[Progressive axial exophthalmy--case report].
BACKGROUND
It is being presented the clinical case of a 67 year old male patient who has been under clinical observation and treatment for 10 years. The diagnosis rests upon clinical methods, imaging techniques (ocular-orbital examination, computerized tomography and magnetic resonance imaging) as well as post-operative histopathology reports.


RESULTS
The clinical diagnosis was supported by the progressive decrease in visual acuity, painful, irreducible, non-pulsating axial progressive exophthalmia, associated with disorders of the ocular motility initially at the level of the RE, followed by bilateral involvement. The RE ocular-orbital ultrasound and the MRI examination point out a homogenous retro bulbar formation that caudally compresses and exceeds the optic-nerve. The mass lesion from the right orbit was afterwards partially removed by neurosurgical excision. The general treatment was initiated with steroidal and non-steroidal anti-inflammatory drugs in repetitive cures, under protection of antibiotics and anti-secretory drugs, the response to treatment being unfavorable. In time, the exophthalmia increased progressively, fact that imposed right de-compressive orbitotomy, with the surgical ablation of the lateral orbital wall. About 1 year after the neurosurgical intervention the initial clinical symptoms insidiously reinstalled throughout 3 - 4 years. The ultrasound, completed by the cranium CT and MRI examinations have identified the bilateral presence of myositis. DEBATES: Regardless of all the therapeutical means applied in time, not only the medical treatment (the systemic corticotherapy), but also the surgical one (with palliative effect), the patient's evolution was unfavorable; the axial exophthalmia persists, it is painful and irreducible. The evolution is aggravated also by the fact that both orbits have been affected; the specialty literature mentions cases with frequent unilateral involvement.


CONCLUSIONS
In the case presented the axial exophthalmia is irreversible; it is determined by an inflammatory pseudotumor of both orbits, that represents a chronic inflammatory, idiopathic disease, with unpredictable clinical evolution. The diagnosis is usually one of exclusion, the complementary imaging examinations being necessary to rule out other pathologies of the orbit.
Szabo
Bianca
B
Clinica Oftalmologie, Universitatea de Medicina si Farmacie "Iuliu Haţieganu" Cluj-Napoca, Spitalul Clinic Judeţean de Urgenţă.
Szabo
I
I
Teodosescu
Oana
O
Belicioiu
Roxana
R
D000368:Aged; D018450:Disease Progression; D005094:Exophthalmos / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D009915:Orbit / Q000473:pathology* / Q000601:surgery*; D016727:Orbital Pseudotumor / Q000150:complications* / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012720:Severity of Illness Index; D014792:Visual Acuity