A 50-year-old woman presented to the emergency department for 3 months of right orbital pain. Her medical history was noncontributory. Examination revealed a right afferent pupillary defect, visual acuity of hand motion OD and 20/30 OS, full extraocular movements, and bilateral retinal dot blot hemorrhages. Magnetic resonance imaging (MRI) showed enhancement along the right intracanalicular optic nerve and adjacent sinuses (Figure). Glycosylated hemoglobin level was elevated at 10.3% (to convert to proportion of total hemoglobin, multiply by 0.01). Workup results for sarcoidosis, IgG4-related disease, seropositive and seronegative arthropathies, human immunodeficiency virus, tuberculosis, syphilis, Epstein-Barr virus, and herpes simplex virus types 1 and 2 were negative.
Kalin-Hajdu E, Vagefi MR, Levin MH. Recalcitrant Orbital Pain in a 50-Year-Old Woman. JAMA Ophthalmol. Published online December 22, 2016. doi:10.1001/jamaophthalmol.2016.3783