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Poster 27 - Proptosis: A Sign of a Rare Nasopharyngeal Melanoma
logical therapy. Although primary ocular non-Hodgkin's lymphoma is rare, the systemic disease and treatment can directly or indirectly affect the ocular adnexa. This poster will review non-Hodgkin's lymphoma and a case of retinopathy in a patient with end-stage disease. Case Report: A &year-old man came to us with sudden vision loss in his right eye after heavy coughing. He had a history of Stage IV non-Hodgkin's lymphoma, for which he was receiving chemotherapy. Dilated fundus examination revealed severe anemic retinopathy OU secondary to the chemotherapy, and Valsalva retinopathy O.D. secondary to heavy coughing induced by occlusion of the trachea by the thymus. He was prescribed cough suppressants and underwent multiple transfusions to alleviate the anemia. Conclusion: Non-Hodgkin's lymphoma can affect the eye through numerous mechanisms. Direct cellular infiltration can occur and cause lid swelling, diplopia from extraocular muscle restriction, increased intraocular vressure, lacrimal gland or sac infiltration, infiltrative optic neuropathy, central retinal artery or vein occlusion, choroidal folds, and proptosis. Cells found in the anterior or posterior chamber can mimic a uveitis or vitritis in appearance. Many of the treatments of this disease may have ocular side affects. Retinopathy can occur from chemotherapy, radiation, and interferon use. This case illustrates non-Hodgkin's lymphoma may directly or secondarily affect the eyes and adnexa. These patients should be monitored closely for ocular involvement.
POSTER 27 Proptosis: A Sign of a Rare Nasopharyngeal Melanoma Susan Yee, O.D. Advance Eye Care, 3702 High Point Road, Greensboro, North Carolina 27407 Background: Nasopharyngeal cancer is difficult to detect due to its location and the lack of subjective symptoms. Many of the symptoms do not have ocular involvement. The more common symptoms reported include facial pain and nasal obstruction. Symptoms of diplopia and proptosis have been reported with large tumors. Among nasopharyngeal malignancies, spindle-cell melanoma is an uncommon finding in the area. A melanoma is diagnosed after a thorough examination of cell types manifest their ultrastructural features and reactions to specific tumor markers. Case Report: This case involves a 47-year-old man who came to us with ocular pain, reduced vision, severe proptosis, and corneal ulcer of the right eye. The onset of proptosis occurred 6 months earlier, following a blunt trauma to the face. No pain or decreased vision was noted at the time; therefore, he did not seek any medical treatment. Imaging tests (CT scan and MRI] revealed a large mass lesion with extension into the right nasal cavity, maxillary sinus, orbit, and the right frontal region. The patient was suspected of having either a mucocele-type lesion or a squamous cell carcinoma. However, a repeated biopsy revealed findings consistent with spindle-cell melanoma. The patient was a poor candidate for surgical excision. Therefore, he was being treated with radiation therapy. The corneal ulcer was treated with fortified ophthalmic antibiotics and a partial tarsorrhaphy.
OPTOMETRY
Conclusion: Nasopharyngeal melanoma is a rare malignancy of the head and neck. Only a limited number of cases have been cited in literature. A spindle-cell melanoma displays a specific set of cellular and structural characteristics. It also reacts to specific tumor markers. The present case explores the uniqueness of a nasopharyngeal melanoma and its various affects on the ocular system. The case also outlines the methods used to diagnose and treat a spindle-cell melanoma of the nasopharynx.
POSTER 28 Vascular Optic Neuropathies: A Case Series H. Simon Ghazi-Birry, M,D., Ph.D., 0 .D., and Erin R. Nosel, O.D. Southern College of Optometry, 1245 Madison Avenue, Memphis, Tennessee 38104 Background: Deficiency of vascular perfusion is a common etiological basis for many optic nerve pathologies. This poster will present three cases of vascular optic neuropathies, non-arteritic ischemic optic neuropathy (AION), diabetic papillopathy, and normal-tension glaucoma ,INTGI. ,. to demonstrate and discuss the recent studies in which a link between such pathologies has been shown. Visual fields (VFs],fundus photographs, MRI imaging, Bscans, and fluorescein angiograrns (FA]will be presented. Case Reports: Case 1: A 75-year-old man came to us with sudden vision loss (O.D.) upon wakening. There were no reports of other symptoms. Medical history included HTN and ischemic vascular disease. Examination revealed visual acuities of 201100 O.D., 20120 O.S.; 2 + APD, ( 2 +) disk swelling O.D., and an altitudinal inferior visual-field defect; O.S. CID: 0.2R (disk-at-risk).Stat ESR and CRP were normal. Diagnosis: Non-arteritic AION O.D. HTN medications were adjusted and ticlopidine was added, with stable results for the last 2 years. Case 2: A 28-year-old man with diabetes mellitus came to us with decreased visual acuities: 20130 O.D.; 20125 0,s.; normal EOMs and intraocular pressure with no RAPD and HBalc: 7%. Hyperemic optic nerve swelling with prominent dilated vessels were found O.S. > O.D., with a corresponding visual-field mild enlargement of the blind spot OU. Fluorescein angiograms revealed the presence of optic nerve telangiectasia OU. ESR, CRP, MRI, and CSF opening pressure were normal. Diabetic papillopathy OU was diagnosed; tight glycemic control and frequent followup were instituted. The optic nerve swelling was resolved at 9 months. Case 3: A 48-year-old man came to us for an eye examination. An hlo cardiomyopathy and a myocardial infarction 8 months earlier, with asystole followed by low BP for over 90 minutes, was elicited. Examination revealed visual acuities of 20125 O.D. and O.S., normal gonioscopy; intraocular pressure: 14 mmHg O.D. and 13 mmHg O.S.; CIDs: 0.7510.8 O.D. and 0.8R O.S., with a Drance heme (previous year CIDs: 0.45R O.D. and O.S.) and inferior arcuate defects with depression OU. Ultrasonography revealed bilateral carotid occlusive disease. Dingnosis: Normal-tension glaucoma OU. Travatanmand Azopt OU successfully lowered the intraocular pressure to 8 to 9 mmHg. No deterioration was detected for 1.5 years on this regimen.
