Neuro-ophthalmic manifestations of a complicated cholesteatoma.

BACKGROUND A cholesteatoma, also known as an epithelioma, is a mass of soft tissue that results from the accumulation of keratin protein debris enclosed by a layer of stratified squamous epithelium. CASE REPORT A patient with cholesteatoma surrounding both internal carotid arteries presented with cerebral ischemic symptoms expressed as visual and ocular symptoms. Because of its location, mass effect, and potential stenosis of the internal carotids, this slow-growing tumor is potentially sight threatening. Asymmetric cupping of the optic nerves associated with symptoms such as dizziness, diplopia, or facial pain should be worked up carefully. CONCLUSION The primary care optometrist can play an important role in the diagnosis and continued management of a patient with a cholesteatoma, carefully monitoring early signs of progression or change. This case illustrates how an intracranial lesion, away from the eye, can impact a number of ocular and visual functions.

[1]  M. Gleeson,et al.  The inner ear and the neurologist , 2007, Journal of Neurology Neurosurgery & Psychiatry.

[2]  J. Pulec.  Cholesteatoma of the Cerebellopontine Angle , 1998, Ear, nose, & throat journal.

[3]  B. Thompson,et al.  Ocular ischemic syndrome after occlusion of both external carotid arteries. , 2005, Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society.

[4]  R. Lufkin,et al.  Congenital Implantation Cholesteatomas of the Occipitoparietotemporal Junction , 2002, The Annals of otology, rhinology, and laryngology.

[5]  M. Kupersmith,et al.  Cupping of the optic disc with compressive lesions of the anterior visual pathway. , 1984, Annals of ophthalmology.

[6]  D. Hadley,et al.  Syndromes of the orbital fissure, cavernous sinus, cerebello- pontine angle, and skull base , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[7]  Albino Ap,et al.  Cholesteatoma: a molecular and cellular puzzle. , 1998 .

[8]  M. Zaal,et al.  Scleral Melting in a Patient With Carotid Artery Obstruction , 2006, Cornea.

[9]  T. Sakaki,et al.  Effect of Carotid Endarterectomy on Chronic Ocular Ischemic Syndrome Due to Internal Carotid Artery Stenosis , 2001, Neurosurgery.

[10]  J. Rizzo,et al.  Quantitative analysis of optic disc cupping in compressive optic neuropathy. , 1995, Ophthalmology.

[11]  M. Brown.  IDENTIFICATION AND MANAGEMENT OF DIFFICULT STROKE AND TIA SYNDROMES , 2001, Journal of neurology, neurosurgery, and psychiatry.

[12]  M. Matsumura,et al.  Optic nerve compression by normal carotid artery in patients with normal tension glaucoma , 2005, British Journal of Ophthalmology.

[13]  R. Irving,et al.  Facial palsy secondary to cholesteatoma: analysis of outcome following surgery , 2006, The Journal of Laryngology & Otology.

[14]  K. L. Moore,et al.  Clinically Oriented Anatomy , 1985 .

[15]  D. Schaff.  Common Questions About Transient Ischemic Attacks , 1997 .

[16]  A. Safran,et al.  Cholesteatoma of the sphenoid sinus presenting as painful optic neuropathy , 1994 .

[17]  M. Mafee.  MRI and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. , 1993, The Journal of otolaryngology.

[18]  C. Tulleken,et al.  Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors. , 1997, Stroke.