A man’s chewing caused a cyst to form behind his eye: about a case

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A 21-year-old man went to the doctor after noticing his left eye protruding more and more from his skull, only to find he had a cyst behind his eye, which had been caused by his chewing.

The rare situation, described in a published case report BMJ Case Reports last week, arose due to a defect in the skull that allowed jaw movement to put excessive pressure on the structures around the eye, disrupting his vision.

The patient first visited an ocuplasty clinic – a clinic that performs cosmetic eye surgery – complaining that his left eye had been slowly bulging more and more out of his face over the past 18 months.

He also suffered from oscillopsia, an unsteady 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 forward position of the eye, and when doctors investigated, they found that there was no difference between the vision of his eyes and that he was able to move all of his eye muscles. .

When doctors dilated his eyes to inspect the back of the eyeball, they saw no obvious problem, but there was a visible bulge in his left eye of about three millimeters.

Eventually, doctors discovered the problem stemmed from a mass in the intraconal space, an area of ​​muscle directly behind the eyeball itself, but they weren’t sure what it was. They thought it was either made up of a tangle of bleeding capillaries, a tumor in the nervous system itself, or a dermoid cyst containing fluid.

The third option proved culpable: CT scans revealed a cystic lesion in the patient’s left eye measuring two centimeters long and two centimeters wide.

Doctors realized that a pre-existing bony defect in the patient’s eye socket allowed this cyst to extend into a cranial structure called the infratemporal fossa, which nerves pass through, displacing the optic nerve itself.

Once the problem was isolated, the question turned to how the cyst got there.

Further examination of the patient showed that the bulge in his eye, which persisted even when he was at rest, worsened when he chewed.

“During repeated chewing movements, the eyeball was seen to oscillate in the anteroposterior direction,” the case report states.

They were able to surgically remove the cyst, after which the patient reported that the oscillopsia had ceased and the bulge had disappeared.

According to the case report, dermoid cysts are the most common type of orbital tumors seen in infants and children, and dumbbell dermoid cysts account for about 6% of all dermoid cysts.

For a person’s chewing to cause oscillopsia, they must also have a defect in the bones around the eye itself, the case study clarified.

If a patient has this bony defect, jaw movement can push soft tissue into the eye or the muscles and nerves behind it.

During the three years of follow-up after the patient’s surgery, there was no recurrence of oscillopsia or protruding eyes.

“I am happy that I no longer have visual problems and facial disfigurement,” the patient said in the case report. “I am grateful to the entire team of doctors for their care.”

The case report authors said this highlights the importance of asking patients about their chewing history and whether their vision changes while chewing.

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