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At least 613 records · Page 34Linked to original sources
PubMed2006

Efficacy and side effects of 'swinging eyelid' orbital decompression in Graves' orbitopathy: a proposal for standardized evaluation of diplopia.

OBJECTIVES: To evaluate the efficacy and side effects of 'swinging eyelid' orbital decompression in patients with Graves' orbitopathy (GO). To calculate the incidence of postoperative new-onset diplopia (NOD) using a newly proposed scoring system for diplopia. METHODS: We reviewed the clinical data on proptosis, visual acuity, and diplopia in 104 consecutive patients (198 orbits) with GO, who underwent orbital decompression. A combined lateral canthal and inferior fornix incision ('swinging eyelid' approach) was used for removal of the medial wall, the orbital floor and, if indicated, the lateral wall. Indications for surgery were disfiguring/congestive GO (DGO) in 79 patients (149 orbits) and compressive optic neuropathy (CON) in 25 patients (49 orbits). Diplopia was scored according to four grades. In both groups, the incidence of new-onset (continuous) diplopia (NOD), deterioration of diplopia (DOD), and improvement of diplopia (IOD) were calculated, using strictly defined criteria. Our data on NOD were compared to those from other series, after recalculation according to our criteria. RESULTS: The mean proptosis reduction was 4.6 mm (range 0-9.5 mm) after three-wall decompression (95 patients, 180 orbits) vs 3.1 mm (range 0-7 mm) after two-wall decompression (nine patients, 18 orbits). The visual acuity improved in 98% of the patients with CON. In patients with DGO, NOD occurred in 14%. In patients with CON, NOD was not observed, but DOD occurred in 41%. Our data compare favourably to the reported incidence of NOD after either transantral or transnasal decompression. CONCLUSIONS: "Swinging eyelid' orbital decompression is efficacious for proptosis reduction as well as for optic nerve decompression. A scoring system for standardized evaluation of diplopia is proposed.

Adolescent↗
PubMed2006

Cosmetic orbital surgery.

PURPOSE: Current indications for orbital surgery primarily aimed at improving cosmesis are considered in the context of subspecialist orbital practice by an ophthalmologist. SCOPE: Thyroid eye disease, orbital vascular anomalies, and dermolipomas are common orbital diseases in which the symptoms can be purely cosmetic. Accurate anatomical awareness, preoperative scanning, control of medical factors including smoking and thyroid status, and endoscopic techniques have all contributed to the aesthetic outcome of orbital surgery. The threshold for performing reconstructive orbital surgery has also been lowered by public demand. CONCLUSIONS: Orbital surgeons can therefore offer the familiar techniques, such as orbital decompression, for pure cosmesis. Sensitive history taking and awareness of the psychological element are of paramount importance for the orbital surgeon who develops a cosmetic practice.

Decompression, Surgical↗
PubMed1998

[Epithelial giant inclusion cyst 50 years after enucleation without orbital implant].

BACKGROUND: Conjunctival cyst formation following enucleation may occur in 3% to 7% of patients receiving orbital implants, especially secondary implants. We present a patient with a giant epithelial inclusion cyst of the anophthalmic orbit 50 years after enucleation without orbital implant. PATIENT: A 54-year-old male presented with increasing proptosis of the ocular prosthesis, shallowing of the inferior fornix, a palpable orbital mass, and difficulty in retaining the ocular prosthesis. At the age of 1 year enucleation of the right eye without orbital implant was performed following perforating ocular trauma. Results of examination of the other eye were unremarkable. Transillumination of the orbital mass was possible. The clinical diagnosis of an epithelial inclusion cyst was confirmed using ultrasonography and CT scan. An incision of conjunctiva and cyst wall and subsequent marsupialization were performed. Nine months postoperatively there was no evidence of recurrence of the cyst. The ocular prosthesis was well in place. CONCLUSION: Conjunctival cyst formation following enucleation may rarely occur in patients receiving orbital implants, especially secondary implants. The presentation of a conjunctival cyst formation following enucleation without orbital implant 50 years after surgery is noteworthy in comparison to implantation cysts which are known to occur more commonly within the first two years following secondary orbital implants.

