A CASE OF PROPTOSISA CASE OF PROPTOSIS

Abubaker Ahmed MS ophthAbubaker Ahmed MS ophthdr-abubaker@hotmail.comdr-abubaker@hotmail.com

Clinical presentationClinical presentation

A 40 years old male presented to us complaining A 40 years old male presented to us complaining of painless protrusion of the left eye 4 months of painless protrusion of the left eye 4 months

ago of insidious onset slowly progressive associated ago of insidious onset slowly progressive associated with progressive diminution of vision in that eye .with progressive diminution of vision in that eye .

Past historyPast history

An old picture taken 4 years ago showing that An old picture taken 4 years ago showing that the proptosis is an old standing event .the proptosis is an old standing event .

No history of trauma No history of trauma No history of any systemic diseasesNo history of any systemic diseases

Family historyFamily history

Not significantNot significant

General examinationGeneral examination

Well conscious and oriented of average Well conscious and oriented of average intelligenceintelligence

No signs of facial asymmetryNo signs of facial asymmetry

No signs of hyperthyroidismNo signs of hyperthyroidism No signs of lymphadenopathy or No signs of lymphadenopathy or

hepatosplenomegaly.hepatosplenomegaly. No neurological manifestationsNo neurological manifestations

Ocular examinationOcular examination

Visual acuity 6/18 corrected to 6/12 and 6/6 in the Visual acuity 6/18 corrected to 6/12 and 6/6 in the healthy eyehealthy eye

Mild limited ocular motility laterally and up and outMild limited ocular motility laterally and up and out Unsustained pupillary reaction to lightUnsustained pupillary reaction to light Color test : +ve red desaturation testColor test : +ve red desaturation test Intact corneal sensation and no punctate epithelial Intact corneal sensation and no punctate epithelial

erosionerosion Fundoscopy shows disc swelling surrounded by hard Fundoscopy shows disc swelling surrounded by hard

exudates and tortuous veinsexudates and tortuous veins

FunFun

dus Picturedus Picture

Fundus Fundus

Exclusion of pseudoproptosisExclusion of pseudoproptosis

No ipsilateral buphthalmos or high myopiaNo ipsilateral buphthalmos or high myopia No ipsilateral lid retractionNo ipsilateral lid retraction No contralateral enophthalmosNo contralateral enophthalmos

Proptosis of the lt eyeProptosis of the lt eye

It is a unilateral , axial , non pulsatile not aggravated by It is a unilateral , axial , non pulsatile not aggravated by straining straining

Not associated with lid edema ,chemosis or injectionNot associated with lid edema ,chemosis or injection No thyroid eye signsNo thyroid eye signs Moderate in severity ( 25 mm by hertle Moderate in severity ( 25 mm by hertle

exophthalmometer and 15 mm in the healthy eye) exophthalmometer and 15 mm in the healthy eye) +ve retropulsion +ve retropulsion No thrill or bruitNo thrill or bruit

InvestigationsInvestigations

Complete blood count Complete blood count Kidney and liver functionKidney and liver function Thyroid hormonal profileThyroid hormonal profile CXRCXR Abdominal USAbdominal US Ct orbit Ct orbit MRIMRI

SURGICAL TREATMENTSURGICAL TREATMENT

Excisional biopsy under general anesthesia Excisional biopsy under general anesthesia through transconjuctival medial orbitotomythrough transconjuctival medial orbitotomy

The mass sanded for histopathological The mass sanded for histopathological examinationexamination