Purpose: To describe a rare case of orbital inflammatory disease associated with panuveitis in an adult.
Methods: A patient diagnosed and treated for orbital inflammatory disease and panuveitis was studied.
Results: A 47-year-old woman presented with abrupt and painful proptosis with complete vision loss of the left eye for 20 days. She had no fever or chill. Antibiotic therapy was insensitive. She reported having a history of uveitis in the affected eye for one year. Topical and systemic corticosteroids and immunosuppressant were used irregularly with her vision losing gradually to 0.1 before the onset of proptosis. Physical examinations showed normal body temperature and pulse; blood pressure was 151/95 mmHg. Left eye visual acuity was NLP. Intraocular pressure was T+1. Redness and massive firm swelling of lids were obvious with high skin temperature and 3-mm dysraphism. Slit lamp examination revealed conjunctival redness, edema, prolapse, and subconjunctival firm mass. KP was positive; corneal epithelial defects and exposure corneal ulcer was detected in the inferior third of the cornea. Anterior chamber flare and activity cells both graded 2+ without hypopyon. Posterior synechiae and pupillary seclusion made posterior segment examination not feasible. Orbital pressure graded 3+ and eyeball fixation was noted. Exophthalmometer examination showed 7-mm more projecting of the affected eye than the fellow eye. WBC and Neutrophil were 12.3 and 8.9*10^9, respectively. B-scale ultrasonography showed retina detachment with a characteristic“T” sign, and orbital space-occupying mass with effusion. Superior and medial rectus hypertrophy was detected in the fellow eye. MR showed orbital space-occupying mass with molding pattern. In consideration of corticosteroids, immunosuppressant and antibiotic therapy were of limited effects in this patient, to exclude malignant orbital diseases, an orbitotomy was performed. The diagnosis of orbital inflammatory disease with lymphocyte hyperplasia subtype was confirmed by histopathology.
Conclusions: Orbital inflammatory disease concomitant with panuveitis could be a very unusual ophthalmic manifestation in adults; biopsy or immediate surgery with histopathologic evaluation is essential to distinguish orbital inflammatory disease with other more severe and life-threatening orbital mass.