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Exophthalmos and orbital floor thickening related to maxillary sinusitis.

A 59-year-old woman presented with periocular pain and 1.5 mm of relative proptosis. A computed tomography scan demonstrated thickening of the orbital floor, and an endoscopic sinusectomy revealed chronic sinusitis. Although cases of maxillary sinus disease with orbital floor thickening have been reported, these findings are in contrast to cases of silent sinus syndrome, in which maxillary sinus disease induces thinning and inferior displacement of the orbital floor with secondary enophthalmos and hypoglobus. Thus, while chronic maxillary sinus disease may create negative antral pressure and inferior displacement of the orbital floor, whether orbital floor thinning or thickening occurs varies with each case. The present case represents a combination of maxillary sinusitis with orbital floor thickening and exophthalmos, a less common manifestation of maxillary sinus-related orbitopathy.

Chronic Disease↗

Decompression of the orbit using a lateral rhinotomy approach in patients with malignant endocrine exophthalmos.

Malignant endocrine exophthalmos is a complication seen in 1-2% of patients treated for thyrotoxicosis. A variety of surgical techniques have been used to prevent loss of vision due to compression of the optic nerve. In this study, nine patients with rapidly diminishing vision were operated upon using a lateral rhinotomy technique creating the largest possible space for expansion into the nose and decompressing the optic nerve far back in the orbit. In all patients the vision was improved 1 year after surgery and the proptosis was decreased.

Adult↗

A case report: corpus callosum dysgenesis, microcephaly, infantile spasm, cleft lip-palate, exophthalmos and psychomotor retardation.

In this report, a case with corpus callosum dysgenesis, infantile spasm, microcephaly, psychomotor retardation, exophthalmos, cleft lip-palate and abnormal EEG findings is presented. His parents are first-degree relatives. We could not fully match the findings of our patient with the criteria of any syndrome published to date.

Agenesis of Corpus Callosum↗

Steroid induced exophthalmos. A case report.

A case of steroid induced exophthalmos in a patient with systemic lupus erythematosus with renal involvement is described. Computed Tomography was used to demonstrate the increased retro-orbital fat.

Adult↗

A case of Epstein-Barr virus infection with exophthalmos and ocular muscle swelling.

A 14-year-old girl with Epstein-Barr virus (EBV) infection developed exophthalmos and ocular muscle swelling. The EBV genome was detected in T lymphocytes taken from the submandibular gland, temporal muscle and cervical lymph nodes. A surface marker analysis of her peripheral blood demonstrated that CD45RO-positive T lymphocytes were strongly activated. Immunosuppressive treatment, including steroid and cyclophosphamide, was effective in improving the symptoms. Immunosuppressive therapy may be included as the choice of treatment for EBV infection.

Adolescent↗

Late recurrent basal cell carcinoma presenting as a unilateral exophthalmos.

A late recurrent basal cell carcinoma which presented as a unilateral exophthalmos is described. Published surgical protocols of the 1960's advocated deferring further treatment for incompletely excised cutaneous basal cell carcinoma unless there was clinical evidence of tumor recurrence. Our patient demonstrates that this approach may result in late, unusual, and fatal patterns of recurrence. Complete excision of primary basal cell carcinoma is advocated.

Aged↗

Computed tomography and magnetic resonance imaging of cavernous sinus enlargement in a dog with unilateral exophthalmos.

Computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed on a dog with a two year history of unilateral exophthalmos occurring two years following head trauma. On CT images, an expansile enhancing mass was present along the right intracranial cavernous sinus and extended through the orbital fissure into the retrobulbar space. With MRI, the structure appeared as a signal void due to the presence of rapidly flowing blood. Gadolinium enhancement of the adjacent brain was not present. A vascular origin of the lesion was confirmed with MRA. Based on the CT and MRI findings, the enlarged cavernous sinus and associated ophthalmic plexus were believed to represent an arterialized aneurysm, most likely the result of traumatic arteriovenous fistulization. Treatment consisted of surgical enucleation. At the time of this report, 29 months later, the dog remains free of clinical signs.

Animals↗

Exophthalmos due to a wooden foreign body in a dog.

An 8-year-old Golden Retriever dog was presented with a 10-month history of right-sided exophthalmos. Radiographs and CT demonstrated a linear density, suggestive of a foreign body, in the region of the ramus of the right mandible. A 7 cm stick, located medial to the right zygomatic arch, was removed during exploratory surgery. The dog recovered with the aid of antibiotics, however was left with a residual facial nerve paralysis.

Animals↗

Radiation therapy for exophthalmos: report of seven cases.

Five of 7 cases of exophthalmos showed improvement within three months with 2,000 rads of 6 MeV radiation. A new technique of X-ray beam localization employing a direct measurement 12 mm posterior to the anterior extent of the cornea was used and found more accurate than using a fixed point (external canthus). All cases should be treated bilaterally. Retreatment after radiation failure is not recommended. There were no complications. Improvement is usually rapid as orbital irradiation, not including the pituitary, causes rapid destruction of the massive collection of lymphocytes and a reduction in the bulky mass and edema of the orbit.

Exophthalmos↗

Unilateral exophthalmos associated with severe fibrous dysplasia.

