Author: Anthia Papazoglou (Switzerland)
Co-authors: Markus Tschopp, Klodian Likaj, Stefan Trachsler, Marcel Menke
Purpose
Choroidal detachments have rarely been described in cases of infectious or non-infectious orbital inflammations. We want to present a case of moderate orbital inflammation associated with choroidal detachment.
Setting/Venue
We report a rare manifestation of orbital inflammation at the right eye of an 88-year-old female patient. The patient was hospitalised for treatment of malnutrition and presented ophthalmic symptoms and periorbital oedema. Apart from malnutrition and a neurocognitive disorder no other health issues existed, in particular no prior maxillofacial infection, trauma, or recent surgery. Other than previous cataract surgery on both eyes and some age-related subretinal drusenoid deposits, the ophthalmic history was unremarkable.
Methods
Clinical examination revealed decreased visual acuity (0.8 Log MAR), restrictive, slightly painful ocular motility, chemosis, conjunctival injection, and a 360⁰ choroidal detachment despite normal intraocular pressure. Ultrasound confirmed a choroidal detachment and showed a positive T-sign, while computer- and magnetic tomography depicted a pre- and post-septal inflammation with enhancement of the lateral rectus muscle. Cavernous sinus, orbital apex, superior ophthalmic vein calibers and the sinuses were normal, no mass or bone erosion was seen. According to blood analysis, inflammation factors were elevated while leukocytes were only slightly elevated and the ANCAs were negative. We suspected an infectious orbital cellulitis. Treatment with high dose intravenous co-amoxicilin and an antibiotic/steroidal ointment was initiated. Because of the very slow response to therapy, an orbital biopsy was performed on day 7. Histopathological analysis showed signs of chronic inflammation. As the oedema decreased, the chemosis disappeared, the motility stopped being painful, the choroidal detachment regressed. On day 10 the choroidal detachment had fully resolved, while a small central macular oedema was documented in optical coherence tomography and fluorescence angiography. Topical treatment with prednisolone and nepafenac was initiated. On day 14 day an almost complete regression of signs was noted.
Results
Although only few cases of choroidal detachment due to orbital inflammation have been described; it appears that choroidal effusion can be part of this disease. The assumption is that the detachment is a result of pressure applied upon the vortex veins from the oedematous intraorbital contents and/or that it is an accumulation of serum in the suprachoroidal space due to inflammation. Our differential diagnosis included infectious cellulitis, posterior skleritis, although symptoms regressed without systemic steroids, orbital and periorbital inflammation due to viral Epstein-Bar infection, which was found in the conjunctival swab sampling, or Aspergillus niger detected in one of the samples taken during orbital biopsy.
Conlusions
Choroidal detachment can be present as a rare clinical manifestation of orbital inflammation.
Financial Disclosure
None
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