VOLUME 76lNUMBER 611UNE 2005
POSTER 27 Proptosis: A Sign of a Rare Nasopharyngeal Melanoma Susan Yee, O.D. Advance Eye Care, 3702 High Point Road, Greensboro, North Carolina 27407 Background: Nasopharyngeal cancer is difficult to detect due to its location and the lack of subjective symptoms. Many of the symptoms do not have ocular involvement. The more common symptoms reported include facial pain and nasal obstruction. Symptoms of diplopia and proptosis have been reported with large tumors. Among nasopharyngeal malignancies, spindle-cell melanoma is an uncommon finding in the area. A melanoma is diagnosed after a thorough examination of cell types manifest their ultrastructural features and reactions to specific tumor markers. Case Report: This case involves a 47-year-old man who came to us with ocular pain, reduced vision, severe proptosis, and corneal ulcer of the right eye. The onset of proptosis occurred 6 months earlier, following a blunt trauma to the face. No pain or decreased vision was noted at the time; therefore, he did not seek any medical treatment. Imaging tests (CT scan and MRI] revealed a large mass lesion with extension into the right nasal cavity, maxillary sinus, orbit, and the right frontal region. The patient was suspected of having either a mucocele-type lesion or a squamous cell carcinoma. However, a repeated biopsy revealed findings consistent with spindle-cell melanoma. The patient was a poor candidate for surgical excision. Therefore, he was being treated with radiation therapy. The corneal ulcer was treated with fortified ophthalmic antibiotics and a partial tarsorrhaphy.
OPTOMETRY
Conclusion: Nasopharyngeal melanoma is a rare malignancy of the head and neck. Only a limited number of cases have been cited in literature. A spindle-cell melanoma displays a specific set of cellular and structural characteristics. It also reacts to specific tumor markers. The present case explores the uniqueness of a nasopharyngeal melanoma and its various affects on the ocular system. The case also outlines the methods used to diagnose and treat a spindle-cell melanoma of the nasopharynx.
POSTER 28 Vascular Optic Neuropathies: A Case Series H. Simon Ghazi-Birry, M,D., Ph.D., 0 .D., and Erin R. Nosel, O.D. Southern College of Optometry, 1245 Madison Avenue, Memphis, Tennessee 38104 Background: Deficiency of vascular perfusion is a common etiological basis for many optic nerve pathologies. This poster will present three cases of vascular optic neuropathies, non-arteritic ischemic optic neuropathy (AION), diabetic papillopathy, and normal-tension glaucoma ,INTGI. ,. to demonstrate and discuss the recent studies in which a link between such pathologies has been shown. Visual fields (VFs],fundus photographs, MRI imaging, Bscans, and fluorescein angiograrns (FA]will be presented. Case Reports: Case 1: A 75-year-old man came to us with sudden vision loss (O.D.) upon wakening. There were no reports of other symptoms. Medical history included HTN and ischemic vascular disease. Examination revealed visual acuities of 201100 O.D., 20120 O.S.; 2 + APD, ( 2 +) disk swelling O.D., and an altitudinal inferior visual-field defect; O.S. CID: 0.2R (disk-at-risk).Stat ESR and CRP were normal. Diagnosis: Non-arteritic AION O.D. HTN medications were adjusted and ticlopidine was added, with stable results for the last 2 years. Case 2: A 28-year-old man with diabetes mellitus came to us with decreased visual acuities: 20130 O.D.; 20125 0,s.; normal EOMs and intraocular pressure with no RAPD and HBalc: 7%. Hyperemic optic nerve swelling with prominent dilated vessels were found O.S. > O.D., with a corresponding visual-field mild enlargement of the blind spot OU. Fluorescein angiograms revealed the presence of optic nerve telangiectasia OU. ESR, CRP, MRI, and CSF opening pressure were normal. Diabetic papillopathy OU was diagnosed; tight glycemic control and frequent followup were instituted. The optic nerve swelling was resolved at 9 months. Case 3: A 48-year-old man came to us for an eye examination. An hlo cardiomyopathy and a myocardial infarction 8 months earlier, with asystole followed by low BP for over 90 minutes, was elicited. Examination revealed visual acuities of 20125 O.D. and O.S., normal gonioscopy; intraocular pressure: 14 mmHg O.D. and 13 mmHg O.S.; CIDs: 0.7510.8 O.D. and 0.8R O.S., with a Drance heme (previous year CIDs: 0.45R O.D. and O.S.) and inferior arcuate defects with depression OU. Ultrasonography revealed bilateral carotid occlusive disease. Dingnosis: Normal-tension glaucoma OU. Travatanmand Azopt OU successfully lowered the intraocular pressure to 8 to 9 mmHg. No deterioration was detected for 1.5 years on this regimen.
VOLUME 76lNUMBER 611UNE 2005