A Case of Nodular Fasciitis Causing Compressive Optic Neuropathy

Abstract

A 16-year-old girl with worsening vision, new OD visual field deficits, and tumor in right orbital apex underwent biopsy and surgical excision. Orbital imaging revealed an apical tumor causing bony erosion. Histopathology confirmed the diagnosis of nodular fasciitis. This is a rare diagnosis, and one that can mimic a neoplastic process. To the authors' knowledge, this is the first case of nodular fasciitis in the deep orbit and the first case of nodular fasciitis causing an optic neuropathy.

Nodular fasciitis of the orbit: rapid growth phase post iatrogenic incisional trauma

“…Given their rapid growth, high cellularity, increased mitotic activity and local infiltrative growth pattern, these benign lesions can often be misdiagnosed as a dermoid cyst or as more sinister pathology such as malignant sarcoma and lead to inappropriate management [ 1 , 3 ]. Orbital NF is a rare occurrence accounting for <1% of all orbital lesions, adding further complexity to its diagnosis and compressive optic neuropathy is the most concerning sequalae for orbital lesions [ 4 , 5 ].…”

Epibulbar Nodular Fasciitis

“…Nodular fasciitis occurs in a variety of anatomical locations in both adult and pediatric populations, without gender predilection. Ocular involvement is rare but documented, especially in the orbit and adnexa [ 1 , 2 , 3 , 4 ]. Epibulbar nodular fasciitis is extremely rare, with seven reported cases prior to ours [ 1 , 5 , 6 , 7 , 8 , 9 ].…”