Blast Injuries↗
PubMed2006

Adult medial orbital wall trapdoor fracture with missing medial rectus muscle.

We report the case of a 28-year-old man presenting with a medial orbital wall trapdoor fracture with a missing medial rectus muscle. We believe this to be the first case report of an adult medial orbital wall trapdoor fracture. Trapdoor fractures most commonly occur in the pediatric population, and those involving the medial orbital wall generally occur in areas with less developed ethmoid air cells. Since the present case followed neither pattern, a different injury mechanism was considered. The ethmoid air cells in this case were well developed, which may have played an important role in the pathogenesis of this adult medial orbital wall trapdoor fracture. Based on our findings, we propose a possible mechanism for a medial orbital wall trapdoor fracture in an adult. The cellular frames enable the medial bone to shift just minimally, regardless of the high orbital pressure during a blow. The excess volume of the orbital content escapes into the cells through narrow cracks; therefore, after a blow, it cannot move back completely into the orbit. Consequently, it pushes the shifted bone towards the orbit, becoming trapped in a manner similar to that of a check-valve mechanism.

Adult↗
PubMed2005

Inverted papilloma invading the orbit through the nasolacrimal duct: a case report.

PURPOSE: Inverted papillomas of the nose and paranasal sinuses are uncommon neoplasms, characterized by their tendency to recur and by their association with malignancy and invasive potential to the adjacent structures. The authors report a case of recurrent inverted papilloma of the nasal cavity and sinuses that eventually invaded the orbit through the nasolacrimal duct. METHOD: Assessment and management of a 47-year-old patient who presented with epiphora, left medial canthal area mass, proptosis and lateral displacement of his left eye associated with significant nasal obstruction. RESULTS: Computed tomography and magnetic resonance imaging studies revealed a mass filling the nasal cavities and sinuses, invading the left orbit without destruction of any orbital walls. During excision of the tumor, it was learned that the orbital component of the tumor was connected with the sinonasal tumor through the nasolacrimal duct without any bony defects of the orbit. Histopathology of tumor proved to be inverted papilloma with areas of malignant transformation. CONCLUSION: Athough a rare cause of proptosis, inverted papilloma with orbital invasion must be considered in the differential diagnosis of nasosinus tumors invading the orbit. The case presented demonstrates that these tumors may invade the orbit through the nasolacrimal duct in the absence of orbital wall defects.

Humans↗
PubMed2000

Somatostatin-receptor scintigraphy in Graves' disease: reproducibility and variance of orbital activity.

Somatostatin-receptor (SSTR) scintigraphy using the single photon emission computed tomography (SPECT) technique allows the assessment of orbital inflammation in patients with Graves' disease. Previous studies showed differences in orbital octreotide uptake already 4 hr after injection. In this study, analysis of inter-/intra-observer variance and reproducibility in the evaluation of orbital SPECT images was performed. First, SPECT data of one representative female patient with clinically active Graves' ophthalmopathy (GO), obtained 4 hr after intravenous injection of 110 MBq 111In-pentetreotide and processed by filtered backprojection, were analyzed. Transverse SPECT images were reconstructed, an optimal orbital image was selected and predetermined regions of interests (ROIs) for both orbits were positioned by three independent observers 15 to 19 times each. In a second step, SPECT data of 8 different patients with GO were evaluated in the same manner by four independent observers 3 to 4 times each. Variance component partitioning was used to compare the order of intra- and inter-observer variation. For the right and the left orbit, the inter-observer variance proportion was 90% and 79%, whereas intra-observer variance partition was 10% and 21%, respectively. The corresponding ratios 0.11 and 0.27 summarize the comparison of sources of variance. The overall reliability was 84%, representing the patients influence on the total variance. Intra-observer reliability for both orbits was 88%, 89%, 97% and 98% (mean over orbits), respectively for observers I to IV. Using the Spearman Brown prophecy formula it follows that two replications per patient are sufficient to ensure a minimum reproducibility of 90%, which is also confirmed by the low intra-observer variation. Furthermore, intra-class correlation as a measure of (multiple) observer reproducibility was 94%. In conclusion, due to the increased inter-observer variance proportion and the high variation in intra-observer reliability, evaluations of orbital SSTR scintigraphy have to be done by the same and experienced observer leading to comparable data. But an automatic and quantitative computerized technique for evaluation of these SPECT data should be exactly reproducible and probably lead to more accurate and representative results.

