Authors : Anuradha A, Anuradha A, Priyam Gupta, Priyam Gupta, Nishat Sultana, Nishat Sultana, Deeksha Bekal, Deeksha Bekal, Meenakshi Dogra, Meenakshi Dogra
DOI : 10.18231/j.ijooo.2019.038
Volume : 5
Issue : 3
Year : 2019
Page No : 146-149
Purpose: We describe the clinical presentation of a 65yr old male patient with orbital pseudotumor of the right eye with secondary Ocular Surface Squamous Neoplasia, not responding to conventional steroid therapy.
Observation: Reporting a case of Pseudotumor of the right orbit with secondary Ocular surface Squamous Neoplasia in a 65yr old diabetic male presenting with painless proptosis and redness of the right eye since 6months. CT orbit scan was suggestive of a Thyroid orbitopathy. Patient initially responded well to steroid therapy along with oral thyroxine and proptosis decreased, but relapsed in few months. Patient was readmitted and a Contrast enhancemed MRI of orbit was done-suggestive of right eye Orbital pseudotumor. A detailed blood investigation and whole-body workup, Fine Needle Aspiration Cytology studies were done to rule out secondaries to the eye and confirmed to have orbital pseudotumor. Patient was started on immunomodulators Oral Methotrexate 7.5mg once a week, after obtaining clearance. Excision biopsy of the proptosed exposed conjunctiva was done and on histopathological examination diagnosis of Orbital pseudotumor tumor was confirmed with Ocular surface squamous neoplasm due to chronic conjunctival exposure secondary to the proptosis.
Conclusion: Patients with orbital pseudotumor typically respond to steroid therapy. However, in patients who are unresponsive or have recurrences, diagnosis should be revised or reconfirmed. Radiotherapy and immunomodulators are modes of treatment of unresponsive cases. Diagnosis and management of atypical cases pose a major clinical challenge.
Keywords: Biopsy, Steroids, Methotrexate, Orbital pseudotumor, Proptosis, Thyroid ophthalmopathy