Dr. S.Uthayageetha

Postgraduate in Pediatrics,

Sundaram Medical Foundation

History17 Y, femaleProtrusion of left eye -1 weekPain in left eye -1 weekBlurring of vision – 4 daysNo H/O redness of eyesNo H/O trauma, fever,No H/O headache, vomitingNo symptoms of hyperthyroidism

Past historyHemolytic anemia 2 years agoTreated with oral steroids Investigations:DCT & ANA +ve,Anti dsDNA – negativeRecovered and asymptomatic since then

O/EAfebrile,Pallor +Icterus +No rash, lymphadenopathySystemic examination:

Spleen 2cm, soft and non tenderENT:Normal

Left eye proptosis

Non pulsatile, no bruit

Fundus:left eye disc edema

Periorbital edema & erythema

Ptosis

Cornea and conjunctiva –normal

Restriction of ocular movements

Examination of eyes

InvestigationsHb:7.1 g/dlTC:5,380/mm3

Platelet count:1,59,000/mm3

ESR:100 mm in 1hrLFT: Sr. Bilirubin:2.9, indirect:2.5mg/dl

Liver enzymes- NormalRFT:NormalLDH:626 U/LPeripheral smear: suggestive of hemolysis

DCT:PositiveANA: PositiveRA factor:NegativeAnti ds DNA: NegativeAnti phospholipid antibody: NegativeLupus anticoagulant: Negative

MRI ORBIT

TreatmentIv methylprednisolone -3 daysFollowed by oral steroidsOral iron and folic acid

CLINICAL PRESENTION:

-Periorbital edema

-chemosis, red eye

-proptosis

-ptosis

-painful eye movementImmune mediated processHistopathology:

-Pleomorphic inflammatory cellular response

-Fibrovascular tissue reaction

MRI orbit:Fluid in tenon’s spaceDiffuse orbital massUveo scleral thickeningExtraocular muscle enlargement

Treatment:Systemic corticosteroids 75% show dramatic response within 48-72hrs

Association with systemic disordersRheumatoid arthritisSystemic lupus erythematosisCrohn’s diseaseGiant cell myocarditis

ReferencesImtiazA, Middle east journal of ophthalmology vol 15,

2008

Sonia J.Ahn Yuen, Arch Ophthalmology, 2003,vol.121

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