Adult↗
PubMed2004

Surgical timing in orbital fracture treatment: experience with 108 consecutive cases.

Orbital fractures can lead to esthetic deformities and functional impairments, and adequate surgical timing is considered important in obtaining good results from surgery. By means of chart review, a retrospective analysis was carried out in 108 consecutive cases of pure orbital fractures to investigate the differences in surgical timing and the correlations with patient age and clinical and radiographic findings. In this analysis, surgical timing of pure orbital fractures was strongly related to the combination of parameters such as anatomical location of the fracture, eventual exposure of the fracture, cerebrospinal fluid (CSF) leakage or penetrating wounds, age of patients, eventual functional impairments or muscle entrapment, and serious conditions of compression or ischemia. As the data confirmed, an urgent approach was considered indispensable in severe orbital apex fractures and in orbital fractures with CSF leakage, penetrating objects, or exposure. Early surgery was necessary within 3 days in children with diplopia (type IIIb) and mainly within 7 days in adults with double vision (type IIIa). Delayed surgery, within 12 days in all cases, was performed orbital wall fractures with no impairments (type II) or in orbital rim fractures (type I). Data from this retrospective analysis confirm the need for an aggressive approach to all orbital fractures. In our experience, surgery was performed within 12 days and most orbital fractures were treated during the first week after trauma, which is earlier than previously reported.

Adolescent↗
PubMed1990

The pathophysiology of the anophthalmic socket. Part I. Analysis of orbital blood flow.

A wide variety of complications of the anophthalmic socket develop in patients after enucleation, including enophthalmos, superior sulcus deformities, eyelid malpositions, implant migration and extrusion, poor prosthetic motility, and socket contraction. Changes in the orbital blood flow and metabolic activity of the socket tissues and atrophy of the orbital fat occurring after enucleation have been suggested as two theoretical mechanisms that result in the development of these clinical conditions. Lack of scientific evidence and a limited understanding of the pathophysiologic basis of the features of anophthalmos led us to evaluate the validity of these proposed mechanisms in an animal model. Selected parameters of the normal orbits were compared with the contralateral anophthalmic orbits at different time intervals after surgery. Orbital blood flow was studied with selective ophthalmic artery angiography and radioactive microsphere techniques. Ophthalmic arteriography demonstrated symmetric caliber and filling characteristics of the major orbital vessels of the control and experimental orbits, although their topographic course was slightly more tortuous in the anophthalmic socket. Results of radioactive microsphere analysis of capillary blood flow per weight of the different orbital tissue compartments of the animals in the long-term group showed no significant difference between the normal and anophthalmic sockets. These findings provide evidence that the circulation dynamics and blood flow to orbital tissues do not change after enucleation surgery.

Angiography↗
PubMed1990

The pathophysiology of the anophthalmic socket. Part II. Analysis of orbital fat.

The pathophysiologic mechanisms responsible for the clinical features of the anophthalmic socket are poorly understood. Atrophy of orbital fat has been thought to be a major contributing cause of enophthalmos and the superior sulcus deformities that develop after enucleation, but it has never been demonstrated histopathologically or confirmed by scientific analysis. This study was undertaken to investigate the changes that occur in the orbital fat compartment of the anophthalmic socket in an animal model by measuring orbital soft tissue mass and evaluating adipocyte cell size. Instead of reduction in the tissue mass, a statistically significant greater weight of the fat and connective tissue compartment was found in the anophthalmic orbit by nearly 13% compared to the control orbit in the animals in the long-term group. No significant change in the mean maximal diameter of adipocytes developed 7 months after enucleation. These analyses do not support the concept that orbital fat atrophy or a reduction of metabolic activity occurs in the anophthalmic socket in this animal model. From these results and our previous findings that the circulation dynamics and blood flow to orbital tissues do not change after enucleation, we propose that the pathophysiologic basis of the problems associated with anophthalmos is a disturbance in the spatial architecture and interrelationships of the multiple tissue components of the orbit, not a change in the orbital blood flow or development of fat atrophy.

