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Enophthalmos following orbital trauma: a diagnostic catch
  1. Vasileios Achtsidis1,
  2. Maria Elena Gregory1,
  3. Fiona Roberts2,
  4. Ewan G Kemp1
  1. 1Eye Department, Tennent Institute of Ophthalmology, Glasgow, UK
  2. 2Pathology Department, Western Infirmary, Glasgow, UK
  1. Correspondence to Dr Vasileios Achtsidis, Eye Department, Tennent Institute of Ophthalmology, 1053 Great Western Road, Glasgow G12 0YN, UK; billachtsidis{at}yahoo.gr

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Case report

A 57-year-old woman presented with progressive right enophthalmos 2 years following trauma to the right globe. Initially, she had a fall and a severe head trauma, with periorbital oedema and pain. X-rays had shown no orbital or facial fractures and the rest of the clinical examination was normal. No further investigations were performed at this stage. She also suffered from hypothyroidism and chronic obstructive airway disease. Visual acuity was 6/9 bilaterally and the right eye had reduced motility in all directions of gaze, 5 mm enophthalmos and slight ptosis (Figure 1A–C).

Figure 1

(A–C) Photographs showing severe right enophthalmos, mild right eyelid ptosis and left normal orbit. (D) Axial CT scan demonstrating marked right enophthalmos. (E) Orbital T1-weighed MRI of the patient before treatment for orbital metastasis showing a diffuse fibrosis, hypointense compared with fat, without any sign of a unique solid invasive metastatic tumour.

CT scan of the orbits showed severe right-sided enophthalmos with generalised loss of extraocular muscle definition and markedly reduced retrobulbar fat space suggestive of diffuse fibrosis encasing the muscle cone. There was no mass lesion surrounding the optic nerve or infiltrating the muscles. Bone contours were normal with no fractures or bone destruction (Figure 1D). A presumed diagnosis of post traumatic orbital fibrosis was made and right orbital biopsy performed. Two incisional biopsies of the orbital lesion were taken under general anaesthetic via an inferior fornix incision and preserved in formalin. No frozen sections were performed.

Questions

  1. What histopathological findings are shown in Figure 2?

  2. State other causes of enophthalmos which should be considered in the differential diagnosis. …

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