical presentation and disease development of endocrine orbitopathy. Uncommon clinical expressions of the disease may lead to misinterpretations causing difficulties in treatment. Misdiagnosed forms of the disease can end with irreversible vision loss. PATIENTS A 79-year old female with severe bilateral thyroid eye disease, progressive almost blinding visual loss, with the absence of exophthalmos is described. Second, a 39 year old female with a unilateral thyroid eye disease and relapsing episodes of the disease is reported. DISCUSSION Exophthalmos, as a symptom, occurs in about 60 % of the patients diagnosed with thyroid eye disease. The absence of exophthalmos may be due to a reduced volume (atrophy ) of retrobulbar fat tissue. Progressive visual loss can be related to direct compression of the optic nerve by thickened eye muscles in the orbital apex. Thyroid eye disease presents itself unilaterally in 5-11 % of all cases and involvement of the contra lateral orbit may occur years later. A relapse of the disease may be triggered by episodes of hypo- or hyperthyroidism. Smoking is a significant risk factor for orbitopathy relapse. CONCLUSIONS Physicians treating thyroid eye disease should be aware of atypical clinical presentations in order for early satisfactory treatment. An interdisciplinary approach including ophthalmologists, endocrinologists and oto-rhino-laryngologists is necessary for optimal management.
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Affiliation(s)
- T Breuer
- HNO-Klinik, Hals- und Gesichtschirurgie Kantonsspital St. Gallen.
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25
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Leibovitch I, Selva D, Goldberg RA, Sullivan TJ, Saeed P, Davis G, McCann JD, McNab A, Rootman J. Periocular and orbital amyloidosis: clinical characteristics, management, and outcome. Ophthalmology 2006; 113:1657-64. [PMID: 16828514 DOI: 10.1016/j.ophtha.2006.03.052] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 03/22/2006] [Accepted: 03/22/2006] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To present the clinical features and management outcome in a large series of patients with periocular and orbital amyloidosis. DESIGN Retrospective, noncomparative, interventional case series. PATIENTS All patients diagnosed with periocular and orbital amyloidosis in 6 oculoplastic and orbital units. METHODS Clinical records of all patients were reviewed. MAIN OUTCOME MEASURES Clinical presentation, radiological and histological findings, treatment modalities, and outcome. RESULTS The study included 24 patients (15 female, 9 male) with a mean age of 57+/-17 years. Nineteen cases were unilateral, and 5 were bilateral. Clinical signs and symptoms included a visible or palpable periocular mass or tissue infiltration (95.8%), ptosis (54.2%), periocular discomfort or pain (25%), proptosis or globe displacement (21%), limitations in ocular motility (16.7%), recurrent periocular subcutaneous hemorrhages (12.5%), and diplopia (8.3%). Seven cases had orbital involvement, and 17 were periocular. Immunohistochemistry in 7 patients showed B cells or plasma cells producing monoclonal immunoglobulin chains that were deposited as amyloid light chains. Only 1 patient was diagnosed with systemic amyloid light chain amyloidosis. Treatment modalities were mainly observation and surgical debulking. During a mean follow-up period of 39 months, 21% showed significant progression after treatment, whereas 79% were stable or showed no recurrence after treatment. CONCLUSION Periocular and orbital amyloidosis may present with a wide spectrum of clinical findings and result in significant ocular morbidity. Complete surgical excision is not feasible in many cases, and the goal of treatment is to preserve function and to prevent sight-threatening complications.
