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55-Year-Old Female with Right Eye Pain and Vision Loss Over 3 Months
This case features a 55-year-old female presenting with right eye pain and progressive vision loss over three months, ultimately diagnosed with orbital amyloid.
Imaging overview:
Coronal T2 fat-saturated, axial T1 post-contrast fat-saturated, and axial ADC sequences demonstrate mild right proptosis with heterogeneous intraconal and extraconal fat enhancement and increased T2 signal, along with associated mild diffusion restriction and enlarged extraocular musculature. These findings, highlighted by the yellow arrows on the annotated images, reflect the infiltrative nature of amyloid deposition within the orbit.
Clinical insight:
Orbital amyloid is challenging to diagnose by imaging alone, as its appearance overlaps significantly with a broad differential that includes idiopathic orbital inflammation secondary to IgG4-related disease, lupus, or sarcoidosis, as well as primary amyloidosis and orbital lymphoma. ADC values can serve as a useful discriminator — lymphoma typically demonstrates markedly restricted diffusion with ADC values below 600 × 10⁻⁶ mm²/s, while orbital amyloid tends to show only mild restriction. Clinical correlation and tissue biopsy remain essential for definitive diagnosis.
Case courtesy of Lakir Patel, MD & Saumya Gurbani, MD, Emory University.