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Surgical Excision of Orbital Cysticercosis Lodged in Superior Oblique Muscle: Clinical Case Report.

Ding J, Zhao H, Lin J - Medicine (Baltimore) (2015)

Bottom Line: Ocular motility examination revealed a restriction of the right eye in levoelevation.A contrast-enhanced computed tomographic scan of the orbit revealed the presence of a well-defined hypodense cystic lesion within the right superior oblique muscle.The patient was diagnosed with orbital space-occupying mass with acquired Brown syndrome.Surgical exploration of the superior oblique muscle was performed, and the cyst was removed from the eye and confirmed by histopathological examination.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Ophthalmology (JD, HZ); and Department of Oncology (JL), Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Key Laboratory of Ophthalmology and Vision Science, Tianjin, China.

ABSTRACT
Ocular cysticercosis refers to parasitic infections in humans. Most cases were treated by medicine. The case we reviewed was rarely reported with successful surgical intervention treatment.This case report describes a patient with cysticercosis existing in superior oblique tendon. The main symptom of the patient was recurring history of painless orbital swelling and double vision in upgaze. Ocular motility examination revealed a restriction of the right eye in levoelevation. A contrast-enhanced computed tomographic scan of the orbit revealed the presence of a well-defined hypodense cystic lesion within the right superior oblique muscle.The patient was diagnosed with orbital space-occupying mass with acquired Brown syndrome. Surgical exploration of the superior oblique muscle was performed, and the cyst was removed from the eye and confirmed by histopathological examination. After surgery, an ocular motility examination revealed orthotropia in the primary position and downgaze, with mild restriction in levoelevation.Surgical removal could substitute for medical therapy when the cysticercosis is lodged in the superior oblique muscle, although, prior to surgery, important factors, such as patient requirements, surgical skills of the surgeon, and cyst placement, should be considered.

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Clinical photograph of 9 diagnostic positions before operation and the measurements of deviation (showing limitation of elevation in adduction of the right eye). ET = esotropia, LHT = left hypertropia, Ortho = orthotropia, XT = exotropia.
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Figure 1: Clinical photograph of 9 diagnostic positions before operation and the measurements of deviation (showing limitation of elevation in adduction of the right eye). ET = esotropia, LHT = left hypertropia, Ortho = orthotropia, XT = exotropia.

Mentions: Upon ophthalmological examination, visual acuity was 20/20 in both eyes. The patient had normal stereoacuity of 40 seconds of arc. The ocular motility examination revealed orthotropia in the primary position; a restriction of the right eye in levoelevation was also noted (Figure 1). No significant incoordination of ocular movements was found in any gaze. Measurements revealed maximum diplopia in levoelevation. The patient exhibited 1 mm of left enophthalmos over the right eye, with erythema and mild edema in the tender right upper eyelid. A forced duction test of the right eye was positive for elevation in adduction. The anterior and posterior segments of both eyes showed no significant findings. A contrast-enhanced computed tomographic scan of the orbit revealed the presence of a well-defined hypodense cystic lesion within the right superior oblique muscle (Figure 2). The same lesion was observed using the orbital color Doppler ultrasound (Figure 3). No radiological signs indicating brain infection were found (neurocysticercosis). On the basis of the above findings, the patient was diagnosed with orbital space-occupying mass with acquired Brown syndrome.


Surgical Excision of Orbital Cysticercosis Lodged in Superior Oblique Muscle: Clinical Case Report.

Ding J, Zhao H, Lin J - Medicine (Baltimore) (2015)

Clinical photograph of 9 diagnostic positions before operation and the measurements of deviation (showing limitation of elevation in adduction of the right eye). ET = esotropia, LHT = left hypertropia, Ortho = orthotropia, XT = exotropia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554119&req=5

Figure 1: Clinical photograph of 9 diagnostic positions before operation and the measurements of deviation (showing limitation of elevation in adduction of the right eye). ET = esotropia, LHT = left hypertropia, Ortho = orthotropia, XT = exotropia.
Mentions: Upon ophthalmological examination, visual acuity was 20/20 in both eyes. The patient had normal stereoacuity of 40 seconds of arc. The ocular motility examination revealed orthotropia in the primary position; a restriction of the right eye in levoelevation was also noted (Figure 1). No significant incoordination of ocular movements was found in any gaze. Measurements revealed maximum diplopia in levoelevation. The patient exhibited 1 mm of left enophthalmos over the right eye, with erythema and mild edema in the tender right upper eyelid. A forced duction test of the right eye was positive for elevation in adduction. The anterior and posterior segments of both eyes showed no significant findings. A contrast-enhanced computed tomographic scan of the orbit revealed the presence of a well-defined hypodense cystic lesion within the right superior oblique muscle (Figure 2). The same lesion was observed using the orbital color Doppler ultrasound (Figure 3). No radiological signs indicating brain infection were found (neurocysticercosis). On the basis of the above findings, the patient was diagnosed with orbital space-occupying mass with acquired Brown syndrome.

Bottom Line: Ocular motility examination revealed a restriction of the right eye in levoelevation.A contrast-enhanced computed tomographic scan of the orbit revealed the presence of a well-defined hypodense cystic lesion within the right superior oblique muscle.The patient was diagnosed with orbital space-occupying mass with acquired Brown syndrome.Surgical exploration of the superior oblique muscle was performed, and the cyst was removed from the eye and confirmed by histopathological examination.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Ophthalmology (JD, HZ); and Department of Oncology (JL), Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Key Laboratory of Ophthalmology and Vision Science, Tianjin, China.

ABSTRACT
Ocular cysticercosis refers to parasitic infections in humans. Most cases were treated by medicine. The case we reviewed was rarely reported with successful surgical intervention treatment.This case report describes a patient with cysticercosis existing in superior oblique tendon. The main symptom of the patient was recurring history of painless orbital swelling and double vision in upgaze. Ocular motility examination revealed a restriction of the right eye in levoelevation. A contrast-enhanced computed tomographic scan of the orbit revealed the presence of a well-defined hypodense cystic lesion within the right superior oblique muscle.The patient was diagnosed with orbital space-occupying mass with acquired Brown syndrome. Surgical exploration of the superior oblique muscle was performed, and the cyst was removed from the eye and confirmed by histopathological examination. After surgery, an ocular motility examination revealed orthotropia in the primary position and downgaze, with mild restriction in levoelevation.Surgical removal could substitute for medical therapy when the cysticercosis is lodged in the superior oblique muscle, although, prior to surgery, important factors, such as patient requirements, surgical skills of the surgeon, and cyst placement, should be considered.

Show MeSH
Related in: MedlinePlus