Adipose Tissue↗
PubMed1999

Orbital volume expansion of dysthyroid ophthalmopathy by surgical placement of lateral rim implants: a case study.

PURPOSE: To measure the increase in orbital volume expansion effected by surgical placement of a lateral rim implant. METHODS: Computed tomography was used to obtain 1-mm axial sections of a normal human cadaver skull. A computer program was used to measure the orbital area of each section and integrate the sum of the areas to obtain the total orbital volume. Following placement of a lateral orbital rim implant, this procedure was repeated to obtain the new orbital volume. RESULTS: The orbital volume increased from 22.2 cm3 to 23.6 cm3 (an increase of 6%) following placement of the lateral orbital rim implant. CONCLUSION: Surgical placement of a lateral orbital rim implant can be an effective method of orbital volume expansion in dysthyroid ophthalmopathy.

Cadaver↗
PubMed2002

Computed tomographic findings of distensible orbital venous anomalies.

PURPOSE: To describe the CT findings of distensible orbital venous anomalies. METHODS: We reviewed the records of 17 consecutive patients who met the imaging criteria for orbital venous anomalies. We analyzed the clinical data and the CT scans qualitatively and quantitatively. RESULTS: Distensible venous anomalies usually occupied both intraconal and extraconal spaces of the orbit (65%). The contour of the mass was ovoid or fusiform in 3 of the orbits (18%) and tubular or lobular in 14 orbits (82%). The optic nerve was encased by the mass in 8 orbits. Changes in the adjacent bone were detected in 9 orbits. The average volume of the venous anomalies was 1.1 mL in the axial scan and 5.7 mL in the coronal scan. The patients who showed clinically evident exophthalmos on the Valsalva maneuver had larger volumes than those who did not. CONCLUSIONS: The orbital structures adjacent to the distensible orbital venous anomalies were vulnerable to intermittent compression. CT scans, including both postcontrast axial and coronal images, were useful in demonstrating the presence of distensible venous anomalies, even in cases with no apparent exophthalmos on the Valsalva maneuver.

Adolescent↗
PubMed1998

Balanced orbital decompression for Graves' ophthalmopathy.

OBJECTIVE/HYPOTHESIS: Surgical management of Graves' ophthalmopathy is an alternative to medical therapy with corticosteroids or external beam radiotherapy. Orbital decompression has commonly been performed via a transantral approach to the medial orbital wall and floor. Although an endoscopic approach to these walls has been described, a balanced approach (incorporating a lateral decompression by an ophthalmology team) is desirable. STUDY DESIGN: Retrospective review. METHODS: Endoscopic medial decompression and extended lateral decompression were accomplished in 18 orbits (11 patients); inferior decompression was performed in 11 of these. Five additional procedures were performed. RESULTS: Exophthalmos improved by a mean of 4.6 mm. All patients who underwent decompression for vision loss had improved vision after surgery. Exposure keratitis improved in six of six orbits. Two of five patients undergoing orbital decompression for vision loss developed postoperative diplopia, which was successfully treated with strabismus surgery or prism glasses. There were no other significant complications. CONCLUSIONS: The endoscopic approach to the medial orbital wall is an important component of balanced orbital decompression for patients with Graves' ophthalmopathy. Balancing the decompression and preserving the medial orbital strut between the ethmoid cavity and the orbital floor may minimize the risk of diplopia.

Adult↗
PubMed1997

Orbital trauma.

