A patient with a past ocular history of orbital lymphatic-venous malformation with left upper eyelid swelling and proptosis at childhood who underwent sclerosing therapy presents 7 years later with newly developed left upper eyelid swelling, proptosis, gaze limitations (mainly left elevation) and headaches over the last 3 weeks. Her exam was notable for visual acuity of 20/100 in the left eye, down from a baseline acuity of 20/25. No RAPD, color vision changes or optic nerve edema were present. Imaging re-demonstrated a left orbital cystic orbital lesion. Angiography of the brain did not show an arterial feeding vessel and did not allow for an intra-arterial intervention. symptoms worsened with IV steroids and a brief period of close observation. Sclerosing therapy of the lesion under direct visualization with sodium tetradecyl sulfate was carried out. Improvement in pain, proptosis and vision followed within the first post-operative week. At post-operative month 3, her vision improved to 20/25 in the left eye and the proptosis and EOM limitation resolved. The headaches significantly improved. Repeat imaging demonstrated significant improvement in the size of the lesion.
Presentation Date: 05/19/2022
Issue Date: 07/01/2022