Orbital Granulomata Associated with Widespread Angiitis.

CONSIDERABLE attention has been paid in recent years to cases in which necrotic granulomata have been found in association with widespread lesions showing angiitis of the polyarteritis nodosa type. Occasionally the orbit is the site of such a granuloma. Straatsma (1957), describing the ocular manifestations of Wegener's granulomatosis, and Cutler and Blatt (1956), making a similar survey of cases of lethal midline granuloma which they look upon as a more local manifestation of the same disease process, each quote a number of cases in which orbital granulomata were presenting or notable features of the disease. Walton (1958) describes proptosis as occurring in nearly 10 per cent. of such cases. Coop (1961) quotes a case of Wegener's granulomatosis (Faulds and Wear, 1960) presenting as an orbital pseudo-tumour, and Ring (1962) presents a similar case. Duke-Elder (1962), describing Wegener's granulomatosis, comments that "the condition is of considerable importance in ophthalmology, as it may first present, or only present, in the ocular or orbital tissues". A new case is here reported in some detail in which signs of an orbital granuloma and generalized vasculitis co-existed, but which differed in many clinical aspects from the classical description of Wegener's granulomatosis, even though the granuloma histologically resembled those found in this condition.