Fibrous dysplasia is a benign developmental anomaly of bone, often affecting craniofacial bones. We report on a 9-year-old boy, who presented for routine checkup. Clinical examination revealed unilateral exophthalmos of his left eye without decrease of visual acuity or double vision. Radiologic studies showed characteristic extensive changes of fibrous dysplasia involving the left frontal bone, left orbital bones, maxillary and sphenoid bones. The patient was started on conservative therapy and the condition of the affected eye remained stable. As fibrous dysplasia of the orbital bones can be a cause of significant dysfunction and a treatable cause of blindness, early diagnosis is very important. These patients are most likely to present with complaints of facial asymmetry, including axial, vertical, or horizontal displacement of the globe, or visual loss. Therefore the ophthalmologist plays an important role in the early diagnosis of fibrous dysplasia.

Antineoplastic Agents↗

Cytoenzymology and 3H-thymidine uptake of retro-ocular connective tissue cultures in experimental endocrino-exophthalmos.

The in vitro retro-ocular connective tissue cultures from guinea pigs with endocrine exophthalmos were studied before and after retro-ocular treatment with cortisol and hyaluronidase. Both cortisol and hyaluronidase inhibited the cell proliferation, the cytoenzymic activities of oxydoreductases, the 3H-thymidine uptake, the number of mitoses and the protein content of cultivated cells.

Animals↗

Exophthalmos caused by an invasive pituitary adenoma in a child.

The authors present a case of exophthalmos caused by invasion from a hypophyseal tumour, rare both for this type of metastasis and for the patient's young age. Histological study of biopsy material enabled the tumour to be classified. Comparison of clinical and microscopic data helps towards a better understanding of the behaviour of invasive adenomas.

Adenoma, Chromophobe↗

Correlation between unilateral exophthalmos and thyroid diseases.

43 clinically euthyroid patients with unilateral exophthalmos were examined using clinical methods, echography, and computerized tomography. The functioning of the hypothalamic-hypophyseal-thyroid axis was investigated by measurements of TSH (before and after stimulation with TRH), thyroid hormones and antithyroglobulin antibodies. After a review of the literature, the results are discussed.

Adult↗

Increased urinary excretion of acidic mucopolysaccharides in exophthalmos.

The excretion of mucopolysaccharides normally found in urine (chondroitin, chondroitin sulfates A and C, keratosulfate, and heparitin sulfate) is increased approximately twofold in patients with progresive exophthalmos. A threefold elevation of total serum mucopolysaccharides is also found. These increases are unrelated to thyroid function.

Adult↗

Exophthalmos in autoimmune thyroid disease.

Protrusion of the eyes of patients with autoimmune thyroid disease was compared with that of healthy subjects. The mean values for protrusion in patients with thyrotoxic Graves' disease and Hashimoto's disease and in healthy subjects were 16.6 +/- 2.1 mm (mean +/- SD; n = 122), 14.2 +/- 1.8 mm (n = 100), and 13.9 +/- 1.9 mm (n = 558), respectively. The value of Graves' disease was significantly different from that for healthy subjects (P < 0.001). Individual values for protrusion showed a similar normal distribution in these three groups, but were displaced to higher values as a whole in Graves' disease. These results, which suggest that almost all patients with Graves' disease have exophthalmos, do not support the idea that Graves' ophthalmopathy is a distinct single autoimmune disease.

Autoimmune Diseases↗

Pleomorphic adenoma of the lacrimal gland manifesting as exophthalmos in adolescence--case report.

A 16-year-old girl presented with a pleomorphic adenoma of the lacrimal gland manifesting as left painless exophthalmos which had persisted for 3 years. Computed tomography revealed a tumor about 15 mm in diameter in the superolateral site of the left orbit. The tumor was removed completely by combined orbitofrontal craniotomy through a transcranial approach. Histological examination demonstrated the growth of tumor cells as glandular cavities or sheets, with myxoid and partly chondroid connective tissue stroma. Pleomorphic adenoma of the lacrimal gland is unusual in adolescents.

Adenoma, Pleomorphic↗

Exophthalmos caused by excessive fat: CT volumetric analysis and differential diagnosis.

CT has proven to be excellent in identifying orbital pathology responsible for proptosis. Occasionally, no discrete mass or extraocular muscle enlargement to explain the exophthalmos is found, only an appearance suggestive of an abnormal increase in orbital fat volume. Fifteen patients were studied with proptosis apparently resulting from increased orbital fat. Clinical follow-up revealed that four of them had Graves orbitopathy, unilateral in one; two had Cushing disease/syndrome; and nine were obese without endocrinopathy. The orbital volume and percentage orbital fat volume were measured by CT software analysis in these patients and in a control group of 16 patients without proptosis. Measurements of proptosis and thickness of the scalp fat pad at the inion level were also performed. Significantly greater values for orbital fat volume, percentage fat volume, and proptosis were found in the proptosis group compared with the control group. There was excellent correlation between proptosis and percentage fat volume, supporting the contention that increased orbital fat is responsible for the proptosis. The thickness of the scalp fat pad at the inion level was significantly greater in obese and Cushing patients than in control subjects, but the thickness was not significantly greater in Graves patients than in controls. Proptosis and inion fat were well correlated (r = 0.74) in the control and obese patients, which suggests a relation between general body fat and orbital fat volume.

Adipose Tissue↗