This article is a review of recent advances in the evaluation and treatment of orbital and periorbital trauma. We present the pertinent literature from the past year dealing with orbital injuries, orbital imaging, assessment and management of orbital fractures, and traumatic optic neuropathy. Managing orbital trauma can utilize different approaches to achieve the same final goal: the restoration of normal orbital and craniofacial anatomy and the return of function. We provide the perspective of our orbital and ophthalmic plastic and reconstructive practice and relate the recent literature to our current treatment of orbital trauma. We find that often a multidisciplinary effort is advantageous for managing complex orbital and craniofacial injury.

Eye Injuries↗
PubMed2005

Expanding MIRAgel scleral buckle simulating an orbital tumor in four cases.

PURPOSE: To describe four patients with an enlarging orbital mass from a swollen MIRAgel scleral buckle that simulated an orbital neoplasm. METHODS: In a retrospective, single-center case series at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University, 4 eyes of 4 patients were referred for evaluation and treatment of a suspected orbital tumor. RESULTS: The initial presenting features were orbital mass (case 1), strabismus (case 2), and conjunctival mass with orbital extension (cases 3 and 4). Each patient vaguely recalled previous uncomplicated retinal detachment surgery 12 to 20 years earlier. Confirmation of the buckling implant material was made with the retina surgeon in 3 cases. A nontender, forniceal conjunctival mass, deep to the Tenon fascia and appearing as a translucent firm elevation was seen in all 4 cases. Axial CT (case 1) revealed a circumscribed anterior temporal orbital mass, believed to be a large inclusion cyst, 4 times thicker than the nasal scleral buckle. Ocular ultrasonography depicted an echolucent mass in the episcleral region (cases 3 and 4) that was 2 times thicker than the nasal scleral buckle (case 3). Excision was attempted in case 1, but only piecemeal removal was achieved, leading to extensive postoperative inflammation and decreased vision. The other 3 cases were followed conservatively without excision because they were each recognized to be a swollen MIRAgel implant and not an orbital tumor. CONCLUSIONS: MIRAgel scleral buckle material can greatly enlarge over a period of 10 years and simulate an orbital tumor or orbital cyst. Patients often do not recall details of the retinal surgery. Caution is advised regarding excision of this material because it is friable and can lead to extensive postoperative inflammation.

Adult↗
PubMed2005

Endoscopic approach to orbital apex lesions.

PURPOSE: To examine the role of transnasal and transantral endoscopic surgical approaches in the management of apical orbital lesions. METHODS: Retrospective case series. RESULTS: Three patients underwent combined orbital and endoscopic surgery for treatment of apical orbital lesions. In two of these patients, the orbital apex was decompressed, which resulted in visual recovery. Using endoscopic approaches to the posterior orbit and orbital apex allowed better visualization, with minimal manipulation of tissues in an area where surgical access is limited. CONCLUSIONS: Apical orbital lesion management benefits from a multidisciplinary and individualized plan. Endoscopic approaches can be used to improve visualization and access to a difficult surgical area. They also allow extra instrumentation to be used through the relatively capacious paranasal sinuses. These advantages may obviate lateral orbitotomy in some situations. Although endoscopic techniques are useful for biopsy, debulking, and removal of orbital apex lesions, they may be more difficult to apply to an intraconal lesion at the orbital apex.

Biopsy↗
PubMedDate not supplied

Orbital complications of hydrogel scleral buckles.

PURPOSE: Hydrogel is a biocompatible osmotic expansile material used in contact lenses, scleral buckles, and orbital expanders. Three unique complications from hydrogel scleral buckle use are presented: orbital cellulitis mimicry, fornical shortening with orbital prosthetic intolerance, and orbital pseudotumor. METHODS: A retrospective chart review was conducted on three subjects with unknown hydrogel scleral buckle complications at a tertiary care oculoplastics practice. Demographics, imaging studies, and pathologic specimens were reviewed. RESULTS: All three patients had a history of encircling hydrogel scleral buckle placed for retinal detachment. The mean time from implantation to presentation was 10.7 years (range, 7 to 15 years). One patient had an onset of presumed orbital cellulitis caused by an enlarged buckle and no abscess. The second patient had inability to wear an evisceration prosthesis as the result of a shortened fornix from an enlarged hydrogel scleral buckle implant. The third patient presented with an orbital mass caused by the enlarged implant. In all cases, surgical removal of the expanded buckle relieved the patient's symptoms. CONCLUSIONS: Although the hydrogel scleral band is designed to expand in a controlled fashion, overexpansion can occur. Expansion can cause buckle extrusion, prosthetic intolerance, a pseudo-orbital cellulitis, or orbital pseudotumor and may be due to a chemical change in the hydrogel polymer. Patients with hydrogel scleral buckles should be followed long-term for possible complications. Patients with newer uses of hydrogel, such as orbital expanders, should also be observed for long-term complications.

