Panophthalmitis complicated by optic neuritis

Case contributed by Dr Ammar Haouimi

Presentation

Purulent discharge from the right eye with pain and extensive orbital and periorbital edema. An intraocular lens implant was performed on the same side one year ago.

Patient Data

Age: 90 years
Gender: Female

The MRI sequences demonstrate:

  • areas within the vitreous chamber of the right globe of intermediate signal on T1, intermediate to high signal on FLAIR/T2 with no enhancement, representing most likely vitreal exudates
  • diffuse smooth uveal/scleral thickening with enhancement
  • retinal detachment
  • swelling with enhancement of the retrobulbar intra-orbital segment of the optic nerve and surrounding nerve sheath (optic neuritis)
  • extensive intraorbital/peribulbar fat stranding with enhancement
  • abnormal swelling with enhancement of the orbital muscles
  • edematous infiltration with enhancement of the periorbital soft tissues
  • the cavernous sinuses are patent

Note a slow flow within the left transverse/sigmoid sinuses and internal jugular vein mimicking thrombosis. Their patency is confirmed on enhanced sequences.

Case Discussion

MRI features are most consistent with a right panophthalmitis with associated optic neuritis

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