Unilateral exophthalmos and strabismus due to cranio-mandibular osteopathy

A nine-month-old male West Highland white terrier puppy presented because of non-painful exophthalmos and strabismus of the left eye. Ultrasonographic examination of the globe and retrobulbar space showed abnormal prominence of the dorsal and medial bony wall of the orbit resulting in compression of the retrobulbar structures and indentation of the globe. A similar but less dramatic finding was present in the clinically unaffected right eye. Radiographic examination demonstrated the presence of extensive, active new bone on the frontal and parietal bones, with almost total occlusion of the frontal sinuses. In view of the dog's breed and age a tentative diagnosis of craniomandibular osteopathy was made. Although the dog was clinically well at the time of the initial presentation he sub-sequently suffered an acute episode of severe pain, pyrexia and depression with marked swelling of the periocular tissues and conjunctival oedema. This episode responded well to symptomatic treatment with corticosteroids and analgesics and the dog has continued to progress well with a reduction in the degree of deviation of the eye.