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JAMA Ophthalmology Clinical Challenge
December 22, 2016

Recalcitrant Orbital Pain in a 50-Year-Old Woman

Author Affiliations
  • 1Department of Ophthalmology, University of California–San Francisco, San Francisco
JAMA Ophthalmol. Published online December 22, 2016. doi:10.1001/jamaophthalmol.2016.3783

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.

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