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At least 685 records · Page 38Linked to original sources
PubMed1999

Orbital development after enucleation in early childhood.

PURPOSE: To identify growth retardation in the orbits of children who have undergone enucleation and orbital implantation. METHODS: Children who underwent unilateral enucleation for retinoblastoma were examined. Any patient who had received external beam radiation or chemotherapy was excluded. Follow-up time was 5.5 to 10 years (mean, 8.33 years). Several linear measurements were made on the enucleated orbit and the fellow orbit. These measurements were compared using the paired Student t test and multivariate analysis of variance. RESULTS: There was no statistically significant difference in any of the measured orbital dimensions between the enucleated and fellow orbits. CONCLUSIONS: Enucleation in children, when combined with a large orbital implant, does not cause orbital growth retardation.

Child↗
PubMed1999

Removal of orbital apex hemangioma using new transorbital craniotomy through suprabrow approach.

PURPOSE: To describe a technique combining the expertise of the oculoplastic orbital surgeon and the neurosurgeon which allows access to the posterior orbit, anterior fossa, cavernous sinus and suprasellar region with minimal brain manipulation. METHODS: A transorbital craniotomy through a suprabrow incision is performed removing part of the frontal bone and orbital roof as a single piece. This allows wide access with only minimal, if any, brain retraction. The superior, lateral and medial orbit is clearly visualized, as well as the apex of the orbit. The bone flap is replaced at the end of the case with Tantalum plates. RESULTS: A cavernous hemangioma at the orbital apex was removed without complications. The exposure was superb and allowed identification and preservation of orbital structures. CONCLUSIONS: Transorbital craniotomy allows for wide access to the posterior orbit and parasellar region and anterior fossa of the brain with minimal brain manipulation. The use of a suprabrow incision results in an excellent cosmetic result. There is minimal postoperative morbidity, which decreases hospitalization time.

Adult↗
PubMed2001

Solitary fibrous tumor of the orbit with extraorbital extension: case report.

OBJECTIVE AND IMPORTANCE: Solitary fibrous tumors (SFTs) are rare tumors of mesenchymal origin that typically arise in the pleura. Only 24 cases of SFTs in the orbit have been reported, all located within the orbit and generally with a benign course. We report the first case of an orbital SFT with extraorbital extension and short-term regrowth. CLINICAL PRESENTATION: A 54-year-old man presented with proptosis and double vision that had persisted for 7 months. The tumor extended from the right extraconal inferolateral orbit to the extradural middle cranial fossa and cavernous sinus, via the superior orbital fissure, on magnetic resonance imaging scans. Positron emission tomography with [(18)F]fluorodeoxyglucose demonstrated faint uptake in the orbital portion. INTERVENTION: Resection of the tumor was performed twice, because of short-term regrowth of the residual tumor in the orbit. The histological diagnosis was a SFT. The MIB-1 labeling index was 7% and the mitotic count was 5 mitotic figures/10 high-power fields at the time of the second operation. These findings indicate the malignant nature of the tumor. CONCLUSION: The natural history of SFTs of the orbit remains unclear, and the importance of careful and continued follow-up monitoring of the tumor should be emphasized.

Brain Neoplasms↗
PubMed2003

Orbital roof fractures: management of ophthalmic complications.

PURPOSE: To review the clinical features and management of patients with orbital roof fractures. METHODS: Non-comparative, retrospective case review of 21 patients presenting with orbital roof fractures. RESULTS: The orbital roof fractures in our series resulted from motor vehicle accidents, blunt trauma, head injuries, and penetrating orbital injuries. Associated orbital and ocular injuries included other ipsilateral orbital fractures (16 cases), traumatic optic neuropathy (3 cases), ptosis (2 cases), perforating eye injuries (2 cases), intraorbital foreign bodies (2 cases), and oculomotor nerve palsy (1 case). Six patients required surgical intervention for ophthalmic sequelae, which included motility problems (4 cases), lagophthalmos (1 case), and a retained intraorbital foreign body with a cerebrospinal fluid leak (one case). The outcome of surgery was favorable in all cases, with complete resolution of symptoms in five of six patients. CONCLUSIONS: Orbital and ocular injuries are common in association with orbital roof fractures. A multidisciplinary approach to management is required because facial and cerebral injuries are also common. Most patients can be managed conservatively. The specific ophthalmic indications for surgical intervention are limited, but the outcome in these cases is gratifying.

Adolescent↗
PubMed1982

Computed tomography in the management of orbital infections associated with dental disease.

Two patients developed orbital infection secondary to dental infections. In one patient the infection spread from maxillary premolar and molar teeth to the infratemporal and pterygopalatine fossa and then through the inferior orbital fissure to the subperiosteal space. A subperiosteal abscess in the posterior orbital wall developed, which subsequently spread within the muscle cone. In the second patient infection of an anterior maxillary tooth caused a pansinusitis and unilateral orbital cellulitis. In both patients computed tomographic scanning of the orbit proved valuable in localising the infection and, in one case, planning a surgical approach to the orbit. The infection in both patients responded to treatment, with no permanent visual impairment. Appropriate antibiotics and prompt identification and surgical drainage of orbital abscesses are essential for the preservation of vision in cases of orbital infection.

Abscess↗
PubMed2002

[Late reconstruction and repositioning of enophthalmos of orbital blow-out fractures].

