RESUMO
This study aimed to report a rare case of a rapidly progressive isolated unilateral orbital compression syndrome in a male with homozygous sickle cell disease, who presented with proptosis and optic nerve dysfunction. He neither had long bone pain crisis nor fever at the time of presentation that was managed surgically to preserve vision. Rapidly progressive left orbital swelling is observed in a 19-year-old homozygous sickle cell disease patient associated with severe pain, headache, and impaired vision. Computed tomography of the orbit confirmed the presence of a unilateral large superior sub-periosteal cystic mass. Surgical exploration via anterior orbitotomy revealed a large sub-periosteal hematoma occupying the superior orbit which was evacuated. The patient completely recovered within 14 days post-surgery and regained his vision. Orbital involvement in sickle cell disease is rare, however, it can occur as a sequela of vaso-occlusive crisis and bone marrow infarctions leading to bleeding and sub-periosteal hematomas in the orbit. Prompt diagnosis and management of orbital compression syndrome are crucial to prevent permanent optic nerve damage. Hence, cautious evaluation and close monitoring are important, especially in cases where surgical evacuation is indicated for quick recovery and prevention of visual loss.
RESUMO
Purpose: To describe visual morbidity in thyroid orbitopathy in Asian Indians and the factors influencing its onset. Methods: A retrospective chart review was performed for patients with thyroid related orbitopathy seen between May 2014 and April 2019. Three hundred and one patients were included in the study. Relevant history, clinical findings, investigations, and treatment were documented. Results: Nineteen percent of patients had at least 1 visual morbidity feature such as compressive optic neuropathy, exposure keratopathy or diplopia, requiring intravenous glucocorticoid. Male gender, older age, and diabetes were the significant risk factors for high visual morbidity (all P < 0.05). Systemic thyroid status, degree of proptosis, and duration of disease were not significant. Average dose of intravenous glucocorticoid needed was 3.8 g; 24 (7.9%) patients required orbital decompression, and 13 (4.3%) needed eyelid surgery. At the last follow-up, 97% of patients had vision 6/12 or better in both eyes. Conclusion: There is significant visual morbidity found in Indian patients with TED, even with moderate proptosis and systemic control of thyroid status. This is the first set of data on the subject.