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Affiliation(s)
- Igal Leibovitch
- Oculoplastic & Orbital Division, Department of Ophthalmology & Visual Sciences, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
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26
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Shimura H, Endo T, Kobayashi T. [EMO syndrome]. Nihon Rinsho 2006; Suppl 1:311-5. [PMID: 16776152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Hiroki Shimura
- Third Department of Internal Medicine, University of Yamanashi
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27
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Masud MZ, Babar TF, Iqbal A, Khan MT, Khan MD. Proptosis: etiology and demographic patterns. J Coll Physicians Surg Pak 2006; 16:38-41. [PMID: 16441987 DOI: 12.2005/jcpsp.3841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 10/25/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the demographic pattern of patients presenting with proptosis and its etiology. DESIGN A cross-sectional descriptive study. PLACE AND DURATION OF STUDY Khyber Institute of Ophthalmic Medical Sciences (KIOMS), Hayatabad Medical Complex, Peshawar from July 2001- December 2002. PATIENTS AND METHODS Sixty cases of proptosis presenting at KIOMS were included. Thirtysix patients were male while 24 were female. They were divided into two age groups; 0-15 years (paediatric group) and above 15 years (adult group). An elaborate work up plan was formulated for all patients, which included detailed history, clinical examination (ocular, orbital and systemic), radiological and histopathological investigations. RESULTS Neoplasms (33%) were the most common causes of proptosis in all the patients followed by orbital inflammations (23%), orbital infections (20%), structural abnormalities (12%), vascular abnormalities (7%) and trauma (5%). CONCLUSION Neoplasms were the most common cause of proptosis in both paediatric and adult group. Proptosis was the cardinal feature and visual deterioration was present in more than half of the patients. Timely referral, early diagnosis and appropriate management can result in reduction of visual morbidity.
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28
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Abstract
A 14-year-old boy suffered right blunt orbital trauma. X-ray revealed a compressed fracture of the right ethmoidal sinuses. Three months after the trauma, progressive, painless right proptosis developed. Ocular examination revealed a severe proptosis and pronounced down displacement of the right globe without signs of orbital inflammation. A well-demarcated, extraconal right orbital cystic mass was seen on computerized tomography scan. The cyst contents were aspirated and found to contain echinococcal scolices and "hydatid sand." Hypertonic saline was injected and the cyst was excised. Progressive proptosis after blunt orbital trauma in patients from endemic areas should be suspected of being an orbital hydatid cyst.
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Affiliation(s)
- Valery Diatchuk
- Department of Ophthalmology, Western Galilee, Nahariya Medical Center, Nahariya, Israel
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29
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Konuk O, Pehlivanli Z, Yirmibesoglu E, Erkal HS, Erekul S, Unal M. Compressive optic neuropathy due to orbital metastasis of a sacral chordoma: case report. Ophthalmic Plast Reconstr Surg 2005; 21:245-7. [PMID: 15942507 DOI: 10.1097/01.iop.0000159175.89287.1f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 44-year-old man presented with unilateral proptosis and progressively deteriorating vision of his left eye over a 2-week period. He had a history of recurrent sacral chordoma for 1 year that had previously been treated with combined surgical excision, chemotherapy, and radiation therapy. MRI showed compression of the optic nerve by an orbital mass that proved to be an orbital metastasis of his sacral chordoma. The tumor mass was excised subtotally, and adjuvant orbital radiation therapy was administered.
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Affiliation(s)
- Onur Konuk
- Department of Ophthalmology, Gazi University Medical School, Ankara, Turkey.
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30
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Affiliation(s)
- J M Preece
- Peter Congdon Neonatal Unit, Clarendon Wing C floor, Leeds General Infirmary, LS2 9NS, UK.
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31
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Fung S, Selva D, Leibovitch I, Hsuan J, Crompton J. Ophthalmic manifestations of multiple myeloma. Ophthalmologica 2005; 219:43-8. [PMID: 15627827 DOI: 10.1159/000081782] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Accepted: 03/25/2004] [Indexed: 12/15/2022]
Abstract
PURPOSE To describe ophthalmic manifestations in a series of patients with multiple myeloma (MM) and review the literature. DESIGN Retrospective case series. METHODS Review of all cases with ophthalmic manifestations of MM seen at the Department of Ophthalmology, Royal Adelaide Hospital, between 1987 and 2002. RESULTS Of all patients with MM who were managed at the Royal Adelaide Hospital in the study period, only 8 were referred to the Ophthalmology Department with ophthalmic manifestations. Five males and 3 females with a mean age of 61.25 years (range 42-78) who exhibited ophthalmic manifestations were studied. Six patients (75%) had known MM at the time of their ophthalmic evaluation. Four patients (50%) had neuro-ophthalmic symptoms resulting in diplopia or visual disturbances. Three patients (37.5%) presented with orbital involvement and 1 (12.5%) with hyperviscosity retinopathy. Five patients (62.5%) died within 2 months of their ophthalmic presentation. CONCLUSION Ophthalmic manifestations of MM are uncommon and diverse. They may appear at the initial presentation of the disease or occur late in the disease process. Awareness of the possible manifestations may lead to an earlier diagnosis and have a positive influence on the disease course.
