Sumary of Woman presents with worsening pain, redness in right eye:
- Her medical history included hypertension, hyperlipidemia, osteoporosis, stage 1 breast cancer status post excisional biopsy and partial mastectomy 5 years prior, anxiety and depression.
- Examination Best corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye.
- When assessing for proptosis with the Hertel exophthalmometer, the right eye was noted to have 2 mm of proptosis compared with the left eye.
- External exam noted 1+ right upper lid edema and erythema, upper lid ptosis with 0.5 mm lagophthalmos and mild proptosis (Figure 1).
- Figure 1. External photos of the right eye demonstrated upper lid edema and erythema, upper lid ptosis, mild proptosis and significant conjunctival chemosis with mild injection.
- Dennett, MD, Geetha Athappilly, MD, and Sarkis Soukiasian, MD Slit lamp examination noted 2+ diffuse conjunctival chemosis with trace injection in the right eye, trace inferior punctate epithelial erosions of the right cornea, deep and quiet anterior chambers bilaterally, flat iridis and 1+ nuclear sclerotic cataracts.
- Posterior segment examination demonstrated bilateral posterior vitreous detachments, pink and healthy optic nerves with a cup-to-disc ratio of 0.6, flat maculae, vessels of normal course and caliber, and a flat and attached retinal periphery bilaterally.
- MRI of the brain and orbits showed right-sided periorbital soft tissue swelling, conjunctival edema and postseptal inflammatory changes, including edema and enhancement along the posterior scleral margin, along the optic nerve sheath, throughout the intraconal fat and involving the anterior aspect of the right superior muscle complex (Figure 3).