‘A down and out eye’ - A case report of unilateral eccentric proptosis secondary to frontoethmoidal mucocele

Proptosis, the forward protrusion of the eyeball, is a common manifestation of a wide variety of diseases inside the orbit and its spaces. The causes of unilateral proptosis are innumerable and its evaluation requires a multidisciplinary approach. Paranasal sinus mucoceles are epithelium-lined cystic masses usually resulting from obstruction of sinus ostia. The close proximity of paranasal sinus mucoceles to the orbit and skull base predispose patients to significant morbidity. Primary ethmoid mucocele is an uncommon entity, especially in the absence of prior ear, nose and throat complaints, and therefore should remain an important differential when a patient presents with a unilateral swelling causing proptosis. Herein, we report an unusual case of a primary frontoethmoid mucocele in a 35 years old woman who presented with a painless swelling with an obvious displacement of the left eye since 1 year, associated with restriction of ocular movements, thus prompting radio imaging of orbits. The results showed a large well-defined expansile lesion suggestive of Left Eye frontoethmoidal mucocele, prompting an immediate surgical referral.

A rare case of acquired ptosis in a child secondary to Pituitary macroadenoma

Pituitary adenomas are rare neoplasms with a propensity for unusual presentations and an aggressive clinical course. An 8 years old female child presented to Department of Ophthalmology at SVS Medical College and Hospital Mahabubnagar with the chief complaints of mild ptosis of RE since 1month, associated with fever, headache, vomiting and diplopia since 2 days. On ocular examination, BCVA in BE - 6/9 and anterior segment examination suggested RE mild ptosis with hypotropia and adduction restriction. Fundus examination was normal. There was no palpable mass/ bruit in the orbit. MRI revealed lobulated enhancing soft tissue lesion in sella and parasellar region extending into basifrontal region causing pressure over optic chiasm, 3rd ventricle and cavernous sinuses suggestive of pituitary macroadenoma. Hormonal essays revealed elevated prolactin, beta HCG levels and abnormal thyroid profile. On the basis of clinical examination and investigations a clinical diagnosis of pituitary macroadenoma was made. Then the case was referred to department of neurosurgery where transphenoidal resection under GA was planned and after 2days of admission she had a respiratory arrest and could not be resuscitated.