Ocular Findings in Juvenile Nasopharyngeal Angiofibroma

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is the most common benign neoplasm of the nasopharynx. While histologically benign, it has the propensity for aggressive local growth. This highly vascular tumor predominantly occurs in adolescent males. The literature fails to provide a thorough description of ocular complications and their incidence in JNA. This report summarizes the data from those clinical series detailing ocular findings in a total of 218 JNA cases. Exophthalmos was found in 14% of all cases. Decreased visual acuity and partial ophthalmoplegia occurred in 5% and 2% respectively. Recognition of ocular involvement in JNA is of the utmost importance, for it is often a manifestation of orbital or intracranial extension or both. We describe the diagnosis and management of a case of JNA in a five-year-old white male. The patient developed ocular findings of marked exophthalmos and optic atrophy. Early multidisciplinary diagnostic evaluation (otolaryngological, neurosurgical, and ophthalmological) followed by a team surgical approach to excision is most likely to yield efficacious results.

Loss of Reflex Tearing: An Expected Consequence of Juvenile Nasopharyngeal Angiofibroma

“…The loss of reflex tearing is similar to other reported neurological deficits, such as facial pain or paresthesia and partial ophthalmoplegia. 13,[16][17][18] In this case, tearing deficit was likely caused by neuropraxic or axonotmetic injury of the nerve pathway to the lacrimal gland.…”

“…Ocular involvement of JNA frequently results in specific pathophysiologic signs that correlate with localized anatomic extension of the tumor. In a meta-analysis, Stern et al 16 reported proptosis in 14% of JNA; the proposed mechanism being tumor pressure on orbital structures. Additionally, optic atrophy is associated with tumor extension through the orbital fissure into the cranium.…”