|ONE MINUTE OPHTHALMOLOGY
|Year : 2019 | Volume
| Issue : 8 | Page : 1264
Grace L Su, Sara E Lally, Carol L Shields
Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
|Date of Web Publication||22-Jul-2019|
Dr. Carol L Shields
Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA - 19107-5109
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Su GL, Lally SE, Shields CL. Unilateral enophthalmos. Indian J Ophthalmol 2019;67:1264
| Case|| |
A 55-year-old Caucasian lady with a history of breast carcinoma noted increasing pain and pressure in the right eye (OD) for 1 year. She had an upper tooth dental implant about 1 year ago after which the symptoms started. On examination, best corrected visual acuity was 20/25 OD and 20/20 in the left eye (OS). Motility and color plates were full. There was no optic nerve edema or pallor in either eye (OU). There was 2 mm enophthalmos OD on Hertel exophthalmometry and no proptosis with and without Valsalva maneuver [Figure 1]a.
|Figure 1: External photograph revealed unilateral enophthalmos OD in a Caucasian female (a). CT scan showed a density connecting the inferior and superior recti muscles (b). MRI confirmed a muscular band (c)|
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| What is your Next Step?|| |
- Close monitoring with serial examinations every 3 months
- Perform orbital magnetic resonance imaging (MRI)
- Obtain blood work for inflammatory markers
- Initiate metastatic evaluation.
| Findings|| |
Computed tomography imaging was performed which showed curvilinear density of the right retrobulbar region confluent with the inferior rectus (IR) muscle, extending to the superior rectus (SR) complex [Figure 1]b. Magnetic resonance imaging (MRI) revealed a muscular band between the right IR and SR muscles OD [Figure 1]c. The patient was managed conservatively with repeat imaging ordered in 3 months.
| Diagnosis|| |
| Correct Answer : B|| |
| Discussion|| |
Orbital bands—also known as supernumerary extraocular muscles—are anomalous muscle attachments between rectus muscles or a rectus muscle and the globe. The etiology of these bands is unclear, but may represent extraocular muscle tissue that was never innervated or lost innervation during development. The impact of the accessory bands depends upon the size and location, and can cause restrictive strabismus and globe retraction. Other causes of enophthalmos must be ruled out. For asymptomatic patients, ocular management involves observation followed by serial imaging, preferentially orbital MRI coronal view T-1 and T-2 weighted images with/without fat suppression and surface coil for higher resolution.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Khitri MR, Demer JL. Magnetic resonance imaging of tissues compatible with supernumerary extraocular muscles. Am J Ophthalmol 2010;150:925-31.
Lueder GT. Anomalous orbital structures resulting in unusual strabismus. Surv Ophthalmol 2002;47:27-35.
Patel SH, Cunnane AF, Juliano MG, Vangel MG, Kazlas MA, Moonis G. Imaging appearance of the lateral rectus-superior rectus band in 100 consecutive patients without strabismus. AJNR Am J Neuroradiol 2014;35:1830-5.