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1.
Arq. bras. oftalmol ; 74(5): 374-376, set.-out. 2011. ilus
Article in English | LILACS | ID: lil-608414

ABSTRACT

Primary localized amyloidosis is rare in the orbit. We report the case of a 63-year-old woman that presented with bilateral proptosis and ophthalmoplegia. A computed tomography scan revealed an infiltrative amorphous and markedly calcified mass in both orbits while a magnetic resonance scan showed a heterogeneous hypointense signal on T2-weighted images. A biopsy was performed through an anterior orbitotomy. Microscopy revealed extracellular amorphous and eosinophilic hyaline material which stained pink with Congo red and displayed green birefringence on polarized microscopy, leading to a diagnosis of amyloidosis. The results of the systemic workup were completely normal. A two-year follow-up period without any treatment disclosed no worsening of the condition. While calcification of nonvascular orbital lesions has often been regarded as suggestive of malignant disease, our case is a reminder that it can also be a characteristic presenting sign of orbital amyloidosis.


Amiloidose primária e localizada na órbita é rara. Relatamos o caso de paciente do sexo feminino, 63 anos que se apresentou com proptose bilateral e oftalmoplegia. A tomografia computadorizada mostrou uma massa infiltrativa amorfa e calcificada em ambas as órbitas enquanto que a imagem por ressonância magnética mostrou imagem heterogênea hipointensa ponderada em T2. Uma biópsia foi realizada por orbitotomia anterior. A microscopia revelou um material extracelular amorfo, hialino e eosinofílico que corou com vermelho Congo e mostrou cor verde birrefringente à microscopia com luz polarizada, levando ao diagnóstico de amiloidose. O resultado da investigação sistêmica foi inteiramente negativo. Um período de seguimento de dois anos sem qualquer tratamento não evidenciou piora da condição. Enquanto que a presença de calcificação de lesão não vascular da órbita frequentemente é considerada sugestiva de doençamaligna, o nosso caso serve para lembrar que pode também ser um sinal característico de amiloidose orbitária.


Subject(s)
Female , Humans , Middle Aged , Amyloidosis/diagnosis , Calcinosis/diagnosis , Orbital Diseases/diagnosis , Amyloidosis/complications , Calcinosis/etiology , Diagnosis, Differential , Magnetic Resonance Imaging , Orbital Diseases/etiology , Tomography, X-Ray Computed
2.
Rev. Méd. Clín. Condes ; 21(6): 942-948, nov. 2010. ilus
Article in Spanish | LILACS | ID: biblio-999244

ABSTRACT

La enfermedad de Graves corresponde a un síndrome que comprende: bocio hipertiroídeo habitualmente, oftalmopatía asociada a la tiroides y dermatopatía. No se cuenta con estadísticas nacionales, sin embargo la mayoría de los estudios internacionales muestran una frecuencia mayor en la mujer. Desde el punto de vista del manejo quirúrgico de esta enfermedad, éste se basa en tres etapas fundamentales: descompresión orbitaria, cirugía de los músculos extraoculares y finalmente la cirugía de reposicionamiento palpebral, no todos los pacientes requieren estos tres tipos de tratamiento, pero en caso de necesitarlos esta debe ser la secuencia. La indicación quirúrgica dependerá de la fase en que se encuentre el paciente, idealmente deberá realizarse en la fase de inactividad de la enfermedad caracterizada por la ausencia de signología inflamatoria periocular. Este artículo está destinado a mostrar las alternativas quirúrgicas en el tratamiento de las complicaciones oculares de la Orbitopatía de Graves orientado principalmente hacia el exoftálmo y la patología palpebral


Graves' disease is a syndrome comprising usually hyperthyroid goiter, thyroid-associated ophthalmopathy and dermopathy. We do not have national statistics, however International studies show a grater frequency in females. Surgical management is based in three stages: orbital decompression, eye muscle surgery and finally eyelid repositioning, not every patient needs all of these surgical treatments, but in case they do need them this must be the sequence. Surgical indication will depend on the phase of the disease; ideally it will be performed in the phase of inactivity of the disease, which is characterized by the absence of periocular inflammatory signs. This article describes the surgical alternatives in the treatment of the ocular complications in the Graves' orbitopathy, oriented mainly towards exophthalmos and palpebral disease


Subject(s)
Humans , Male , Ophthalmologic Surgical Procedures , Exophthalmos/surgery , Graves Ophthalmopathy/complications , Eyelid Diseases/surgery , Exophthalmos/etiology , Decompression, Surgical , Blepharoplasty , Graves Ophthalmopathy/surgery , Eyelid Diseases/etiology , Eyelids/surgery
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