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Affiliation(s)
- Shirley Fung
- Oculoplastic and Orbital Unit, Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
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32
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Csiszar A, Rusu M, Albert A. [Exophthalmos--case report]. Oftalmologia 2005; 49:38-42. [PMID: 16245742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Exophthalmos is one of the most common clinical manifestations of an orbital abnormality. It usually results from a mass, a vascular abnormality, or an inflammatory process. We discuss the difficulty to obtain a correct diagnosis and the applied treatment in a clinical case, and at the same time we remark the importance of the close collaboration between the ophthalmologist and other specialists.
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33
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Zheng J, Zhang X, Gong R, Wang J, Tan T. [Therapy for Graves' ophthalmopathy]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2004; 21:876-9. [PMID: 15553880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Graves' ophthalmopathy (GO) is also called thyroid-related eye disease, infiltrative ophthalmopathy, which is related with the autoimmunity of thyroid, especially hyperthyroidism. Its morbidity ragnes from five percent to ten percent of hyperthyroidism, and the morbidity of male patients is higher than that of the female patients. The treatment of severe GO is a difficult task for doctors. The therapeutic effect is not always satisfactory. In order to solve this knotty problem, researchers have been devoting themselves to the development of new therapeutic methods. Here, the development of the therapies for GO is introduced, and the trends of treatments are prospected.
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Affiliation(s)
- Jianguo Zheng
- Department of Nuclear Medicine, Beijing Hospital, Beijing, 610041, China
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34
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He JF, Wu ZY, Yang HS, Yan JH, Mao YX, Chen ZC, Ai SM. [Clinical analysis of 339 cases of thyroid-associated ophthalmopathy]. Zhonghua Yan Ke Za Zhi 2004; 40:368-72. [PMID: 15312599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To summarize the clinical manifestation of thyroid-associated ophthalmopathy (TAO), to analyze the thyroid function and to monitor the therapeutic effect of anti-hyperthyroidism on the progression of TAO. METHODS Three hundred and thirty nine TAO cases (597 eyes) were collected from 1994 to 2001 and their clinical manifestations were summarize and analyzed. RESULTS TAO occurred mostly in individuals over 40 years with no gender preference. Exophthalmos and diplopia were the major manifestations and main reasons for ophthalmic examination. Retraction of eyelids and involvement of extraocular muscle were present in over 70% cases. In 339 TAO cases, euthyroidism was found in 93 cases and abnormal thyroid function (hyperthyroidism or hypothyroidism) was present in 246 cases. The V and VI grade of TAO occurred more frequently in patients with abnormal thyroid function than those with euthyroidism. (131)I, oral anti-hyperthyroidism drug, or thyroidectomy was used for all patients with abnormal thyroid function. TAO occurred in 39.3% cases treated with (131)I, in 15.6% cases with oral anti-hyperthyroidism drug, and in 14% cases with thyroidectomy. All ocular pathologic changes occurred after hyperthyroidism had been controlled and hypothyroidism was found in most of these cases. CONCLUSIONS The condition of thyroid function has a certain relationship to the severity of TAO. Over-fast and undue anti-hyperthyroidism therapy may impact an untoward effect on TAO; immediate and appropriate treatment can improve the effect of therapy on TAO.
