Proptosis from a Baerveldt tube shunt implant.

PURPOSE: The purpose of this case report is to describe a patient presenting with unilateral proptosis associated with a Baerveldt tube shunt implant that had been previously implanted for treatment of elevated intraocular pressure not sufficiently responsive to pressure-lowering medications. Because this particular device is impregnated with barium, it is radio-opaque and must be discriminated from ferromagnetic and other foreign bodies in the differential diagnosis of orbital space-occupying lesion. Although the incidence of proptosis resulting from glaucoma drainage devices is rare, radiologists and ophthalmic clinicians must be aware of this possibility as well as the appearance of these devices in orbital imaging.

CASE REPORT: A patient with advanced glaucoma presented for an intraocular pressure check. Upon examination, proptosis was noted in the left eye. Exophthalmometry was performed and revealed asymmetry between the eyes. The patient was sent for a computed tomography scan of the orbits that revealed a foreign object in the left eye, which was identified as a Baerveldt tube shunt with surrounding fibrosis. The patient was sent to a glaucoma specialist for a consult regarding the efficacy of the implant.

CONCLUSIONS

Late-onset proptosis is a rare complication of a glaucoma implant but can lead to concern for an orbital mass or other pathology, which should be ruled out. Also, because this particular device is impregnated with barium, it is radio-opaque and must be discriminated from other metallic foreign bodies.