An Unusual Case of Bilateral Exophthalmus

Overview

Differ ential diagnosis of swelling in the region of orbita is relative broad. Exophthalmusmay be caused by inborn defects, injuries, inflammations or tumors of orbita. The diagnosisand therapy of these conditions mostly requires a interdisciplinary approach with participation ofthe otolaryngologist. About 8% of all edemas affecting orbita is caused by mococoele of auxiliarynasal cavities. The otolaryngologist also participates in the solution of endocrine orbitopathies incases, where a decompression operation is indicated. Although most diseases mentioned abovebecome manifest by affecting one eye, endocrine orbitopathy causes. This contribution describesan unusual case of tumour disease of orbita. In view of bilateral exophthalmus, clinical course andcharacter of the infiltrate during the examination by magnetic resonance and computer tomography,endocrine orbitopathy was taken into consideration. This diagnosis was also supported bysonographic finding of enlargedthyroid gland.Thecorrect diagnosis of bilateralmetastasis of breastcancer was only established on the basis of histological examination in the course of decompressionoperation. The differential diagnosis of swelling in the region of orbita and, particularly, thealgorithm of individual diagnostic procedures are discussed. The imaging examinations and probatoryexcision of the tumor tissue under suitable surgical procedure should play a key role. Ina unilateral non-inflammatory affection of orbita, primary or secondary tumor or metastasis intoorbita should be considered. The bilateral affections may include endocrine orbitopathy, andinflammatory pseudotumor of orbita affects both eyes in 20%of cases.Another possibility of bilateralaffection is the infiltration in lymphoproliferative diseases. Even metastases into orbita are notalways affecting one eye - the survey of literature indicates bilateral disease in around 5% of cases.It is therefore necessary to point out the necessity of general examination of the patient, which inour patient revealed an advanced primary breast cancer, affecting both mammary glands andregional lymphatic nodes.

Key words:
ex ophthalmus, orbita metastases, breast cancer.