View 2019 Abstracts

TitlePost-radiation orbital fibrosis: A newly described cause of frozen orbit.
Submitted byGregory Fincham
Abstract Number330
Review Resultposter presentation
Purpose

To describe a case of unilateral orbital and paranasal sinus sclerosing fibrosis in a patient 14 years after high-dose radiotherapy for maxillary sarcoma.

Methods

In the past decade, a syndrome of radiation induced fibrosis has been increasingly recognised as a rare long-term side effect of radiotherapy. We present an orbital case and compare clinical, histological and radiological features with existing literature on post-radiation fibrosis (PRF) in other anatomic sites.

Results

A 47-year old man presented with diplopia, left ptosis and proptosis two weeks after DCR surgery outside our unit. He initially attributed symptoms to minor facial trauma. MRI showed a mass in the medial and inferior orbit. He underwent radical radiotherapy for left maxillary sarcoma 14 years before, so our initial differential was recurrent sarcoma or secondary lymphoma. However, biopsy revealed dense fibrotic tissue consistent with cases of delayed onset post-radiation fibrosis of lung and spine previously reported following high-dose radiation for lung and breast carcinoma. In this orbital case, PRF did not resolve spontaneously or with oral steroid therapy; extensive debulking of the mass reduced the strabismic angle but ophthalmoplegia persisted.

Conclusion

To our knowledge, there have been no previous reports of PRF of the orbit. This case illustrates a progressive chronic inflammatory response resulting in sclerosing fibrosis of orbital soft tissue and paranasal sinuses in a patient who had undergone previous high-dose radiotherapy. The response to oral steroids was poor with persistent frozen orbit, and literature suggests a trial of early intra-venous supra-physiological steroid therapy may be warranted in this rare and debilitating condition.


Additional Authors

Last nameInitialsCity / HospitalDepartment
FordRLBristol / Bristol Eye HospitalOculoplastics