Clinical presentation
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Transcript of Clinical presentation
A CASE OF PROPTOSISA CASE OF PROPTOSIS
Abubaker Ahmed MS ophthAbubaker Ahmed MS [email protected]@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