Gallo Ryan A, Zhang Michelle G, Abou Khzam Rayan, Tang Vincent D, Dubovy Sander R, Rong Andrew J
Department of Oculoplastic Surgery, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Pathology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Orbit. 2023 Oct;42(5):548-552. doi: 10.1080/01676830.2022.2042826. Epub 2022 Mar 21.
A 69-year-old woman with a history of a left orbital mass presented to the emergency room with progressive breakthrough pain in her left orbit despite medical therapy. On examination, there was extraocular motility restriction with diplopia upon left supraduction. Computed tomography (CT) scan of the orbits revealed soft tissue thickening of the left medial and superior periorbita and left lacrimal fossa; bony erosion of the left frontal bone, left orbital roof, and left lamina papyracea; and bilateral mass-like enlargement of the extraocular muscles. An orbitotomy with incisional biopsy was performed, and histopathological examination revealed non-caseating granulomatous inflammation consistent with sarcoidosis. Chest imaging demonstrated no sequela of pulmonary sarcoidosis, and her serum angiotensin converting enzyme (ACE) level was within normal range. She was treated with high-dose oral steroids with resolution of her symptoms. Her pain returned at the conclusion of the steroid taper, and it was controlled with chronic subcutaneous methotrexate and adalimumab injections.
一名69岁有左眼眶肿物病史的女性因尽管接受了药物治疗但左眼眶仍出现进行性突破性疼痛而前往急诊室就诊。检查发现，左眼上转时存在眼球运动受限伴复视。眼眶计算机断层扫描（CT）显示左眼眶内侧和上缘骨膜及左泪囊窝软组织增厚；左额骨、左眶顶和左纸样板骨质侵蚀；以及双侧眼外肌呈肿块样增大。进行了眼眶切开术及切开活检，组织病理学检查显示为符合结节病的非干酪样肉芽肿性炎症。胸部影像学检查未发现肺结节病的后遗症，其血清血管紧张素转换酶（ACE）水平在正常范围内。她接受了大剂量口服类固醇治疗，症状得到缓解。在类固醇减量结束时疼痛复发，通过慢性皮下注射甲氨蝶呤和阿达木单抗得以控制。