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Affiliation(s)
- Jian-feng He
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
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35
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Abstract
PURPOSE To describe the clinical and morphologic features of patients with orbital xanthogranuloma (XG) with or without Erdheim-Chester disease (E-Cd). METHODS Retrospective, noncomparative case series. A review of 8 consecutive histopathologically proven cases of orbital XG from 3 medical centers. Four male and four female patients with ages ranging from 23 to 79 years presented with 4 bilateral and 4 unilateral orbital XGs. RESULTS Age at diagnosis, ocular and systemic manifestations, histopathologic and radiologic features, type of treatment, and prognosis were evaluated for each patient. Six of 8 patients had proptosis and 2 presented with afferent pupillary defect and severe extraocular motility limitations. Other signs and symptoms included eyelid retraction, mechanical ptosis, and chemosis. Planar xanthomas of eyelids were present in 3 individuals. CT and MRI showed infiltrating soft tissue masses within the orbit in 7 and 2 patients, respectively. Histopathology revealed proliferation of foamy histiocytes intermingled with Touton and multinucleated giant cells and lymphocytes. The absence of Birbeck granules within the histiocytic elements of the tumor, indicating that the cell of origin is a non-Langerhans histiocyte, was documented with electron microscopy in 3 cases. The most common treatment was surgical excision combined with oral corticosteroids. Two patients with E-Cd with involvement of the long bones of the upper and lower extremities and retroperitoneal region died of kidney failure within approximately 1 year of diagnosis. CONCLUSIONS Orbital XG is a proliferative lesion of the non-Langerhans histiocytes, which may present as a solitary orbital lesion or may be associated with a systemic condition known as E-Cd with very poor prognosis.
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Affiliation(s)
- Zeynel A Karcioglu
- Tulane University Health Sciences Center, Departments of Ophthalmology and Pathology, New Orleans, Louisiana, USA
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36
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Pérez Moreiras JV, Coloma Bockos JE, Prada Sánchez MC. [Thyroid orbitopathy (pathogenesis, diagnosis and treatment)]. Arch Soc Esp Oftalmol 2003; 78:407-31. [PMID: 12955622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE To review and to update the current diagnostic and therapeutic approaches and the pathogenesis of thyroid orbitopathy. To propose a practical, basic and precocious approach based in the knowledge of the disorder. METHODS Literature review and exposition of our experience in the management of thyroid orbitopathy. RESULTS Thyroid orbitopathy is an inflammatory orbital disease that probably has an autoimmune origin and most of the time is related to systemic disorders of the thyroid gland. The disease has a variable clinical presentation and it may cause severe damage in vision and orbital architecture, therefore, producing a decrease in the patient's quality of life and may also alter significantly the personal behavior. Pathogenesis of the disease is not yet fully understood, but it is widely held that there is a common autoantigen shared between the thyroid gland and the orbital adipogenic fibroblasts. Women are more likely to develop thyroid orbitopathy, and the disease is clearly affected by several factors such as smoking, age, sex and race. CONCLUSIONS Clinical knowledge is essential for the early diagnosis of this disorder, and it is the most important factor for the proper management of the disease. The medical treatment must be initiated promptly and should be aggressive and based in the current phase of the disease, in order to avoid the severe damage that follows thyroid orbitopathy. The surgical approach must be logical and sequential, but, on the other hand, must be rapid and aggressive in order to return the patient to his/her labour, social and familiar environment.
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Affiliation(s)
- J V Pérez Moreiras
- Instituto Internacional de Orbita y Oculoplástica, Santiago de Compostela, Spain
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37
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Srinivasan S, Gaskell A, McWhinnie H, McClure JP, Corrigan N. Conservative management of globe luxation associated with congenital orbital venous anomaly. J Pediatr Ophthalmol Strabismus 2003; 40:170-1. [PMID: 12795440 DOI: 10.3928/0191-3913-20030501-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sathish Srinivasan
- Department of Ophthalmology, Crosshouse Hospital, Kilmarnock, Scotland, United Kingdom
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38
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Ramschak-Schwarzer S, Langmann A, Lindner S, Prettenhofer U, Moncayo R, Baldissera I, Lind P, Ettl A, Maschek W, Pichler R, Weissel M, Leb G. [Diagnosis and therapy of Graves' ophthalmopathy--consensus guidelines]. Acta Med Austriaca 2002; 29:117-9. [PMID: 12424935 DOI: 10.1046/j.1563-2571.2002.02021.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
On 22-09-2001 the VIth Grazer Hormonsymposion took place. Diagnosis and therapy of Graves' Ophthalmopathy was discussed in an interdisciplinary way by endocrinologists, surgeons and ophthalmologists. The results of the round-table discussion and the consensus talk are presented.
