Martin C J
Albuquerque VAMC, New Mexico, USA.
J Am Optom Assoc. 1997 Dec;68(12):775-81.
The most common cause of a sudden onset of painful proptosis with diplopia in an otherwise healthy adult is orbital pseudotumor. However, there are other conditions that mimic this presentation and must be ruled out with laboratory testing and imaging studies.
A 41-year-old Hawaiian man sought treatment for an acute, progressive, painful, left ophthalmoplegia without exophthalmos. During the next week, a loss of accommodation and associated pupillary reaction, decreased visual acuity, color vision deficits, and a paracentral scotoma developed. CT and MRI revealed a mass in the orbital apex. All systemic findings were negative, and high-dose systemic steroid therapy was initiated. Symptoms resolved within hours of the first dose, and signs were completely absent 1 month later. Follow-up MRI revealed complete absence of the previously noted mass.
This is an atypical case of orbital pseudotumor, since there was no exophthalmos. It was diagnosed by clinical presentation, laboratory and imaging studies, and response to therapy.
在其他方面健康的成年人中，突然出现疼痛性眼球突出伴复视的最常见原因是眼眶假瘤。然而，还有其他情况会模仿这种表现，必须通过实验室检查和影像学研究予以排除。
一名41岁的夏威夷男子因急性、进行性、疼痛性左侧眼肌麻痹且无眼球突出而寻求治疗。在接下来的一周内，出现了调节和相关瞳孔反应丧失、视力下降、色觉缺陷以及旁中心暗点。CT和MRI显示眶尖有一个肿块。所有全身检查结果均为阴性，遂开始大剂量全身类固醇治疗。症状在首次用药后数小时内缓解，1个月后体征完全消失。随访MRI显示先前发现的肿块完全消失。
这是一例非典型的眼眶假瘤病例，因为没有眼球突出。它是通过临床表现、实验室和影像学研究以及对治疗的反应而确诊的。
