A 35 yr. old male presented with a 15 day history of proptosis in his right eye and pain on eye movement. There is difficulty in upwards and down wards gaze movements. CT scan showed a cystic lesion with a hyperdense opacity within it, located in the superior oblique muscle. Most probable diagnosis is :
Ans. is 'd' ie Cysticercosis cellulosae [Ref Kanski, 4/e, p572, General ophthalmics, 15/e, p 239; Parson 19th/e, p 512Let's see each option one by oneDermoidit can be easily ruled out as it is not found within the musclesIt is located subcutaneously along the embryonic lines of closure*Hemangiomacan be of two typesCapillary orCavernousCapillary hemangiomasare seen in the infants (90% of them present before the age of 6 months)The cavernous hemangiomamay present in the middle life but in slow growing and would not present so rapidly (within 15 days) as in this patientIt is mostly located within the muscle conePseudotumoralso k/a Idiopathic orbital inflammatory disease (IOID)Though it's a frequent cases of proptosis in adults and children, its signs and symptom easily rule it out.It is non-infections, non-neoplastic inflammatory condition characterized by :periorbital swellingchemosis andconjunctival inflammationophthalmoplegiaCysticercosis cellulosaeThough cysticercosis cellulosae commonly lodges in the subretinal space causing retinitis, but may also invade the extraocular muscles.On CT scan it appears as a cystic lesion with a hyperdense scolex inside.Orbital USG - Demonstration of a cystic lesion with a central hyperechoic highly reflective scolex is diagnostic.
Dermoid
Hemangioma
Pseudotumor
Cysticercosis cellulosae
Ocular Motility