Schwannoma Masquerading as Recurrent Painful Ophthalmoplegic Neuropathy: A Diagnostic Dilemma.

Recurrent painful ophthalmoplegic neuropathy, or ophthalmoplegic migraine, is characterized by recurrent cranial nerve paresis following headache. Imaging may demonstrate cranial nerve enhancement during episodes, but absence of structural lesions is required for diagnosis. [J Pediatr Ophthalmol Strabismus. 2020;57:e68-e70.].

Case Report: Adenocarcinoma of the Lacrimal Gland Presenting as an Abduction Deficit.

SIGNIFICANCE: It is imperative to follow the clinical guidelines for abduction deficits to ensure prompt diagnosis of potentially serious etiologies and monitor only those in which a microvascular etiology is most likely. This case reports highlights a rare diagnosis of a malignant tumor of the lacrimal gland presenting as an abduction deficit. PURPOSE: Tumors of the lacrimal gland can cause abduction deficits, which may mimic an abducens nerve palsy. Abducens nerve palsies are often encountered by optometrists. This case report highlights the appropriate workup of an abduction deficit and reviews the literature of adenocarcinoma not otherwise specified. CASE REPORT: A 67-year-old white man was transferred to the optometry clinic with a presumed ischemic abducens palsy. He was found to have an isolated left abduction deficit without vascular risk factors that prompted neuroimaging revealing a mass of the lacrimal gland. After an en bloc resection, a diagnosis of adenocarcinoma not otherwise specified was made. The patient underwent aggressive surgical exenteration followed by radiation. CONCLUSIONS: Using the guidelines for evaluation of an abduction deficit, this serious malignancy was diagnosed. An adenocarcinoma not otherwise specified of the lacrimal gland is rare, and there are limited data on its clinical course, prognosis, and treatment. Recurrence and metastases occur at high rates; therefore, prompt diagnosis and aggressive intervention are crucial.

Imatinib mesylate (Gleevec) induced unilateral optic disc edema.

PURPOSE: Imatinib mesylate (Gleevec) is a chemotherapy medication developed to treat chronic myelogenous leukemia as well as gastrointestinal stromal tumors (Savage, N Engl J Med 2002;346:683-93). Ocular side effects are commonly reported with the use of imatinib mesylate, such as periorbital edema and epiphora. More serious ocular side effects, such as optic disc edema, are rarely reported. CASE REPORT: This case is of a patient who presented with monocular painless loss of vision in the left eye from a previously documented 20/20 to 20/70 shortly after starting treatment with imatinib mesylate. RESULTS: Every aspect of the ocular presentation and clinical history were addressed to unveil the cause of the disc edema. After ruling out all other causes, the patient was later diagnosed with unilateral optic disc edema as a related side effect of the toxicity from imatinib mesylate. CONCLUSIONS: The properties of imatinib mesylate and the possible etiology of secondary optic disc edema are discussed. This study aims to highlight the importance of systemic medications review for possible etiology of ocular disease as well as the multidisciplinary approach to managing oncology patients with ocular side effects.