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JAMA Ophthalmology Clinical Challenge
August 2014

Numbness of the Forehead

Author Affiliations
  • 1Department of Ophthalmology, University of California, San Francisco
JAMA Ophthalmol. 2014;132(8):1013-1014. doi:10.1001/jamaophthalmol.2014.1415

An 86-year-old man presented with left forehead numbness and intermittent left eyelid edema for the past several months. His medical history was significant for hypertension, gastroesophageal reflux, and prostate cancer. On examination, uncorrected visual acuity was 20/25 OU, pupils were equal and reactive to light without afferent defect, confrontational fields were normal, and ocular motility was full. External examination was significant for decreased sensation in the distribution of the ophthalmic branch of the left trigeminal nerve. A palpable mass was appreciated at the left supratrochlear notch. There was 4 mm of proptosis and 2 mm of inferior globe dystopia, with increased resistance to retropulsion in the left eye. Magnetic resonance imaging of the orbits demonstrated an infiltrating superomedial mass involving the extraconal and intraconal space on the left side (Figure 1).

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