Sens F. M., Messerli J., Meyer P.

University Eye Clinic Basel, Mittlere Str. 91, CH-4012 Basel

Objective: Pseudotumour orbitae is an unspecific orbital inflammation of unknown origin. The fibrotic pseudotumour is the most severe of 4 histological forms. With our case report, we want to show and discuss the difficulties in diagnosis and therapy one can be confronted with.
Patient and Method: We report the diagnostic procedures, therapy and clinical course in the case of a 34 years old Asian patient with fibrotic pseudotumour orbitae.
Results: An painful inflammation of the superior orbit with exophthalmos progressed under a therapy with nonsteroidal anti-inflammatory drugs and steroids. The histological diagnosis of pseudotumour orbitae was confirmed by biopsy, with no signs of a malignant tumour. In spite of high doses of steroids, an immunosuppression with antimetabolites and an irradiation of the orbit, chronic immobilising fibrosis the globe could not be prevented. Under irradiation, the process even progressed, proven by histology. Because of double vision and massive surface problems, a complete tarsorrhaphy was performed.
Conclusion: Although our patient with fibrotic pseudotumour was treated with the full spectrum of anti-inflammatory therapy, we failed stopping the inflammation completely. The process ended in a complete fibrosis of the intraorbital tissues with exophthalmos, motility disturbances and massive surface problems. In patients with clinical signs of pseudotumour orbitae, an early diagnosis and a staging of the inflammatory process is important. Immunosuppressive and antimetabolic treatment should not be delayed. The effect of irradiation is doubtful and should be discussed critically in the future.

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