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Affiliation(s)
- Sigrid Ramschak-Schwarzer
- Klinische Abteilung für Endokrinologie und Nuklearmedizin, Medizinische Universitätsklinik, Auenbruggerplatz 15, A-8035 Graz.
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39
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Grevers G, Klemens A. [Complications of rhinosinusitis]. MMW Fortschr Med 2002; 144:36-8. [PMID: 12494596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Rhinogenous complications may manifest in the region of the orbits, bone or soft parts of the wall of the frontal sinus, or endocranially. With regard to orbital complications, a differentiation is made between edema, periostitis, subperiosteal abscess and phlegmon--depending on severity and extent. A possible sequela of frontal sinusitis may be osteomyelitis. If the frontal bone is involved, there is a danger that the infection may spread to the endocranium via medullary spaces and blood vessels. The diagnostic basis for deciding appropriate treatment is CT or MRI. While orbital edema and periostitis usually respond to conservative treatment, subperiosteal abscess, orbital phlegmon and abscess of the brain require immediate operative treatment under antibiotic cover. The treatment of choice for osteomyelitis of the frontal bone is the liberal removal of affected bone, also under antibiotic cover.
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Affiliation(s)
- G Grevers
- HNO-Klinik, Klinikum Starnberg GmbH.
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40
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Abstract
PURPOSE To report a case of localized orbital Castleman's disease of mixed cell type with a follow-up of 20 years. METHODS A female patient presented at the age of 12 years with constitutional symptoms and left-sided proptosis. Laboratory tests revealed marked hypergammaglobulinaemia and high erythrocyte sedimentation rate (ESR), suggesting an immunological disturbance. A CT scan and MRI showed an infiltrating orbital mass lateral to and behind the eye. RESULTS Histological examination of orbital biopsies showed a lymphoid lesion consistent with Castleman's disease of the mixed cell type. The patient was treated with systemic steroids, immunosuppressives and irradiation. She is now 33 years old and has been without relapse for the last 7 years. CONCLUSION Orbital involvement in Castleman's disease is very rare. The clinical course, good prognosis and histological picture of the present case favour the diagnosis of localized Castleman's disease of mixed cell type. The successful medical treatment suggests that such a regime may substitute for surgery when the latter proves difficult.
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41
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Brun V, Lafitte F, Hamedani M, Héran F, Koskas P, Bergès O, Chiras J, Piekarski JD. [How to investigate a patient with exophthalmos?]. J Neuroradiol 2002; 29:161-72. [PMID: 12447139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Exophthalmos is the main symptom revealing orbital masses. This sign needs to be imaged mainly by MRI and/or CT. As Graves disease is the main etiology of exophthalmos, CT scan should be performed as the initial imaging modality. Indications for US and Doppler are mostly limited to the study of ocular masses, and eventually may help the characterization of extra-ocular lesions. In all cases, imaging is useful to characterize: the precise location of the lesion which can be the intra-conal space (including muscles), the extra-conal space (associated or not to an extra-orbital lesion), or the eyeball; the features of the lesion (density, signal, enhancement.). These findings are used to generate a differential diagnosis. Imaging is also useful to precise the extension of the mass, and in some cases to select the appropriate surgical approach, and for follow-up.
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Affiliation(s)
- V Brun
- Service de radiologie, fondation ophtalmologique A. de Rothschild, 25-29, rue Manin, 75019 Paris, France
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42
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Kolasa P, Kaurzel Z. [Post-traumatic pulsating exophthalmus coexisting with congenital carotid-cavernous fistula]. Neurol Neurochir Pol 2002; 35 Suppl 5:58-63. [PMID: 11935683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Pulsating exophthalmus develops most frequently in the course of penetrating or bitemporal head trauma. Idiopathic form is even more rare. Orbit venous system over-loading with pathological arterial blood infiltration is the cause of pulsating exophthalmus. A patient with congenital carotid-cavernous fistula (right eyeball enlargement and noise), suffering from head trauma after road accident has been presented. Carotid-cavernous fistula was diagnosed and than treated casually by endovascular closure of the infiltration between internal carotid artery and cavernous sinus. After 5-month treatment regression of the noise and exophthalmus was observed.
