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M. Dey, D. Situnayake, S. Sgouros, P. Stavrou; Bilateral Exudative Retinal Detachment in a Child With Orbital Pseudotumour. Cautionary Note Against Early Surgical Treatment . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5713.
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Purpose: Orbital pseudotumour is defined as a non–specific inflammatory condition for which no identifiable cause or systemic disease can be found. We report a patient with bilateral orbital pseudotomour who presented with marked reduction of vision due to bilateral exudative retinal detachment. Original plans for surgical decompression of the optic nerves were postponed, and the patient responded to non–operative treatment. Methods: A 15 year old African girl underwent full ophthalmic and general examination. Including laboratory tests and T1 weighted fat supressed – gadolinium enchanced MRI scan Results: The patient presented with bilateral painful loss of vision for one week. Visual acuity was 2/60 right eye and 1/60 left eye. There was bilateral proptosis, lid oedema and limitation of extraocular movements. Slit lamp examination revealed 2+ cells in anterior chamber of both eyes. Fundal assessment revealed 2+ cells in the vitreous, exudative retinal detachment, marked disc oedema, tortuous retinal vessels and scattered retinal haemorrhages. Laboratory findings were normal. MRI showed mild enchancement of the orbital inflammatory changes within the extraocular muscles and lacrimal gland. No intracranial abnormality was noted. These features were consistent with a diagnosis of orbital pseudotumour. Initial consideration of urgent surgical decompression of the orbit and optic canals was pursued, and medical treatment was given first. The patient initially responded to oral corticosteriods. However, the inflammation relapsed when the corticosteriods were reduced and required the addition of azathioprine. At 9 months follow–up the patient remains well with visual acuity of 6/6 in both eyes, maintained on azathioprine 50mg and prednisolone 5mg. Conclusions: Bilateral exudative retinal detachment is an unreported and potentially blinding complication of orbital pseudotumour. MRI findings are helpful in establishing the diagnosis of orbital pseudotumour. Orbital biopsy and decompression is not indicated as a first line investigation as most patients respond well to medical therapy.
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