Adult↗
PubMed2004

Reconstruction of orbital floor fracture using solvent-preserved bone graft.

The orbital floor is one of the most frequently damaged parts of the maxillofacial skeleton during facial trauma. Unfavorable aesthetic and functional outcomes are frequent when it is treated inadequately. The treatment consists of spanning the floor defect with a material that can provide structural support and restore the orbital volume. This material should also be biocompatible with the surrounding tissues and easily reshaped to fit the orbital floor. Although various autografts or synthetic materials have been used, there is still no consensus on the ideal reconstruction method of orbital floor defects. This study evaluated the applicability of solvent-preserved cadaveric cranial bone graft and its preliminary results in the reconstruction of the orbital floor fractures. Twenty-five orbital floor fractures of 21 patients who underwent surgical repair with cadaveric bone graft during a 2-year period were included in this study. Pure blowout fractures were determined in nine patients, whereas 12 patients had other accompanying maxillofacial fractures. Of the 21 patients, 14 had clinically evident diplopia (66.7 percent), 12 of them had enophthalmos (57.1 percent), and two of them had gaze restriction preoperatively. Reconstruction of the floor of the orbit was performed following either the subciliary or the transconjunctival approach. A cranial allograft was placed over the defect after sufficient exposure. The mean follow-up period was 9 months. Postoperative diplopia, enophthalmos, eye motility, cosmetic appearance, and complications were documented. None of the patients had any evidence of diplopia, limited eye movement, inflammatory reactions in soft tissues, infection, or graft extrusion in the postoperative period. Providing sufficient orbital volume, no graft resorption was detected in computed tomography scan controls. None of the implants required removal for any reason. Enophthalmos was seen in one patient, and temporary scleral show lasting up to 3 to 6 weeks was detected in another three patients. Satisfactory cosmetic results were obtained in all patients. This study showed that solvent-preserved bone, which is a nonsynthetic, human-originated, processed bioimplant, can be safely used in orbital floor repair and can be considered as another reliable treatment alternative.

Adolescent↗
PubMed2005

Treatment of zygomatic fractures without inferior orbital rim fixation.

Zygomatic fractures can be associated with functional and esthetic problems. Recent improvements in surgical techniques and materials have enabled stable fixation of zygmomatic fractures. Multiple-point fixation is most commonly used for internal fixation. Generally, reduction and fixation are performed through lateral brow, subciliary, temporal, or intraoral incisions (three-point fixation). Our experience indicates that postoperative scarring and sensory disturbances are caused by a subciliary incision with inferior orbital rim fixation. It is thus recommended that inferior orbital rim fixation with mini- or microplates be avoided. In patients in whom the fracture does not involve the orbital floor, reduction of the zygoma and zygomatic arch through a temporal incision is performed at this institution. Fixation of the lateral zygomaticomaxillary buttress and anterior wall of the maxilla with miniplates through an intraoral incision is also performed. If necessary, zygomaticofrontal suture fixation with a miniplate or wire is performed through a lateral brow incision. The status of inferior orbital rim reduction is confirmed by palpitation. Inferior orbital rim fixation with mini- or microplates is recommended for reduction of comminuted fractures and orbital floor fractures with herniation of internal orbit components. Patients who did not undergo inferior orbital rim fixation were free of inferior orbital rim deformity, diplopia, and postreduction rotation.

Adolescent↗