|Year : 1989 | Volume
| Issue : 2 | Page : 99-100
Hydatid cyst of the orbit with papilloedema
Lalit Mohan Shukla, AV Deshpande, IM Shukla
B - 7, Shyledra Nagar, Raipur - 492 001, India
Lalit Mohan Shukla
B - 7, Shyledra Nagar, Raipur - 492 001
Source of Support: None, Conflict of Interest: None
A rare case of Hydatid cyst of the orbit causing, unilateral axial proptosis is reported. The presence of gross unilateral papilloedema misled us to the character of the cystic swelling causing axial proptosis.
|How to cite this article:|
Shukla LM, Deshpande A V, Shukla I M. Hydatid cyst of the orbit with papilloedema. Indian J Ophthalmol 1989;37:99-100
| Introduction|| |
Hydatid disease of the orbit causing proptosis is relatively common, as compared to other parasitic infestations, of the orbit. Only a few cases have been reported from India. The highest incidence with unilateral proptosis has been reported from Iraq (19.8%)  .
| Case Report|| |
A 25 years old male, farmer was admitted in the ophthalmic ward of the Medical College Hospital, with forward protrusion of the right eye since eight days, preceded by redness and mild pain. He complained of pain during movements of the right eye and diplopia, specially in right lateral gaze. Slight blurring of vision was also noticed in the same eye.
| Examination|| |
Visual acuity in the right eye was 6/'9. Eye ball was axially proptosed being non-reducible and rion-pulsatile, movements were restricted in all the directions, while abduction and elevation were most affected. The orbital margins were normal and there was no palpable mass in it. Along with widening of the palpebral fissure, conjunctival vessels in the lowere fornix showed dilatation The anterior segment was normal.
Ophthalmoscopy revealed gross papilloedema in the right eye with marked engorgement of blood vessels. The visual field showed enlargement of the blind spot. The left eye was absolutely normal.
No abnormality was detected on general and systemic examination. Regional lymph nodes were not palpable, E.N.T. examination was normal.
| Investigations|| |
Urine and stool examination were normal, TLC, 8400/cm mm., DIC., P.64, L.32, E2, M2, ESR. 11 mm. Ist hour Westergren, Hb, 14 gm. Blood V.D.R.L.: Negative: Mantoux Test: negative, Casoni's Test: Negative; x-rays of orbit,optic foramen and canal, skull, paranasal sinuses and chest: normal.
The patient was kept on anti-inflamatory treatment, and as his sysmptoms were relieved dramatically, while proptosis remained as such, he absconded from the ward.
About four and half months later, he came back with gross proptosis (more than 35 mm.) of the right eye. Right eye was vision reduced to finger counting at 1metre. There was marked restriction of movements in all directions. The bulbar conjuctive showed marked chemosis in the lower half, and was prolapsed out [Figure - 1]. The Cornea was normal, while the interior chamber was shallow as compared to the left eye. Pupillary reaction was relatively sluggish.
Ophthalmoscopic examination showed gross papilloedema (about 10 D), There was elevation of all the coats of the eye ball inside with smooth outlines, in the lower half, without detachment of the retina, blood vessels were markedly dilated and tortuous. No haemorrhages were seen, while superficial exudates were limited to the posterior pole.
All investigations were within normal limits, provisional diagnosis of a mass in the floor of the right orbit was made.
| Treatment|| |
The patient was kept on antibiotic and anti-inflammatory drugs.
Later the right orbit was explored through an anterior orbitotomy approach by an inferior transconjunctival incision, under general anaesthesia. The orbit septum was severed, fibres of the inferior oblique muscle were reflected and immediately a whitish cyst wall bulged out into the incision and ruptured suddently and a clear fluid came out. The white cyst wall was taken out totally by gentle dissection.
Clinincal diagnosis of hydatid cyst was then made on the table.
During the post-operative period, patient was treated with broad spectrum antibiotic, ant-inflammatory drugs, and plenty of vitamin B complex and C, Although the cyst ruptured, it did not present much problem, like anaphylaxis or other allergic reactions.
On the 7 th post-operative day, there was marked reduction in the proptosis (18.5) and the disc swelling; and his vision recovered to 6/36.
The cyst removed, was about 30 mm. in diameter with a thin, delicate and shiny white wall [Figure - 2]. Histopathological report confirmed the diagnosis, as the cyst showed structureless laminated wall, with only a few scolices attached on the inner side.
| Discussion|| |
Incidence of orbital involvement constitutes only 1 per cent of all the cases of hydated disease  . Huigol 4 reported the incidence as a varying from 0.7% - 1% of all orbital tumours. highest incidence with unilateral proptsis has been reported from Iraq (19.8%)  , Shukla and Sharva  reported on interesting case which simulated lacrimal gland tumour. Chitable  reported an unusual subperiosteal hydatid cyst in the orbit. Few other cases have been reported in India, ,,,,
The occurrence of papilloedema is quite unusual in hydatid cyst of the orbit. In the present case, the cyst was situated on the floor of the orbit beyond the equator, extending almost upto the apex, so as to cause sufficient pressure over the optic nerve leading to papilloedema. History of association with dogs was positive, but absence of eosinophilia and a negative Casoni's test were against the clinical diagnosis of hydatid cyst.
This is an unusual site for hydatid cyst, for it is more common in the upper temporal quadrant.
| References|| |
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[Figure - 1], [Figure - 2]