PMC9834917_01
Anterior and lateral views of left eye chemosis, proptosis, and erythema
before steroid therapy at initial presentation at the ophthalmology
clinic.
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Ten days later, the patient presented to the ophthalmology clinic with worsening vision loss bilaterally, worsening headaches and retro-orbital pressure sensation, and periorbital swelling (Figure 1).
Magnetic resonance imaging head, coronal, and axial views. Enlargement of all
extraocular muscles bilaterally. Scattered fluid-attenuated inversion
recovery (FLAIR) hyperintensities were also noted within the white
matter.
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Magnetic resonance imaging (MRI) (Figure 2) of the orbits showed significant proptosis with straightening of the optic nerves and enlargement of all extraocular muscles to include the tendon sheath. On MRI (Figure 2), the radiologist noted enlargement of all extraocular muscles bilaterally.
Anterior view of dramatic improvement of proptosis, chemosis, and
conjunctival injection after only 24 hours of intravenous
corticosteroid.
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His extraocular movement was full, and orbital swelling greatly decreased (Figure 3). He was held at the hospital for 2 more days on 1000 mg of IV prednisone and finally discharged on 100 mg per os (PO) of prednisone with a weekly taper.
Computed tomography head, coronal, and axial views. Taken in the emergency
room at the time of initial presentation. The radiologist report stated no
evidence of acute hemorrhage, edema, or mass effect.
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In the emergency department at the time of presentation, a CT scan of the patient's head was ordered (Figure 4).
Conjunctival biopsy taken was normal and showed no sign of
lymphoproliferative disease.
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Conjunctival biopsy (Figure 5) was normal and showed no sign of lymphoproliferative disease.