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Affiliation(s)
- P Kolasa
- Oddziału Neurochirurgii, Wojewódzkiego Szpitala Specjalistycznego im. M. Kopernika w Łodzi
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43
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Ramschak-Schwarzer S, Lindner S, Langmann A, Prettenhofer U, Stammberger H, Leb G. [Treatment results in 25 patients with Graves' ophthalmopathy between 1998 and 2001]. Acta Med Austriaca 2002; 28:102-4. [PMID: 11593891 DOI: 10.1046/j.1563-2571.2001.01025.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In our outpatient clinic 25 patients with Graves' ophthalmopathy were treated, 21 women, mean age 58.8 years (range 19-74 years) and 4 men, mean age 47.5 years (range 38-56 years). In the female group two showed euthyroid Graves' ophthalmopathy and one Hashimoto's disease; in the male group one showed euthyroid ophthalmopathy. Treatment was done depending on the findings of the NOSPECS-classification in identical way for each group. Final results were obtained three and six months after therapy, at that time all patients were euthyroid. In five patients (two men and three women) sicca-treatment was sufficient because the ophthalmopathy improved by therapy of the thyroid disease only. Three women were treated by oral steroids over three months and had a complete remission. Nine women were treated by oral steroids and external radiation, six of them showed major improvement but in one case orbital decompression had to be done. Somatostatin therapy was done over six months in six women who showed no change after oral steroids plus radiation. Out of them five showed major improvement but in spite of a positive octreoscan in one case orbital surgery had to be performed. Two men were treated by oral steroids and external radiation without change of disease, somatostatin therapy was not done because of a negative octreoscan. With the exception of one nonsmoking woman in whom orbital surgery had to be done, the treatment results were worse in smokers.
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Affiliation(s)
- S Ramschak-Schwarzer
- Klinische Abteilung für Endokrinologie und Nuklearmedizin, Medizinische Universitätsklinik, Auenbruggerplatz 15, A-8036 Graz.
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Denislam D, Constantin F. [Exophthalmia]. Oftalmologia 2001; 50:13-6. [PMID: 11392822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The authors present the association of signs and symptoms in exophthalmos syndrome, which occurs in many diseases. Although exophthalmos was considered to be of ophthalmological interest, according as researches were made on its pathogeny and according as investigation methods were developed, exophthalmos is no more considered a symptom, but a syndrome. After defining the syndrome, the present study shows its classifications, clinical and complementary investigations, and its treatments.
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Affiliation(s)
- D Denislam
- Clinica de Oftalmologie, Spitalul Municipal Constanţa
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Affiliation(s)
- T J McKenna
- Department of Endocrinology and Diabetes Mellitus, St Vincent's University Hospital, Dublin 4 and University College Dublin Registrar, Royal College of Physicians of Ireland, Dublin, Ireland.
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Prophet H, Matic GB, Winkler RE, Tiess M, Schneidewind JM, Hebestreit G, Michelsen A, Ramlow W. Two Cases of Refractory Endocrine Ophthalmopathy Successfully Treated with Extracorporeal Immunoadsorption. Ther Apher Dial 2001; 5:142-6. [PMID: 11354299 DOI: 10.1046/j.1526-0968.2001.005002142.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endocrine ophthalmopathy (EO) is a severe disease entity that is characterized by retrobulbar swelling due to accumulation of glycosaminoglycans on an autoimmune basis. This disorder can lead to the loss of vision and often is resistant to conventional therapy. There is a relation to Graves' hyperthyroidism, but probably no close association. Two patients with severe EO that was resistant to usual therapeutic approaches including steroids and radiological and surgical measures underwent a 20 session course of intensive immunoadsorption therapy (Plasmaselect/Therasorb Anti-IgG) with a mean 2- to 3-fold plasma volume treated. After the first sessions, both patients voiced an impressive relief of their major symptoms, which was confirmed by ophthalmological investigation. Throughout the time of therapy until present, these patients have remained at their respective levels of improvement. We consider immunoadsorption an effective therapeutic opportunity in severe EO resistant to conventional treatment.
