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Updated: Jun 23, 2026
08:18
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
A case of a rapidly progressing, recurrent orbital mass
Du Cheng1, Sharanya Deshmukh2, Leila Mabudian2
1Virginia Commonwealth University (VCU) Department of Ophthalmology, Richmond, Virginia, United States.
Summary
Orbital sarcoidosis, a rare condition, can present as a fast-growing mass. This case highlights the importance of advanced imaging like Chest CT for diagnosis, even with normal chest X-rays, and effective treatment with corticosteroids and methotrexate.
Area of Science:
- Ophthalmology
- Pulmonology
- Pathology
Background:
- Orbital masses can present diagnostic challenges.
- Sarcoidosis is an inflammatory condition that can affect various organs, including the orbit.
- Systemic symptoms are often associated with sarcoidosis, but presentation can vary.
Purpose of the Study:
- To report a case of orbital sarcoidosis.
- To highlight diagnostic challenges in orbital masses.
- To discuss treatment strategies for orbital sarcoidosis.
Main Methods:
- A case report was conducted.
- Magnetic Resonance Imaging (MRI) was used to evaluate the orbital mass.
- Excisional biopsy and histopathological examination were performed.
- Acid-Fast Bacilli (AFB) culture, Grocott's methenamine silver (GMS) stain, and flow cytometry were used to rule out other conditions.
- Chest X-ray and Chest Computed Tomography (CT) were utilized for systemic evaluation.
- Angiotensin-Converting Enzyme (ACE) and Lysozyme levels were measured.
Main Results:
- A 58-year-old woman presented with a fast-growing, recurrent orbital mass.
- Pathology revealed non-necrotizing granulomatous inflammation, consistent with sarcoidosis.
- Initial chest X-ray was unremarkable, but Chest CT revealed pulmonary nodules and hilar lymphadenopathy.
- ACE and Lysozyme levels were marginally elevated.
- The patient responded well to corticosteroids and methotrexate after surgical debulking.
Conclusions:
- Chest CT is more sensitive than chest X-ray for detecting systemic involvement in suspected sarcoidosis.
- Surgical intervention can be valuable for both diagnosis and symptom management of orbital sarcoidosis.
- A combination of corticosteroids and antimetabolites provides an effective long-term treatment for orbital sarcoidosis.
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