Diagnostic and therapeutic challenges in non-specific orbital inflammation - a case report.

Objective: The aim of this report is to present the diagnostic and therapeutic approach in a case of non-specific orbital inflammation complicated with sight-threatening exposure keratopathy. Case presentation: An 81-year-old female patient presented to our Ophthalmology Department for left, painful, unilateral exophthalmia and decreased vision in the same eye. The clinical examination revealed left proptosis, inferior dystopia, upper lid edema, erythema and moderate retraction, ocular motility restriction, chemosis and corneal epithelial defect. The keratopathy complicated in evolution with hypopyon. The patient received treatment for the exposure keratopathy and, after every specific cause of unilateral exophthalmia was ruled out using imagistic and laboratory examinations, systemic corticosteroid treatment was initiated. Although the response to treatment was prompt, it was incomplete because of the long-standing evolution. Discussions: In this case, the diagnosis was difficult because a malignant breast tumor was encountered and an orbital biopsy was impossible to be performed. The presence of exposure keratopathy complicated with hypopyon imposed the exclusion of an infectious process and delayed the initiation of the corticosteroid therapy. Conclusions: The diagnosis and treatment of this disease represent a challenge given the need to rule out all the local and systemic conditions that may present with exophthalmia.

Unilateral Mooren's ulcer in a patient with bilateral partial optic nerve atrophy - a case report.

Objective: The aim of this report is to present the diagnostic and therapeutic approach in a case of long standing peripheral ulcerative keratitis of a patient with already decreased visual acuity due to preexistent optic nerve partial atrophy. Case presentation: A 58-year-old male patient presented to our clinic with unilateral pain, photophobia, tearing and decreased visual acuity in the right eye. The symptomatology began 4 months prior to the presentation, after trauma with a vegetative corneal foreign body, for which he received treatment in another Ophthalmology Service. After every specific cause of peripheral ulcerative keratitis was excluded, using extensive laboratory testing, the diagnosis of unilateral Mooren's ulcer in the right eye was established and the topical steroid treatment was initiated. A very good response to the treatment was observed, with complete resolution of the affliction. Discussions: Mooren's ulcer represents an idiopathic form of peripheral ulcerative keratitis. The diagnostic approach in this type of cases consists in the exclusion of infectious etiology (to safely use topical steroids) and of specific autoimmune etiologies. As the evolution of this pathology is severe with frequent complications, the treatment must be initiated as soon as possible. Conclusions: Despite being a rare diagnosis, Mooren's ulcer must be considered in cases in which clinical and paraclinical presentation is highly suggestive. A rapid therapeutic approach can offer good results despite the usual severe evolution of this disease.