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Affiliation(s)
- H Prophet
- Dialyse-Gemeinschaft Nord e.V, Rostock, Germany
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Defuentes G, Mayaudon H, Bordier L, Fabre R, Dupuy O, Sarret D, Crépy P, Bauduceau B. [Means syndrome. 8 cases]. Presse Med 2001; 30:527-30. [PMID: 11317925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Euthyroid Graves' disease is defined as an ophthalmopathy without dysthyroidism. We report 8 cases in 6 women and 2 men with an average follow-up of 16 months after diagnosis. CASE REPORTS Unilateral ex-opythalmos was the first and most frequent sign. Ultrasonographic and immunological thyroid abnormalities were frequent but of questionable significance. Thyroid hormone levels continued to remain normal. The orbital CT-scan, used to screen for infra-clinical exophthalmos, evidenced focal or diffuse hypertrophy of the extraocular muscles and normal tendon insertions. More than 3 years after diagnosis, only one patient developed overt Graves' disease and clinical signs resolved spontaneously in one other. DISCUSSION In mild to moderate forms of euthyroid Grave's disease, therapeutic abstention is advisable. Corticosteroids and orbital radiotherapy are interesting options in functionally disabling forms. Decompressive surgery is rarely needed.
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Affiliation(s)
- G Defuentes
- Service d'Endocrinologie, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, F94160 Saint-Mandé
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Lavard L, Sehested A, Brock Jacobsen B, Muller J, Perrild H, Feldt-Rasmussen U, Parma J, Vassart G. Long-term follow-Up of an infant with thyrotoxicosis due to germline mutation of the TSH receptor gene (Met453Thr). Horm Res 2000; 51:43-6. [PMID: 10095169 DOI: 10.1159/000023312] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED A 18-year clinical follow-up period in a male patient with a germline TSH-R gene mutation (Met453Thr) is described. Nonautoimmune thyrotoxicosis was diagnosed at the age of 7 months. The patient had exophthalmus, failure to thrive, advanced bone age and no goiter. Long-term antithyroid drug treatment (ATD) was necessary during childhood. At the age of 7 years he developed a goiter. Subtotal thyroidectomy was performed at the age of 9 years, followed by repeated ablative radiotherapy at the age of 9.5-13 years due to a toxic multinodular goiter. After 13 years ATD could be discontinued and the patient was euthyroid until 16 years of age, where L-thyroxine substitution had to be started. The exophthalmus diminished, and had disappeared at the age of 18 years, when CT scan of the orbit was performed. CONCLUSION TSH-R mutation must be considered in early nonautoimmune thyrotoxicosis. A very aggressive treatment strategy is necessary.
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Affiliation(s)
- L Lavard
- Department of Pediatrics, Amager Hospital, Copenhagen, Denmark
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Abstract
OBJECTIVE To report the clinical and pathologic features of sarcomatous transformation of the skull with involvement of the orbit, in Paget's disease. DESIGN Interventional case report. PARTICIPANT An 83-year-old woman with Paget's disease who experienced progressive proptosis of the left eye. INTERVENTION Fine-needle aspiration biopsy of the orbital mass. RESULTS Cytologic examination revealed round to oval malignant cells with wispy cytoplasm, consistent with the diagnosis of sarcoma. The patient died shortly after institution of orbital radiation therapy and systemic steroid therapy. CONCLUSIONS Proptosis related to Paget's disease is uncommon, and only rarely is it a result of sarcomatous transformation. Sarcomatous transformation of the skull involving the orbit should be included in the differential diagnosis of progressive proptosis in patients with Paget's disease.
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Affiliation(s)
- S Goldberg
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Osmundson G, Giangiacomo J. Traumatic optic neuropathy in a newborn. J Ophthalmic Nurs Technol 2000; 19:198-9. [PMID: 11309997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- G Osmundson
- Ophthalmology Ltd, Sioux Falls, South Dakota, USA
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