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Resumen: Objetivo: reporte de caso de enfermedad relacionada con IgG4 tratada exitosamente con azatioprina. Caso clínico: varón de 53 años con proptosis, cefalea y masa extraocular derecha visible por tomografía, el estudio anatomopatológico concluyó en enfermedad relacionada con IgG4. Se inició tratamiento con prednisona en dosis altas con descenso progresivo, añadiendo azatioprina a los 3 meses para inducción rápida de remisión. Resultados: se observó una mejoría significativa a los 6 meses de tratamiento mixto con prednisona y azatioprina, observándose ausencia de masa extraocular derecha en la resonancia magnética cerebral. Conclusiones: se puede optar por terapia doble con prednisona y azatioprina en un paciente con masa orbitaria debido a enfermedad relacionada con IgG4, ello con la intención de remisión rápida de la enfermedad. Abstract: Objective: case report of IgG4-related disease successfully treated with azathioprine. Clinical case: 53-year-old male with proptosis, headache and right extraocular mass visible by tomography, the pathological study concluded in IgG4-related disease. Treatment with high-dose prednisone was started with progressive reduction, adding azathioprine at 3 months for rapid induction of remission. Results: significant improvement was observed after 6 months of mixed treatment with prednisone and azathioprine, observing the absence of a right extraocular mass in the magnetic resonance imaging brain. Conclusions: dual therapy with prednisone and azathioprine can be chosen in a patient with an orbital mass due to IgG4-related disease, with the intention of rapid remission of the disease.

Background: IgG4-related disease is a newly recognized fibroinflammatory disease presenting with multiple features including mass forming lesion; a dense lymphoplasmacytic infiltrate; a characteristic histopathological appearance and often elevated serum of IgG4. This disease can potentially affect any organ and interestingly, the affected organs share common histopathological features including a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and mild to moderate eosinophilia Case Presentation: A 45-year-old man presented complaining of proptosis and gradual decrease in visual acuity of right eye. He had undergone many work-ups but without any definitive diagnosis. Through a combination of clinical and para-clinical investigations, the diagnosis of IgG4-RD was established. 693 mg/dL). Aggressive treatment (pulse of cyclophosphamide and pulse of corticosteroid) was started hoping to save the patient’s vision. Two weeks following the treatment, there was improvement with his visual acuity and proptosis. Conclusion: In any patient with chronic tumor like lesions and pseudotumors without the evidence of malignancy, we should think of IgG4-related disease. In this circumstance, biopsy may lead us to the definitive diagnosis. Early diagnosis and treatment of IgG4-RD may inhibit further irreversible organ damages.

A 47-year-old patient with a swelling of the left upper eyelid, redness, proptosis, and defective vision of few days duration was seen in our clinic. The history, examination, and investigations were suggestive of cavernous sinus thrombosis complicating orbital cellulitis. The patient was admitted and treated by a team of specialists including ophthalmology, neurosurgery, and hematology. Patient recovered fully after 3 weeks of treatment. This case report is being presented to highlight the importance of careful clinical examination and high index of suspicion in recognizing such a serious complication.

Objective: To determine the etiological pattern, clinical presentation and outcome of patients with proptosis in a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department, Khyber Teaching Hospital, Peshawar Pakistan, from Jan 2019 to Jun 2020. Methodology: This study was conducted on 60 patients having proptosis. Patients were treated either medically, surgically or both. The demographic profile included age, gender and type of proptosis. The outcome included recovery, re-treatment, referral to the relevant speciality and loss to follow-up, were measured. Results: Out of 60 patients with proptosis, 39 were males, and 21 were female. Fifty-two patients had unilateral, and 8 had bilateral proptosis, with the majority suffering from non-axial proptosis. On aetiology exhibited tumours (45%), infectious (25%), inflammatory (16.6%), vascular (6.66%) and injury (6.66%). The surgical procedure was indicated in 27(45%) patients, while medical treatment was given in 28(46.6%) patients. Five patients (8.4%) received both surgical and medical treatment. Out of 60 patients, 26 patients (46.33%) fully recovered and 11 patients (18.33%) did not recover, 17(28.33%) patients were referred to other specialities for management, and 5(8.3%) patients lost to follow-up. Conclusion: In our study, tumours were the main cause of proptosis, followed by infective and inflammatory causes, with the paediatric age group (<18 years) at more risk. [ABSTRACT FROM AUTHOR]

