A 69-year-old woman was admitted for asthenia and fatigue in the course of a temporal arteritis sprout under maintenance glucocorticoid treatment.
The ophthalmologist consulted urgently for decreased visual acuity (VA), pain, tearing and difficulty opening the eyelids of the right eye (OD), associated with ipsilateral exophthalmos of unknown onset.
VA was 0.3 in the RE and 0.6 in the left eye (LE) with a relative afferent pupillary defect of 3+/4+ in the RE.
There was mild conjunctival hyperemia, restrictions on supraduopia ipsilateral OD with dipl vertical and mild exophthalmos with eyelids edematous tension.
Intraocular pressure (IOP) was 15 mmHg and 17 mmHg in supraduction of the RE and 14 mmHg in the LE.
The macula was normal and the papilla did not present edema or authenticity.
1.
Two months before, the VA was 0.8 in both eyes with incipient cataracts.
a CT scan of the orbit was requested in which there was thickening of the inferior rectus and lateral rectus muscles of the right eye, especially in the distal ethmile and orbital cellulitis with slight increase in fat.
1.
It was decided to start treatment with intravenous methylprednisolone 250 mg every 6 hours for 3 days.
The patient was evaluated 2 days later and reported significant improvement.
In the visual field, a concentric reduction is observed, which subsequently normalizes.
1.
After eight months, the VA of the RE operated on from cataracts is the unit, with normal pupillary reflexes and without papillary stenosis.
CT and MRI showed nonspecific occupation of the pterygopalatine fossa and orbital vertex with mild distal thickening of the inferior rectus and lateral rectus muscles compatible with an orbital pseudotumor.
