True Pseudotumors and “Pseudo” – Pseudotumors: A Case Series

Objective@#To characterize the clinical and pathological features of 4 patients with histopathology-confirmed idiopathic orbital inflammatory disease (OID) initially diagnosed as an orbital neoplasm and 9 patients with histopathology-confirmed orbital neoplasm that presented as idiopathic OID.@*Methods@#The medical records of 13 patients with orbital mass were reviewed. All biopsies were performed by one orbit surgeon.@*Results@#There were 4 patients in the histopathology-confirmed idiopathic OID group with preoperative diagnosis of orbital neoplasm. Mean age at presentation was 27 years. Follow-up period ranged from 6 to 41 months. The left orbit was predominantly involved (3/4). The presenting symptoms and signs included proptosis (2/4), diplopia (1/4), and inflammation (1/4). The preoperative best-corrected decimal acuity mean was 0.92. Three of 4 patients retained their preoperative visual acuity postoperatively. There was recurrence of inflammatory signs in only 1 patient, which responded well to oral corticosteroids. In the histopathology-confirmed orbital neoplasm with preoperative diagnosis of idiopathic OID group, there were 9 patients with mean age at presentation of 52 years. Follow-up period averaged 7.5 months (range: 0.5 - 83 months). The presenting symptoms and signs included proptosis (4/9), inflammation (3/9), orbital pain (1/9), and epiphora (1/9). The preoperative best-corrected decimal acuity mean was 0.78. Histopathology and immunohistochemistry of the orbital masses revealed malignancy in 80% (7/9) of these cases@*Conclusions@#Idiopathic OID remains a diagnostic dilemma for many physicians. A detailed history, comprehensive physical examination, and appropriate radiological evaluation are essential to differentiate OID and non-inflammatory orbital conditions such as neoplasms. Biopsy is recommended when there is poor or equivocal response to steroids or suspicion of orbital malignancy

Orbital Apex Syndrome after Uneventful Phacoemulsification

PURPOSE: We report a case of orbital apex syndrome associated with ocular ischemic syndrome after unenventful cataract surgery. CASE SUMMARY: A 74-year-old female came to our clinic with vision loss, ptosis, total ophthalmoplegia and ocular pain in the left eye after cataract surgery. On radiologic examination, diffuse hypertrophy of the extraocular muscles and a crowded orbital apex were observed. Additionally, the arm to retina and choroidal filling times were delayed on fluorescence angiography. Based on these findings, the patient was diagnosed with ocular ischemia complicated by orbital apex syndrome. After prompt pulse steroid therapy, improvement in extraocular muscle and pupil movement, ptosis and proptosis were observed; however, visual acuity failed to return to baseline. CONCLUSIONS: We report a rare case of orbital apex syndrome associated with ocular ischemic syndrome after cataract surgery, indicating the orbital apex syndrome may occur in healthy patients after uneventful cataract surgery.

Orbital compartment syndrome in idiopathic orbital inflammatory disease: A case report

Orbital compartment syndrome (OCS) is a visual threatening ocular emergency. We report a 50-year-old male with acute presentation of OCS, a rare manifestation of idiopathic orbital inflammatory disease. At presentation, high intraocular pressure was reduced by prompt lateral canthotomy and cantholysis. The disease responded to systemic steroids and treatment resulted in good visual outcome. Detail evaluation and early detection and treatment are mandatory to prevent permanent vision loss.

A Case of IgG4-Related Sclerosing Disease Involving the Optic Nerve

PURPOSE: To report a case of IgG4-related sclerosing dacryoadenitis masquerading for a long period as a. CASE SUMMARY: A 59-year-old man with visual acuity loss and proptosis in the left eye was referred to our hospital. Ten years prior, the patient was diagnosed with lymphoma and underwent chemotherapy at another hospital. However, the patient spontaneously stopped treatment and took steroids for the relief of periorbital swelling. Magnetic resonance imaging revealed diffuse infiltrative lesions involving both optic nerves and extraocular muscles. Incisional biopsies of the lacrimal gland's posterior side and the lateral rectus muscle's lateral side were performed. Staining for IgG4 via immunochemistry showed infiltration of IgG4-positive lymphoplasmacytic cells. Under the diagnosis of IgG4-related sclerosing disease, the patient underwent high-dose steroid pulse therapy.

A Case of IgG4-Related Sclerosing Disease Involving the Optic Nerve

PURPOSE: To report a case of IgG4-related sclerosing dacryoadenitis masquerading for a long period as a. CASE SUMMARY: A 59-year-old man with visual acuity loss and proptosis in the left eye was referred to our hospital. Ten years prior, the patient was diagnosed with lymphoma and underwent chemotherapy at another hospital. However, the patient spontaneously stopped treatment and took steroids for the relief of periorbital swelling. Magnetic resonance imaging revealed diffuse infiltrative lesions involving both optic nerves and extraocular muscles. Incisional biopsies of the lacrimal gland's posterior side and the lateral rectus muscle's lateral side were performed. Staining for IgG4 via immunochemistry showed infiltration of IgG4-positive lymphoplasmacytic cells. Under the diagnosis of IgG4-related sclerosing disease, the patient underwent high-dose steroid pulse therapy.

Involvement of superior rectus muscles in pansinusitis, a case report / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report the involvement of extraocular muscles in a patient with for a month. Ocular examination revealed right sided superior oblique and inferior rectus palsy or superior rectus restriction. Investigation with CT however revealed superior rectus thickening with surrounding pansinusitis. Drainage of ethmoid sinus and superior rectus recession was done to relieve the diplopia.required to relieve residual diplopia following surgical drainage.