Is It or Isn't It? - Video

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Identifier walsh_2016_s1_c3-3
Title Is It or Isn't It? - Video
Creator Peter W. MacIntosh, Scott Jones, Milena Stocic, Amy Lin, Heather Moss
Subject Orbit; IgG4; Xanthogranuloma
History A 58-year-old woman with recurrent left idiopathic orbital inflammation (IOI) presented with one day of rapidly progressive bilateral proptosis, edema, right eye redness, photophobia, and blurry vision. Her right eye had previously been asymptomatic. Her left eye had macular scarring with reduced vision from presumed IOIassociated posterior uveitis. Past medical history was remarkable for lymph node and orbital biopsy during a previous episode of IOI that were negative for malignancy. Recently she had been diagnosed with asthma. Vision was 20/50 in the right eye and 20/200 in the left. Both eyes were proptotic, left 1mm more than right. She had non-tender bilateral upper eyelid edema with left medial canthal xanthelasma-like changes. The right eye had 3+ conjunctival injection, and 3+ anterior cell. Left eye slit lamp exam was normal except for iris synechiae. The dilated exam was normal in the right eye, but the left eye had macular pigment and a fibrotic scar without active inflammation. The nerves appeared normal, without pallor or edema. She was treated with IV solumedrol, topical steroids and cycloplegics to the right eye. Six hours later, right vision had deteriorated to 20/200. There was new hypopyon and corneal haze in the right eye. Orbital CT scan showed bilateral enlargement of the extraocular muscles and lacrimal glands, ethmoid sinus disease, but no abscess, mass or bony erosion. T1 MRI orbits with contrast showed bilateral enhancement of the retro-orbital fat and extraocular muscles including the tendons, but no optic nerve enhancement. The T2 MRI orbits showed straightening of the optic nerve, but no abnormal signal. Parotid and submandibular glands were enlarged. Thyroid function, TB, syphilis, ANA, RF, ANCA, ACE, Lysozyme, Chest X-ray were normal. Serum IgG4 levels were elevated. A diagnostic procedure was performed.
Date 2016-02-28
Language eng
Format video/mp4
Type Image/MovingImage
Relation is Part of NANOS Annual Meeting Frank B. Walsh Sessions; 2016
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Holding Institution North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416
ARK ark:/87278/s6f21w9d
Contributor Primary Peter W. MacIntosh, Scott Jones, Milena Stocic, Amy Lin, Heather Moss
Setname ehsl_novel_fbw
ID 179380
Reference URL https://collections.lib.utah.edu/ark:/87278/s6f21w9d
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