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Bilateral eye swelling
bigmind - الاثنين, 2008-08-04 01:00 |
الوصف الكامل Background: الشكوى الرئيسية CC: Bilateral eye swelling.
القصة المرضية HPI: This is a 2 year old male who presents with a chief complaint of bilateral eye swelling. He had some swelling noted 2 weeks prior to this admission and was treated with antibiotics for a presumed sinusitis. The swelling did improve to some degree; however it never completely resolved. Over the past 2 weeks the swelling has worsened.There has been some itching but no fever. His vision is unaffected as far as his mother could tell. Diphenhydramine and erythromycin ophthalmic ointment were started and once again the swelling improved.They present today because the swelling is again worse.Mom denied any trauma to the lids or orbit, no eye discharge, and only mild redness.
الأجهزة الأخرى ROS: There are no symptoms to suggest hyperthyroidism .
السوابق المرضية الشخصية PMH: Negative for any diseases of the eyes, severe allergies, renal or cardiac disease, or thyroid dysfunction
السوابق المرضية العائلية FMH: nil.
الوضع الصحي والاجتماعي SH: nil
الفحص السريري Clinical Exam: He is a healthy appearing male who has mild proptosis of both eyes.There is mild conjunctival erythema but no discharge. The corneas are clear. No erythema of the lids is appreciated. Anterior chambers are clear and extraocular movements are conjugate but not fully testable, though the Doll's eye maneuver was normal.There is no preauricular lymphadenopathy
التشخيص التفريقي DD: الاستقصاءات Investigations: التدبير Managment: كتابة حرة وطرح موضوع النقاش!: What is the DD ?
what is your next step? |
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screening the systems ,am thinking of:
1.Inflammation-auto immune diseases -orbital cellulitis .
2.Neoplasm,retroorbital tumor.
so ,i would order :
CT scan,cbc it could help.
i was thinking of reinoblastoma, but i think the family history would somehow exclude it??
THIS CASE IS VERY IMPORTANT TO EVERY MEDICAL STUDENT ,I.E. IT IS NOT ONLY FOR OPHTHALMOLOGISTS!!!
generally ,when we see swelling eyes we have to think of these DDs:
a) non-accidental traum.
b)accidental trauma.
c) hyperthyroidism.
d) periorbital or orbital cellulitis.
f) orbital malignancy (e.g. retinoblastoma).
g)others
well.. let us exclude one by one.
as for traumas, the history and the clinical finding don't show any sense for them.
as for periorbital or orbital cellulitis, the history shows no significant improvement on antibiotics meds BUT this
DON'T exclude them at all.
as for the malignancies, the family history gives us a clue but that means not to exclude it at all.
so we have to think of C+D+F ..
we have to run :
* visual acuity testing.
** complete blood count+ thyroid function work
*** eye culture
why we have to run that??
*** Culture of the eye discharge or conjunctiva is needed to rule out bacterial conjunctivitis.
** Blood work for thyroid function and complete blood count (CBC) is useful to check for other etiologies of the proptosis and for the possibility of hematologic malignancy.
* Visual acuity testing should
be done in every case of symptoms related to the eye.
The Results :
*His visual acuity is normal.
** His CBC is normal. thyroid function is normal as well.
***the cultures: no infection growth has been noticed.
His CT review :
2- Does this alter your DD?
3-What should be done no?
i cane notice an enlargement of the muscles there in the orbital cavity.
Does this alter your DD?
unfortunately it doesn't,am still thinking of either an autoimmune disease or a orbital malignancy .
What should be done now?
i don't know really , but to exclude the malignancy we should get a biopsy ..i don't know how to do it but maybe through the sinuses..
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maybe u mean D+F+G
reinoblastoma..
http://www.hakeem-sy.com/main/node/20207
So after the results showing up our DDX is:F+G
so ?
The CT of this child's orbits reveals thickening of the orbital structures. Thickening/swelling of the extraocular muscles is most evident. No calcifications are noted. The globes are normal and no bony erosions are noted. The remainder of the study is normal. These findings are consistent with: Orbital Pseudotumor.