Introduction Orbital pseudotumor is a rare, idiopathic inflammatory disorder within the orbit that presents with ptosis, eye swelling, pain, and sudden vision loss.
Case Presentation A previously healthy 13-year-old African American male presented with a 3-day history of eye swelling, redness, pain, and discharge that did not resolve with topical antibiotics and progressed to include vision loss on the day of consultation. Physical examination showed ptosis of the right upper lid with lower lid chemosis and bilateral subconjunctival hemorrhage. The cornea and lens were clear, and the pupils were equal and reactive to light. Extraocular movements were limited due to pain, but upward and downward movement was present. Fundoscopic examination showed sharp disk margins with an attached and well-perfused retina. His visual acuity was 20/200 OD and 20/20 OS. CBC, electrolytes, and ESR were all normal. Orbital CT scan showed preseptal soft tissue stranding, with no focal abscess or hemorrhage. The orbital contents appear intact and symmetrical in appearance. The impression of ophthalmology consultation was orbital pseudotumor, and high-dose prednisone was prescribed. Visual acuity improved in 3 days, and the patient completely recovered with no sequelae.
Discussion Orbital pseudotumor is a rare, benign inflammatory disorder of the orbit. It is a diagnosis of exclusion in patients presenting with eye pain, ptosis, chemosis, and vision loss. The differential diagnosis includes orbital cellulitis, allergic conjunctivitis, autoimmune diseases, and syphilis. CT scan or MRI of the orbit with normal serologic tests and a rapid response to steroids clinch the diagnosis. Since it affects the vision, early diagnosis is crucial, so ophthalmology referral and immediate treatment with corticosteroids are essential for optimal outcome.
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