Case:
47 year old female patient has been referred to our clinic with the presumptive diagnosis of optic nerve glioma. Best corrected visual acuity was 10/10 (+0.50 D) on the right and 2/10 (+3.00 +0.75 axis 60) on the left. Anterior segment examination was normal on both sides and fundus examination revealed optic disc edema and vascular engorgement on the left. Right fundus appeared normal. Measurements taken with Hertel exoftalmometer (HE) was 16 mm on the right and 19 mm on the left. Magnetic resonance (MR) imaging revealed intraconal mass lesion typical for cavernous hemangioma. The patient has been operated with anterior orbitotomy via transconjunctival route and showed improvement in her proptosis, visual acuity and fundoscopic appearence. We report postoperative temporary medial rectus paralysis that persisted until 3 months postoperatively and resolved thereafter.
Discussion:
Utilizing imaging in deciding for the best approach in orbital surgery for intraconal mass lesions is the best strategy. Besides the loss of vision which is the most devastating complication, orbital surgery has many complications like diplopia, restrictive movements, mydriasis and extraocular muscle paralysis which are relatively less severe but may affect quality of vision. Reducing large masses such as hemangioma to remove from the orbit, reduce surgical time and allows surgical approach through the narrow space.
Keywords: intraconal cavernous hemangioma, transconjunctival anterior orbitotomy