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Acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas

An elderly diabetic lady presented with a painful swollen right eye and blurred vision for one week, preceded by right eye redness for six months. Her right eye best-corrected visual acuity was finger counting at 1 m. There was right eye proptosis, limited extraocular muscle movements, corkscrew ves...

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Main Authors: Khairul-Anwar, Ibrahim, Tai, Evelyn, Hussein, Adil, Zunaina, Embong
Format: Article
Language:English
Published: Cureus Inc 2021
Subjects:
RC627 Specialties of Internal Medicine-Metabolic Diseases
RE Ophthalmology
Online Access:http://irep.iium.edu.my/91750/7/91750_Acute%20proptosis%20in%20a%20diabetic%20patient%20diagnostic%20and%20therapeutic%20dilemmas.pdf
http://irep.iium.edu.my/91750/
https://www.cureus.com/articles/53395-acute-proptosis-in-a-diabetic-patient-diagnostic-and-therapeutic-dilemmas
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spelling my.iium.irep.917502021-08-26T08:04:36Z http://irep.iium.edu.my/91750/ Acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas Khairul-Anwar, Ibrahim Tai, Evelyn Hussein, Adil Zunaina, Embong RC627 Specialties of Internal Medicine-Metabolic Diseases RE Ophthalmology An elderly diabetic lady presented with a painful swollen right eye and blurred vision for one week, preceded by right eye redness for six months. Her right eye best-corrected visual acuity was finger counting at 1 m. There was right eye proptosis, limited extraocular muscle movements, corkscrew vessels, chemosis and elevated intraocular pressure, but no bruit. Fever was absent. Computed tomography of the brain and orbit showed thickened extraocular muscles and intraconal fat streakiness, with normal superior ophthalmic vein and concavity of the cavernous sinus. Intravenous antibiotics resulted in limited clinical improvement. The subsequent response to oral prednisolone was dramatic, with the improvement of visual acuity to 20/60 after three doses. In cases of atypical orbital cellulitis where antibiotics fail, one should consider differential diagnoses such as orbital inflammatory disease, vascular anomalies and masqueraders. We discuss the approach to the diagnosis of acute proptosis in a diabetic patient and highlight the role of corticosteroids in idiopathic orbital inflammatory disease. Cureus Inc 2021-06-10 Article PeerReviewed application/pdf en http://irep.iium.edu.my/91750/7/91750_Acute%20proptosis%20in%20a%20diabetic%20patient%20diagnostic%20and%20therapeutic%20dilemmas.pdf Khairul-Anwar, Ibrahim and Tai, Evelyn and Hussein, Adil and Zunaina, Embong (2021) Acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas. Cureus, 13 (6). pp. 1-4. ISSN 2168-8184 https://www.cureus.com/articles/53395-acute-proptosis-in-a-diabetic-patient-diagnostic-and-therapeutic-dilemmas 10.7759/cureus.15580
institution Universiti Islam Antarabangsa Malaysia
building IIUM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider International Islamic University Malaysia
content_source IIUM Repository (IREP)
url_provider http://irep.iium.edu.my/
language English
topic RC627 Specialties of Internal Medicine-Metabolic Diseases
RE Ophthalmology
spellingShingle RC627 Specialties of Internal Medicine-Metabolic Diseases
RE Ophthalmology
Khairul-Anwar, Ibrahim
Tai, Evelyn
Hussein, Adil
Zunaina, Embong
Acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas
description An elderly diabetic lady presented with a painful swollen right eye and blurred vision for one week, preceded by right eye redness for six months. Her right eye best-corrected visual acuity was finger counting at 1 m. There was right eye proptosis, limited extraocular muscle movements, corkscrew vessels, chemosis and elevated intraocular pressure, but no bruit. Fever was absent. Computed tomography of the brain and orbit showed thickened extraocular muscles and intraconal fat streakiness, with normal superior ophthalmic vein and concavity of the cavernous sinus. Intravenous antibiotics resulted in limited clinical improvement. The subsequent response to oral prednisolone was dramatic, with the improvement of visual acuity to 20/60 after three doses. In cases of atypical orbital cellulitis where antibiotics fail, one should consider differential diagnoses such as orbital inflammatory disease, vascular anomalies and masqueraders. We discuss the approach to the diagnosis of acute proptosis in a diabetic patient and highlight the role of corticosteroids in idiopathic orbital inflammatory disease.
format Article
author Khairul-Anwar, Ibrahim
Tai, Evelyn
Hussein, Adil
Zunaina, Embong
author_facet Khairul-Anwar, Ibrahim
Tai, Evelyn
Hussein, Adil
Zunaina, Embong
author_sort Khairul-Anwar, Ibrahim
title Acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas
title_short Acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas
title_full Acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas
title_fullStr Acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas
title_full_unstemmed Acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas
title_sort acute proptosis in a diabetic patient: diagnostic and therapeutic dilemmas
publisher Cureus Inc
publishDate 2021
url http://irep.iium.edu.my/91750/7/91750_Acute%20proptosis%20in%20a%20diabetic%20patient%20diagnostic%20and%20therapeutic%20dilemmas.pdf
http://irep.iium.edu.my/91750/
https://www.cureus.com/articles/53395-acute-proptosis-in-a-diabetic-patient-diagnostic-and-therapeutic-dilemmas
_version_ 1709667171976609792
score 13.211869

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