DOI: https://doi.org/10.22263/2312-4156.2020.5.114
Pristupa V.V.1, Karalkova N.K.1, Kozhar V.L.1, Katulskaya T.V.2
Unilateral progressive enophthalmos caused by a neoplasm in the anterior part of the orbit
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus
Vestnik VGMU. 2020;19(5):114-120.
Abstract.
The classical reasons of enophthalmos development are the disturbance of the integrity of the orbital bony walls, involution of retrobulbar tissue, the disturbance of the sympathetic innervation of the orbital tissues. The presence of an orbital neoplasm is usually accompanied by exophthalmos. In this clinical case, a combination of an orbital neoplasm with enophthalmos is presented. The unusual localization of the neoplasm (in the anterior parts of the orbit) and the mechanism of enophthalmos occurrence (annular compression of the anterior parts of the eyeball) caused both difficulties and errors in the diagnosis.
A woman, born in 1962, turned for consultation in November 2017 complaining of enophthalmos on the left. After the ophthalmological examination, CT was performed, and then MRT of the left orbit and a neoplasm (presumably pleomorphic adenoma) was diagnosed as a zone of pathological changes in the anterior parts of the left orbit that had a circular shape which surrounded the eyeball. The patient considered herself to be ill since December 2015. The disease proceeded periodically with exacerbations, which were accompanied by symptoms of inflammation, narrowing of the palpebral fissure, limited mobility of the left eye and increased enophthalmos. A connection was noticed between the condition of the orbital tissues and the retraction of the eyeball with the menstrual cycle, and namely, during menstruation the condition worsened, after it the condition improved. She was observed by an ophthalmologist and a neurologist because of the symptoms of partial ptosis, neuropathy of the oculomotor nerve, and Horner’s syndrome. During the observation process, suspicions of neoplasm of the brain, Rochon-Duvigneaud syndrome, myasthenia gravis and scleroderma were excluded. After an additional examination at the oncological dispensary, a diagnosis was made «Primary multiple synchronous cancer» with the localization of tumors in the right mammary gland, the body of the stomach and metastases to the left orbit, ovaries, paraaortic and iliac lymph nodes. Since December 2017, she has undergone 11 courses of chemotherapy and hormone therapy. After treatment, the condition of the left orbit improved markedly, enophthalmos decreased, and the mobility of the eyeball was restored. At the moment, the condition remains stable. She will be under continuous monitoring and treatment as indicated.
Key words: unilateral progressive enophthalmos, neoplasm of the anterior part of the orbit, primary multiple synchronous cancer, orbital metastases.
References
1. Morozov VI. Enophthalm. V: Petrovskii BV, red. Bol'shaia meditsinskaia entsiklopediia [Elektronnyi reurs]: [v 30 t]. T 28: Ekonomo – Iashchur. 3-e izd. Moscow, RF: Sov Entsikl; 1986. Rezhim dostupa: https://bme.org/index.php/ENOFTAL''M. Data dostupa: 09.10.2020. (In Russ.)
Information about authors:
Pristupa V.V. – Candidate of Medical Sciences, associate professor of the Chair of Ophthalmology, Vitebsk State Order of Peoples’ Friendship Medical University;
Karalkova N.K. – Candidate of Medical Sciences, associate professor, head of the Chair of Ophthalmology, Vitebsk State Order of Peoples’ Friendship Medical University;
Kozhar V.L. – Candidate of Medical Sciences, associate professor of the Chair of Oncology with the courses of Radiodiagnosis & Radiotherapy and the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University;
Katulskaya T.V. – ophthalmologist, head of the department of eye microsurgery, Vitebsk Regional Clinical Hospital.
Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Ophthalmology. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Vadim V. Pristupa.
