Journal of Emergencies, Trauma, and Shock
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Year : 2020  |  Volume : 13  |  Issue : 1  |  Page : 96
Corneal perforation and blindness from extreme proptosis


Department of Ophthalmology and Vision Science, University of California Davis Health Eye Center, Sacramento, CA, USA

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Date of Submission05-Nov-2019
Date of Acceptance10-Dec-2020
Date of Web Publication19-Mar-2020
 

How to cite this article:
Bacorn C, Lin LK. Corneal perforation and blindness from extreme proptosis. J Emerg Trauma Shock 2020;13:96

How to cite this URL:
Bacorn C, Lin LK. Corneal perforation and blindness from extreme proptosis. J Emerg Trauma Shock [serial online] 2020 [cited 2020 Apr 9];13:96. Available from: http://www.onlinejets.org/text.asp?2020/13/1/96/280969




Dear Editor,

The authors report a case of a 55-year-old man with no medical or ophthalmic history who presented to the emergency room with a history of right eye pain and vision loss. He reported that the eye has been “bulging” with a gradual increase in pain for at least 6 months. He did not seek prior medical advice and presented due to the pain and “draining” eye. On examination, his visual acuity was no light perception in the right eye. The globe was proptotic with intraocular content prolapsed through a perforated cornea [Figure 1]a. Magnetic resonance imaging [Figure 1]b demonstrated a large orbital mass causing inferior displacement of the globe. The patient underwent enucleation and orbitotomy for mass removal. The encapsulated mass was completely excised [Figure 1]c. Histopathologic examination of the mass revealed a pleomorphic adenoma.
Figure 1:(a) External photograph depicting right eye corneal perforation with prolapse of intraocular contents. (b) Axial magnetic resonance imaging demonstrated a large intra- and extraconal mass causing inferior displacement of the globe. (c) Gross appearance of the encapsulated mass

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Although progressive proptosis from an orbital mass can lead to vision loss, it is unusual to present as frank corneal perforation and blindness. On review of the literature, the authors are unaware of any other reported cases of corneal perforation due to a pleomorphic adenoma. The differential for orbital lesions is broad and includes inflammatory, infectious as well as neoplastic etiologies such as lymphoid tumors, cavernous malformations, lymphangiomas, and metastasis.[1],[2] In addition, the most common primary ocular malignancy, choroidal melanoma, may invade the orbit.[3]

Many providers fail to recognize proptosis as an orbital sign. This case highlights how proptosis and exposure keratopathy can lead to blindness and perforation if not recognized early.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Tailor TD, Gupta D, Dalley RW, Keene CD, Anzai Y. Orbital neoplasms in adults: Clinical, radiologic, and pathologic review. Radiographics 2013;33:1739-58.  Back to cited text no. 1
    
2.
Shields JA, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1. Ophthalmology 2004;111:997-1008.  Back to cited text no. 2
    
3.
Shields JA, Shields CL. Massive orbital extension of posterior uveal melanomas. Ophthalmic Plast Reconstr Surg 1991;7:238-51.  Back to cited text no. 3
    

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Correspondence Address:
Dr. Lily Koo Lin
Department of Ophthalmology and Vision Science, University of California Davis Health Eye Center, 4860 Y Street, Suite 2400, Sacramento, CA 95817
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_146_19

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