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Primary intra-orbital optic nerve sheath meningioma in an adolescent: a case report
Abstract
Background: Primary optic nerve sheath meningioma is rare, but nearly always results in blindness; whether left alone or surgically treated.
Case report: A 19-year-old male student without antecedents presented to the ophthalmic service of the University of Ilorin Teaching Hospital, Ilorin, Nigeria, with a two-month history of progressive proptosis, pain, and a foul smelling discharge in the right eye. Upon clinical examination with a Hertel's exophthalmometer, the degree of axial proptosis of the right eye was found to be 20mm compared with 16mm in the left eye. Visual acuity was 6/18 in the right eye and 6/5 in the left eye, with a right relative afferent pupillary defect. An ocular ultrasound revealed intra-orbital soft tissue mass. Computed tomography (CT) scanning of the head was not done at this time due to financial constraints on the part of the patient. He thereafter defaulted from follow-up but re-presented a year later with more severe proptosis, conjuctival chemosis, infected exposure keratitis and total loss of vision in the right eye. A computed tomography of the head revealed an enhancing right retro-bulbar intra-orbital soft tissue mass. Enucleation of the right eye and complete extirpation of both the tumour and the intra-orbital optic nerve were carried out without complications. The histopathology revealed transitional meningioma of the optic nerve sheath. The patient is now socially rehabilitated, wears an artificial eye and has returned to his former occupation and society.
Conclusion: This case typically illustrates the complications that could arise if a treatable benign condition is left untreated because of limited affordable diagnostic facilities or the adoption of an unmonitored ‘observational strategy' in the early phase of the disease.
Nigerian Journal of Ophthalmology Vol. 14(1) 2006: 35-38
Case report: A 19-year-old male student without antecedents presented to the ophthalmic service of the University of Ilorin Teaching Hospital, Ilorin, Nigeria, with a two-month history of progressive proptosis, pain, and a foul smelling discharge in the right eye. Upon clinical examination with a Hertel's exophthalmometer, the degree of axial proptosis of the right eye was found to be 20mm compared with 16mm in the left eye. Visual acuity was 6/18 in the right eye and 6/5 in the left eye, with a right relative afferent pupillary defect. An ocular ultrasound revealed intra-orbital soft tissue mass. Computed tomography (CT) scanning of the head was not done at this time due to financial constraints on the part of the patient. He thereafter defaulted from follow-up but re-presented a year later with more severe proptosis, conjuctival chemosis, infected exposure keratitis and total loss of vision in the right eye. A computed tomography of the head revealed an enhancing right retro-bulbar intra-orbital soft tissue mass. Enucleation of the right eye and complete extirpation of both the tumour and the intra-orbital optic nerve were carried out without complications. The histopathology revealed transitional meningioma of the optic nerve sheath. The patient is now socially rehabilitated, wears an artificial eye and has returned to his former occupation and society.
Conclusion: This case typically illustrates the complications that could arise if a treatable benign condition is left untreated because of limited affordable diagnostic facilities or the adoption of an unmonitored ‘observational strategy' in the early phase of the disease.
Nigerian Journal of Ophthalmology Vol. 14(1) 2006: 35-38
