1/ Just because the finding is obvious doesn’t mean the case is easy!
Here’s a thread about an interesting case that takes no time to make the finding, but a lot of time to get the diagnosis
2/ Elderly patient w/a very remote history of retinal detachment presented w/strabismus. On MRI, a tubular, cystic structure wrapped around the globe that looked like the very hungry caterpillar from the children’s books going around an apple. It did not enhance.
3/ On axial images, the cystic structure & the globe looked like a lying down snowman. It looked like a lacrimal duct cyst or dacryops—except it was right against the globe. Dacryops looks more like an decapitated snowman. The borders were also much more smooth
4/ Lower down, it also had smooth margins—it looked like a band aid. The smooth margins suggest a man-made structure. But this did not look like any glaucoma shunt or scleral band I had ever seen. That’s bc it wasn’t—it was a scleral band I had never seen
5/ This is a hydrogel scleral band that was discontinued in 1995 bc the band would absorb water & swell—just like the hungry caterpillar would eat food & swell. It would then become brittle & break apart. Swollen bands could also cause mass effect & strabismus as in this case.
6/ So the next time you see a swollen caterpillar around the eye, remember, hydrogel implants swell just like hungry caterpillars. So just like a caterpillar turns into a beautiful butterfly, you can transform this difficult case into a slam dunk!
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