A 21-year-old man went to the doctor after discovering that his left eye was increasingly protruding from his skull, and discovered that he had a cyst behind his eye, which was caused by his chewing.
The rare situation, described in a case report published last week in BMJ Case Reports, is caused by a skull defect that allows jaw movement to place undue pressure on structures around the eye, interrupt his vision.
The patient first visited a clinic specializing in ophthalmic plastic surgery – complaining that his left eye has been increasingly protruding from his face over the past 18 months.
He also experiences oscillation, unstable vision in which the world around a person appears to be moving when it is actually stationary.
There was no pain associated with the new anterior position of the eye, and when the doctors investigated it, they found no difference between the vision in his eye and that he was able to move all of his eyes. his eye muscles. .
When the doctors dilated to examine the back of the eyeball, they found no problem with glare, but could see that the left eye had bulged about 3mm.
Eventually, doctors discovered the problem stemmed from a mass in the visceral space, an area in the muscles just behind the eyeball, but weren’t sure what it was. They believe it is made up of a tangle of bleeding capillaries, a tumor in the nervous system itself, or a fluid-filled cyst.
The third option turned out to be the culprit: a CT scan revealed a cystic lesion in the patient’s left eye 2 cm long and 2 cm wide.
Doctors realized that a pre-existing bony defect in the patient’s eye socket had allowed the cyst to expand into a skull structure known as the iliac fossa, through which nerves pass. then, the optic nerve itself will be displaced.
Once the problem was resolved, the question turned to how did the cyst get there.
Further examination of the patient revealed protrusion that persisted even at rest, worsening with chewing.
The case report states: “When chewing movements were repeated, the eyeball wobbled in an anteroposterior direction.
They may surgically remove the cyst, after which the patient reports that the oscillation is gone and the bulge is gone as well.
According to case reports, Dermoid cysts are the most common type of orbital cyst seen in infants and children, and dumbbell-shaped dermoid cysts account for approximately 6% of all dermoid cysts.
The case study makes it clear that for a person’s chewing to cause oscillation, they must also have a defect in the bone around the eye.
If the patient has this skeletal defect, jaw movements can push soft tissue into the eye or the muscles and nerves behind.
During the three years of postoperative follow-up, the patient had no recurrence of oscillation or protrusion.
“I am very happy that I do not have vision problems and facial deformities anymore,” the patient said in the case report. “I am grateful to the entire team of doctors who took care of them.”
The authors of the case report say this highlights the importance of asking patients about their chewing history and whether their vision changes during chewing.
