title: [Progressive axial exophthalmy--case report].
abstract: 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.
authors.affiliation: Clinica Oftalmologie, Universitatea de Medicina si Farmacie "Iuliu Haţieganu" Cluj-Napoca, Spitalul Clinic Judeţean de Urgenţă.
authors.forename: Bianca
authors.initials: B
authors.lastname: Szabo
authors.forename: I
authors.initials: I
authors.lastname: Szabo
authors.forename: Oana
authors.initials: O
authors.lastname: Teodosescu
authors.forename: Roxana
authors.initials: R
authors.lastname: Belicioiu
mesh_terms: 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