Year : 1977 | Volume
: 25 | Issue : 1 | Page : 39--40
Unilateral proptosis, its management and rehabilitation-(a case report)
James Kuruvilla, PN Srinivasa Rao
Dept. of Ophthalmology K M.C.H. Manipal, Karnataka, India
Dept. of Ophthalmology K M.C.H. Manipal, Karnataka
|How to cite this article:|
Kuruvilla J, Srinivasa Rao P N. Unilateral proptosis, its management and rehabilitation-(a case report).Indian J Ophthalmol 1977;25:39-40
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Kuruvilla J, Srinivasa Rao P N. Unilateral proptosis, its management and rehabilitation-(a case report). Indian J Ophthalmol [serial online] 1977 [cited 2023 Mar 20 ];25:39-40
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1977/25/1/39/34601
Management of unilateral prop( osis depends on its aetiology, In a case where the proptosis is due to primary malignancy, which could be treated with surgery, radiation or antimetabolites, the practical problems at the end is the rehabilitation of the patient back to society. Here we are presenting a case, where management and rehabilitation took almost an year which in our country is quite a long time for all those who are concerned with the patient.
Patient-P-female, aged 8 came to the Eye O.P.D. with the complaint of "bulging of left eye" of a 4 days duration. There was no history of any trauma, pain, discharge, headache, nausea, vomiting, loss of consciouness, loss of weight, nor any blurring of vision. There was no significant, family, past or personal history.
Left eye showed (1) Minimal proptosis-outward and anteriorly, (2) Restriction of upward movements, (3) Palpable painless, regional glands, (4) Exophthalmometric readings were-R.E. 12mm and L.E. 18 mm.
Vision and fundus were normal in both eyes. All investigations (blood, urine, stools, X ray chest, plain x-ray abdomen, x-ray orbit and skull) were normal except X ray of orbit of left eye which showed double contoured shadow of orbital plate with doubtful erosion of the orbital plate. She never came back for review.
Meanwhile patient was being treated by medical and non-medical men with all kinds of medicines, but the "bulging" increased and hence she was taken to another Ophthalmologist, who did a biopsy and it was reported from our Pathology department as Neuroblastoma. He advised to take the patient for radiation and chemotherapy but added "may not be of any use".
One month later, she was brought to our hospital as in the words of the father "to die in the hospital", so that her kith and kin need not have to bear witness for the impending death.
On Examination: She was in a precarious state of health [Figure 1] with a fungating ulcerated bleeding mass, protruding out from the orbit with the cornea at the anterior most part 7-8 cm. in front of orbital margin. All regional lymph nodes were palpable, mobile, and non-matted. All other systems were normal. No mass in the abdomen was felt in detailed examination by experts. Over and above she was addicted to pethidine.
Investigations: Blood: Hb=4 gm% Total Count= 14,000/cu.mm. Neutrophils-75%, Eosinophils-3%, Lymphocytes-20%, Marcophages-2%, E.S.R.= 160-1st hour, Alk. Phosphatase 18 K.A. units.
Treatment; After consulting with radiotherapy department, her Hb. was brought up by haematinics and blood transfusion to 7 Gms. 3000 rads of radiation was given to the mass after which an exanteration of the orbit was done including the lids, Post-operatively she was given haemtinics, antibiotics and multivitamins. When her Hb. improved to 8.5 gms, a total dose of 5 mgms. of vincristine sulphate in 4 divided doses, one dose, per week for one month was given by I.V. bolus technique. Along with it cyclophosphamide (Endoxan) 100 mgm per day was given for 1 month under weekly blood check up for platelets. She was given another 3000 rads of raditation, after she was discharged. We were planning to do a skin graft later and then a prosthesis according to the prognosis of the patient.
After 15 days, she was admitted with the entire orbital cavity filled with slough with a coating of greenish discharge which has to be removed for a skin graft. Hence a slough excision was performed under general anaesthesia which made the entire cavity bare without any granulation tissue. The cavily was dressed with Eusol, silver nitrate and hydrogen peroxide for 45 days. Slowly the granulation tissues grew evenly over the cavity and a split skin graft. The graft was taken up well without any problems and she was discharged.
Being a growing and school going girl, she refused to go back to school with this horrifying deformity. She became an out-cast to her own brothers and sisters because of her appearance. In the words of the father she refused to look into a mirror, the reflection of her facial appearance frightened her. She came back to us.
We contacted the prosthodontic department of our Dental College. To them also it was a new experience and challenge. After 2 months of trial and error, we could make a mould which will fill the orbital cavity. On that mould, an artificial eye was stuck and the whole thing was later attached to a spectacle frame with brown tinted glasses matching her colour. [Figure 2],[Figure 3].
Acknowledgement: We wish to thank the departments of Surgery, Paediatric Surgery, Plastic Surgery, Radio-Diagnosis and Therapy and Dental Surgery for their valuable help and guidance.
|1||Levy T, Brit. Jour: Ophthal 41.49 1957.|
|2||Rees, A. B., 1963 Tumours of the eye-II Edition --page 208, Harper and Row, New York.|
|3||Swaminathan-P.M. 1976 Jour. of Madras State Ophthal. Asso. Vol. XIII: No. 3 75.|