A 37-Year-Old Woman With Decreased Vision and Proptosis

Karima S. Khimani; Rod Foroozan, MD


February 21, 2017

Case Diagnosis

In the setting of severe myopia with a marked difference in refractive error between the two eyes, this is suggestive of posterior staphyloma. The outpouching of the posterior portion of the eye contributes to visual distortion. Proptosis results from increased axial length of the globe.

Thyroid eye disease is the result of an autoimmune process that is most commonly associated with an overactive thyroid gland. The patient did not present with any signs of hyperthyroidism, such as tachycardia, weight loss, heat intolerance, or diaphoresis.

The patient had no risk factors for carotid cavernous fistula, such as history of trauma, recent surgery, atherosclerotic vascular disease, connective tissue disease, or pregnancy. Although patients with carotid cavernous fistula present with proptosis and decreased vision, they typically have additional findings, such as ophthalmoplegia, elevated intraocular pressure, and conjunctival injection with arterialized conjunctival veins.

Patients with orbital cellulitis typically have a history of recent sinusitis, upper respiratory infection, or trauma involving the orbit and its surrounding tissues. Orbital cellulitis often causes eye pain, impaired extraocular movements, and may be associated with findings consistent with systemic infection. The patient showed no evidence of orbital cellulitis.

Clinical Course

Funduscopic examination showed a tilted optic disc in the left eye with peripapillary atrophy. A staphyloma was noted in the left macula with some concavity.

MRI of the brain and orbits showed posterior staphyloma and increased axial length of the left globe (Figure 4). No abnormal enhancement was noted within the orbit, and the extraocular muscles were normal.

Figure 4. MRI of the brain and orbits showed posterior staphyloma and increased axial length of the left globe.

The patient was seen by an endocrinologist, and blood tests for thyroid function were normal with no evidence of Graves disease.

The diagnosis of posterior staphyloma was made, and the patient was instructed to follow up within 1 year or as needed.


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