Bilateral Orbital Mass Lesions: a Presentation of Wegener’s Granulomatosis

A 33-year-old male patient presented with gradual and progressive protrusion of his left eye. He had a history of rhinoplasty for correction of nasal septal deviation 10 years ago. The patient developed intermittent bloody nasal discharge one year after rhinoplasty and underwent diagnostic paranasal sinus endoscopy and maxillary sinus antrostomy and biopsy. Histopathological studies had revealed a granulomatous leukocytoclastic vasculitis compatible with Wegener’s granulomatosis (WG). Treatment with prednisolone 25 mg/ day and Endoxan (cyclophosphamide) 100 mg/ day was initiated until orbital symptoms and signs appeared, 6 years later. At the time of presentation, uncorrected visual acuity was 20/20 in both eyes without relative afferent pupillary defect. Exophthalmometric readings were 22 and 27 mm on the right and left side, respectively. In addition, saddle nose deformity was noted (Fig. 1). Mild limitation of ocular movements was present in his left eye. Slit lamp biomicroscopy, tonometry and funduscopy were unremarkable in both eyes. Orbital computed tomography (CT) and magnetic resonance imaging (MRI) scans (Figures 2 and 3) revealed