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A young woman with proptosis
  1. Sheila Pabon1,
  2. Todd Emch2,
  3. Joung Lee3,
  4. Arun D Singh1
  1. 1Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Arun D Singh, Department of Ophthalmic Oncology, Cleveland Clinic Cole Eye Institute, 9500 Euclid Avenue, Desk i32, Cleveland, OH 44195, USA; singha{at}ccf.org

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A 31-year-old Caucasian woman was referred to our ophthalmic oncology outpatient clinic with a 4-week history of right eye proptosis, bifrontal pressure like headaches and blurred vision in the right eye. The patient denied diplopia or facial numbness. Review of systems was positive for recent nasal congestion and cough. Past medical history included inflammatory bowel syndrome, hypercholesterolaemia, asthma and acute lymphocytic leukaemia (ALL) at the age of 6 years. She had been in remission since 1987 following treatment with chemotherapy (cytarabine, daunorubicin, hydrocortisone, L-asparaginase, methotrexate, vincristine, teniposide cyclophosphamide, etoposide and prednisone), and prophylactic cranial irradiation with a total dose of 18 Gy.

External examination revealed mild fullness of the temporal region. Normal upper and lower eyelids bilaterally without any erythema, oedema or lid retractions were noted. Conjunctiva was normal bilaterally. Visual acuity was at 20/25 in the right eye and 20/20 in the left eye. Anterior segment examination revealed axial proptosis of 6 mm and afferent pupillary defect on the right eye. Extraocular motions were normal. Slit lamp examination showed normal cornea, iris and lens. Dilated fundus examination revealed mild optic disc pallor with well-demarcated margins in the right eye. The left disc was normal. Colour vision with Ishihara chart was 4/8 on the right eye and 8/8 in the left eye. Visual field revealed superior arcuate scotoma in the right eye with normal fields in the left eye. Neurological examination was normal. Orbital and …

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