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JAMA Ophthalmology Clinical Challenge
March 26, 2020

A Mass in the Greater Wing of the Sphenoid in a Pediatric Patient

Author Affiliations
  • 1Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
  • 2Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
JAMA Ophthalmol. 2020;138(5):584-585. doi:10.1001/jamaophthalmol.2020.0372

A 4-year-old girl with no previous medical or ocular history presented with 10 days of right painless, periorbital swelling and erythema. The patient was previously treated with an oral combination of amoxicillin and clavulanic acid and topical gentamicin therapy without any improvement. The patient’s visual acuity, color vision, and pupillary examination results were within normal limits, and intraocular pressures were 28 mm Hg OD and 20 mm Hg OS. The extraocular movements and confrontational visual fields were normal. There was right upper and lower eyelid edema with mild erythema and 3 mm of proptosis. The eyelids were nontender to palpation. There was trace vasodilation and chemosis of the conjunctiva in the right eye. The remainder of the slitlamp and dilated fundus examination results were within normal limits. Computed tomography of the orbits and magnetic resonance imaging (MRI) of the brain and orbits showed a large lesion of the right greater wing of the sphenoid bone extending toward the orbital apex with edema and enhancement of the right temporal lobe of the brain (Figure 1).

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