F, a 34-year-old woman from a rural village in Eastern Uganda, was brought to the district hospital with a one-year history of progressive swelling around her left eye. Over time, the eye began to bulge outward, causing significant discomfort and double vision. Recently, the swelling had worsened, and F also noticed a decrease in vision in the affected eye. Her family was concerned as she was unable to carry out daily tasks.

On examination, F was found to have marked proptosis (forward displacement) of the left eye, with the globe visibly protruding from the orbit. The eye was red, and her eyelids were swollen, but there were no signs of discharge. The eye movements were restricted, particularly upwards and outwards, indicating potential involvement of the orbital muscles or nerves. Visual acuity in the left eye was reduced compared to the right. A palpation of the orbit revealed a firm, non-tender mass behind the eye, suggestive of a possible orbital tumour.

Further investigation with a CT scan, which was arranged at a regional hospital, showed a large mass occupying the left orbit, causing displacement of the eye and compression of the optic nerve. The differential diagnosis included an orbital tumour, such as a lymphoma or meningioma, though an inflammatory or infectious cause was also considered.

F lives in a remote area with limited access to healthcare. Her symptoms were initially attributed to a minor infection by her family, leading to delayed medical attention. The healthcare facilities in her village lacked the diagnostic tools necessary to evaluate her condition, requiring her to travel to a distant regional hospital for proper imaging and further management.

F was referred to an ophthalmologist at the regional hospital. The treatment plan involved a biopsy of the orbital mass to determine its nature, followed by appropriate therapy based on the diagnosis. If the mass was found to be malignant, she would require oncology services, which were only available in a major city, several hours away. In the interim, corticosteroids were administered to reduce inflammation and relieve some of the pressure on the optic nerve.

The key challenges included ensuring F could access timely and specialised care, given the distance to the nearest comprehensive medical facility. Additionally, the cost of travel, diagnostic tests, and potential long-term treatment posed significant financial burdens on her family.

F underwent a biopsy, which revealed a benign but aggressive orbital tumour, requiring surgical removal. She was scheduled for surgery at the regional hospital, with the hope of preserving as much vision as possible. Post-surgery, she would need regular follow-up to monitor for recurrence.

This case highlights the difficulties faced in diagnosing and managing complex conditions like proptosis in sub-Saharan Africa, where access to specialised care is often limited and delayed diagnosis can lead to complications.