April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Inflammatory Orbital Pseudotumor with involvement of Contiguous Periorbital Structures
Author Affiliations & Notes
  • Roman Shinder
    Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York
  • Qasiem Nasser
    Head & Neck Surgery - Section of Ophthalmology,
    The University of Texas M.D. Anderson Cancer Center, Hosuton, Texas
  • Justin Gutman
    Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York
  • Shelly Brejt
    Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York
  • Michelle Williams
    pathology,
    The University of Texas M.D. Anderson Cancer Center, Hosuton, Texas
  • Bita Esmaeli
    Head & Neck Surgery - Section of Ophthalmology,
    The University of Texas M.D. Anderson Cancer Center, Hosuton, Texas
  • Footnotes
    Commercial Relationships  Roman Shinder, None; Qasiem Nasser, None; Justin Gutman, None; Shelly Brejt, None; Michelle Williams, None; Bita Esmaeli, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 1065. doi:
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    • Get Citation

      Roman Shinder, Qasiem Nasser, Justin Gutman, Shelly Brejt, Michelle Williams, Bita Esmaeli; Inflammatory Orbital Pseudotumor with involvement of Contiguous Periorbital Structures. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1065.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose:
 

Inflammatory orbital pseudotumor (IOP) involving contiguous structures is an uncommon presentation with only a few prior reports. We detail the presentation, radiographic & histologic findings, & treatment outcomes in 3 patients with this condition.

 
Methods:
 

3 consecutive patients who were evaluated for IOP with involvement of contiguous structures at The University of Texas M. D. Anderson Cancer Center between November 2003 and October 2010 were reviewed.

 
Results:
 

2 females & 1 male had a median age of 18 years (range 5-35). Presenting signs & symptoms included pain, periorbital edema, proptosis, globe dystopia, restricted ocular movement with diplopia, & decreased vision. 2 patients had concurrent disease in the orbit & maxillary sinus (Fig 1), while 1 patient had extension from the lateral orbit into the temporal fossa (Fig 2). In 2 patients there was bony orbital wall erosion, but in the third patient the orbital walls were intact. The diagnosis of IOP in all patients was suspected based on exam & CT findings and confirmed via orbital biopsy. In 1 patient (Fig 1) a biopsy of the maxillary sinus was followed by a second biopsy of the orbit to rule out malignancy, given the atypical large mass and significant bony erosion. 2 of the cases were confirmed as sclerosing pseudotumor based on histology. Treatment consisted of high dose oral steroids with a slow taper in all patients; in 1 patient (Fig 1) methotrexate was added to allow successful steroid taper. At last follow up (median 14 months, range 5-26), all patients had improvement of clinical & radiographic findings without residual orbital pain.

 
Conclusions:
 

IOP is typically confined to the orbit, but in some cases there may be involvement of the contiguous structures such as paranasal sinuses and/or temporal fossa with or without bony erosion. Bony erosion of the orbital walls is worrisome for a malignant process or Langerhans cell histiocytosis, and in such cases, the diagnosis of IOP requires confirmatory biopsy.  

 
Keywords: orbit • imaging/image analysis: clinical • inflammation 
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