Dear Editor,
The authors report a case of a 55-year-old man with no medical or ophthalmic history who presented to the emergency room with a history of right eye pain and vision loss. He reported that the eye has been “bulging” with a gradual increase in pain for at least 6 months. He did not seek prior medical advice and presented due to the pain and “draining” eye. On examination, his visual acuity was no light perception in the right eye. The globe was proptotic with intraocular content prolapsed through a perforated cornea [Figure 1a]. Magnetic resonance imaging [Figure 1b] demonstrated a large orbital mass causing inferior displacement of the globe. The patient underwent enucleation and orbitotomy for mass removal. The encapsulated mass was completely excised [Figure 1c]. Histopathologic examination of the mass revealed a pleomorphic adenoma.
Figure 1.
(a) External photograph depicting right eye corneal perforation with prolapse of intraocular contents. (b) Axial magnetic resonance imaging demonstrated a large intra- and extraconal mass causing inferior displacement of the globe. (c) Gross appearance of the encapsulated mass
Although progressive proptosis from an orbital mass can lead to vision loss, it is unusual to present as frank corneal perforation and blindness. On review of the literature, the authors are unaware of any other reported cases of corneal perforation due to a pleomorphic adenoma. The differential for orbital lesions is broad and includes inflammatory, infectious as well as neoplastic etiologies such as lymphoid tumors, cavernous malformations, lymphangiomas, and metastasis.[1,2] In addition, the most common primary ocular malignancy, choroidal melanoma, may invade the orbit.[3]
Many providers fail to recognize proptosis as an orbital sign. This case highlights how proptosis and exposure keratopathy can lead to blindness and perforation if not recognized early.
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Conflicts of interest
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