Incidental hypoglobus: Primary amyloidosis of the superior rectus

The Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
Singapore medical journal (Impact Factor: 0.6). 02/2006; 47(1):65-7.
Source: PubMed


A 69-year-old man who presented with incidental hypoglobus was found to have an isolated superior rectus mass. Diagnosis of primary amyloidosis of superior rectus was made on incisional biopsy and negative systemic work-up. This is an unusual manifestation and site for amyloidosis and should be a differential of any extraocular muscle mass.

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    ABSTRACT: Background: While exophthalmus is quantifiable with readily available measurement tools, there is no such tool for hypoglobus/hyperglobus. Despite its possible life-threatening causes only few articles address the etiologies of vertical globe displacement in the current literature. The aim of our study was to describe etiologies of hypoglobus and to analyze the ratio of malignant diseases. Patients and methods: 3000 portrait photographs taken in our ophthalmology department between 2005 and 2009 were retrospectively screened for patients with vertical globe displacement. Pictures were assessed by three independent ophthalmology-trained observers and matched to the diagnosis based on patient records. Results: 95 patients with supposed vertical globe displacement were identified. Vertical globe displacement was due to an intracranial or orbital disease in 45 patients including 6 patients with a malignant disease. Additional 10 patients had thyroid associated orbitopathy. 11 patients turned out to have mere facial asymmetry, 26 patients had strabism and four patients had an ocular prosthesis. Conclusions: The etiologies of hypoglobus ranges from orbital fractures to life-threatening malignant tumors. Distinction between apparent and true hypoglobus can be challenging.
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