You are rotating on the medical service and are asked to make a diagnosis in a 52-year-old
man whose main complaint is "my eye is bulging". He note that the "bulge" was first
noted about 6 months ago and has gradually increased since then. In addition to noting
the unilateral exophthalamos you find that the patient has an ipsilateral diminished
sense of smell.
DIAGNOSIS: tumor involving the sphenoidal ridge and olfactory groove of the sphenoid
sinus. Unilateral exophthalamos can be seen in Grave's disease (rare), in orbital
and periorbital tumors (including lymphomas and leukemias), in aneurysms of the internal
carotid artery (this is associated with a systolic pulsation of the eye and an orbital
bruit). Bacterial and parasitic infections can also involve the sphenoid sinus and/or
orbital/retroorbital spaces and cause ipsilateral exophthalamos. Unilateral anosmia
can be an early and important sign of frontal lobe gliomas and meningiomas.
Picture of the patient showing his unilateral exophthalamos
.