Background: IgG4-related disease is a newly recognized fibroinflammatory disease presenting with multiple features including mass forming lesion; a dense lymphoplasmacytic infiltrate; a characteristic histopathological appearance and often elevated serum of IgG4. This disease can potentially affect any organ and interestingly, the affected organs share common histopathological features including a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and mild to moderate eosinophilia., Case Presentation: A 45-year-old man presented complaining of proptosis and gradual decrease in visual acuity of right eye. He had undergone many work-ups but without any definitive diagnosis. Through a combination of clinical and para-clinical investigations, the diagnosis of IgG4-RD was established. 693 mg/dL). Aggressive treatment (pulse of cyclophosphamide and pulse of corticosteroid) was started hoping to save the patient's vision. Two weeks following the treatment, there was improvement with his visual acuity and proptosis., Conclusion: In any patient with chronic tumor like lesions and pseudotumors without the evidence of malignancy, we should think of IgG4-related disease. In this circumstance, biopsy may lead us to the definitive diagnosis. Early diagnosis and treatment of IgG4-RD may inhibit further irreversible organ damages., Competing Interests: None of the authors have any conflict of interest.

Acute myeloid leukemia (AML) may rarely involve the orbit as a solid tumor termed granulocytic sarcoma. This report describes the case of a child who presented with rapidly progressive unilateral proptosis and was diagnosed as rhabdomyosarcoma. However subsequent examination of the peripheral blood film revealed AML. Thus proptosis may present as the initial manifestation of AML.

Exophthalmometry, the quantitative assessment of the position of the globe in the orbit, is a clinically useful measurement. The purpose of this study was to examine the performance of a simple exophthal-mometer that would lend itself to accurate and convenient use in clinical practice. In this study, two observers independently performed exophthalmometry on 100 eyes using the Hertel and Luedde instruments. The results were compared between instruments and between observers. There was no statistically or clinically significant difference between measurements taken with the Luedde as compared with the Hertel instrument. The Luedde exophthal-mometer has a number of advantages over the Hertel exophthalmometer, and represents a simple, inexpensive and equally reliable means of evaluating clinically the anteroposterior position of the eye in the orbit. [ABSTRACT FROM AUTHOR]

Background: We report a case of extramedullary plasmacytoma of the orbit. This is a rare tumour which has uncommonly presented in the orbit. Case report: A 58-year-old woman presented with painless proptosis, upper lid swelling and ptosis. Incisional biopsy was performed. Clinical findings and investigations were correlated to establish the diagnosis. Treatment consisted of 35 Gy external beam radiotherapy. Conclusions: This condition is considered to be of low grade malignancy and as such can be regarded as a separate entity to multiple myeloma involving the orbit or solitary myeloma of bone in terms of treatment and prognosis. [ABSTRACT FROM AUTHOR]

Unlabelled: The purpose of this study was to measure the changes in intraocular pressure (IOP) and refraction following orbital decompression for thyroid orbitopathy., Methods: Retrospective review of 18 eyes in 10 consecutive patients who underwent orbital decompression including intraconal fat excision for proptosis secondary to thyroid orbitopathy. IOP using tonopen, exophthalmometry, autorefraction and autokeratometry measurements were performed at 1-week, 1-month and 3-months after surgery., Results: There was no statistically significant difference between the preoperative and postoperative IOP at 3 months. There were no significant differences found between preoperative and post operative keratometry readings or automated refraction following orbital decompression., Conclusion: Our study did not find a significant change in IOP and refraction following orbital decompression with intraconal fat excision. A larger prospective study is required in order to evaluate the role of intraconal fat excision in reducing IOP due to it's potential role in patients with concurrent glaucoma.