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JAMA Ophthalmology Clinical Challenge
January 2017

Periorbital Mass Refractory to Outpatient Management

Author Affiliations
  • 1Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
JAMA Ophthalmol. 2017;135(1):73-74. doi:10.1001/jamaophthalmol.2016.2743

A Hispanic woman in her 60s presented to the oculoplastics clinic with a 1-week history of pain, redness, and swelling in the medial aspect of the right periorbital region. Her medical history included sarcoidosis, type 2 diabetes, hypertension, and coronary artery disease. Her ocular history included pseudophakia and proliferative diabetic retinopathy in both eyes; she had also undergone pars plana vitrectomy and panretinal photocoagulation in both eyes. Seven days prior to presentation, an ophthalmologist prescribed the patient oral amoxicillin-clavulanate, 500 mg 3 times daily, and topical antibiotics. However, her symptoms persisted and eventually worsened. She reported increasing swelling and pain in the affected region. She denied changes in vision, eye pain, or pain with eye movements. The patient’s best-corrected visual acuity was 20/60 OD and 20/50 OS, her pupils were reactive, extraocular motility was full and painless, and intraocular pressures were 18 mm Hg in both eyes. External examination revealed an erythematous, tender, firm mass in the medial periorbital area (Figure, A). Results of anterior slitlamp examination and dilated fundus examination were unremarkable. Contrast-enhanced computed tomographic imaging of the maxillofacial region was performed and showed a peripherally enhancing mass in the affected area (Figure, B).

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