OBJECTIVE: To investigate the surgical technique for late reconstruction and reposition of enophthalmos of orbital blow-out fractures (BOF) and its efficacy, and to evaluate the effectiveness of hydroxyapatite (HA) composite material as orbital implant material. METHODS: Twenty-one patients with enophthalmos of BOF were randomly assigned into 2 groups in which autogenous bone and HA composite material as orbital grafting material were used. Computer orbital three-dimensional measuring technique, Hertel exophthalmometer and Lancaster test were applied. Late reconstruction of the orbit and reposition of the globe were performed on 21 cases during three months to 2 years after injury. Postoperatively, they were followed up for an average of 8 months. RESULTS: In the 21 cases with enophthalmos of BOF, 15 patients presented moderate enophthalmos (3 - 4 mm) and 6 patients presented severe enophthalmos (5 - 6 mm). Three months after operation, the measurements demonstrated that 3 patients had no enophthalmos, 15 patients had mild enophthalmos (1 - 2 mm) and 3 patients had no effect. Sixteen of 21 patients had diplopia preoperatively. Eight patients had satisfactory result, and 8 patients had no change. There was no significant difference between orbital implants of autogenous bone and HA composite material. CONCLUSIONS: Late reconstruction of orbit and reposition of globe for enophthalmos of BOF may obtain satisfactory results. HA composite material is a useful orbital implant material.

Adult↗
PubMed1988

[Painful ophthalmoplegia: the Tolosa-Hunt syndrome and orbital pseudotumor syndrome].

We experienced 9 patients with "painful ophthalmoplegia", which included 7 cases of the Tolosa-Hunt syndrome (2 males and 5 females, with ages ranging from 36 to 65 years) and 2 cases of the orbital pseudotumor syndrome (2 females aged 42 and 68). The diagnosis of these syndromes was based upon Hunt's criteria and the presence of the intraorbital mass on the brain CT scan. Main manifestations of both syndromes were periorbital pain and ipsilateral oculomotor nerve palsies. Out of 9 cases, 1 patient with Tolosa-Hunt syndrome and 1 patient with the orbital pseudotumor syndrome had bilateral retro-orbital pain and ophthalmoplegia. Pain preceded the ophthalmoplegia except in one patient with Tolosa-Hunt syndrome. Total paralysis of the extraocular muscles supplied by the oculomotor nerve was noted in all the nine patients, and mydriasis was observed on the affected side in 4 of 7 patients with Tolosa-Hunt syndrome and 2 patients with the orbital pseudotumor syndrome. Neurological involvement was not only the oculomotor nerve but also the other cranial nerves; the optic nerve (in 4 cases with Tolosa-Hunt syndrome and 2 cases with the orbital pseudotumor syndrome), the abducens nerve (in 3 cases with Tolosa-Hunt syndrome and 1 case with the orbital pseudotumor syndrome), and the first division of the trigeminal nerve (in 2 cases with Tolosa-Hunt syndrome). Six patients with Tolosa-Hunt syndrome and 2 patients with the orbital pseudotumor syndrome had palpebral edema. Visual disturbance and palpebral edema were severer in the patients with the orbital pseudotumor syndrome. After corticosteroid hormone was administered, there was diminution of the pain within 2 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMed1987

The fornix approach to the inferior orbit.

The fornix or transconjunctival approach to the orbital floor and inferior orbit provides excellent exposure for the surgeon managing orbital fractures. The technique is ideally suited for patients with isolated blowout fractures; however, it can be combined with other surgical incisions to provide wide exposure of the inferior orbit, zygoma, and maxilla for the repair of more complex midfacial fractures. The surgical technique provides excellent access to the inferior orbit for biopsy or excision of orbital tumors and excellent opportunity for surgically augmenting orbits with posttraumatic enophthalmos or enophthalmos associated with anophthalmic sockets. Orbital decompression into the maxillary antrum and ethmoid sinus is easily accomplished through this incision. By avoiding a cutaneous incision in the lower eyelid, one reduces the risk for development of postoperative ectropion. During wound closure, the lower eyelid can be elevated and tightened and the canthal angle can be restored if necessary.

Eyelids↗
PubMed1979

Exposure of the inferior orbit with fornix incision and lateral canthotomy.

Exposure of the inferior orbit is necessary for exploration of the orbit for repair of orbital fractures, reconstruction of the orbit to correct enophthalmos with a volume implant, and decompression of the orbit to relieve the symptoms and improve appearance in cases of dysthyroid exophthalmos. The usual approach to the inferior orbit has been through a subciliary skin incision and dissection of a skin flap to the orbital rim. A technique is presented which utilizes an inferior fornix conjunctival incision combined with a lateral canthotomy and outward rotation of the lower lid. The advantages of this technique are that it avoids a lengthy skin incision with dissection which may present skin shrinkage if repeated surgery is necessary, employs a very simple closure, and provides better exposure of the nasal, inferior and lateral orbits while leaving the lower lid structures intact, preserving its integrity.

Adult↗
PubMed1995

Invasive rhinosino-orbital aspergillosis with precipitous visual loss.

OBJECTIVE: To describe the clinicopathological and radiologic features in five cases of primary and secondary orbital aspergillosis. DESIGN: Case series. SETTING: Ophthalmology department of a university hospital. PATIENTS: Five patients over 65 years of age with invasive rhinosino-orbital aspergillosis. RESULTS: Presenting features were abrupt onset of proptosis, ophthalmoplegia and blepharoptosis with precipitous visual loss. All had debilitating periorbital pain or headache, but none had orbital inflammatory signs or appeared "toxic." Predisposing causes included alcoholism, low-dose prednisone therapy and insulin-dependent diabetes mellitus. One patient, suspected of having mucormycosis based on tissue biopsy and results of potassium hydroxide preparations, harboured Aspergillus fumigatus, which grew on culture. Secondary bacterial infections developed in three patients. Three patients died from their disease despite aggressive surgical treatment, including exenteration and sinus extirpation. The one patient with primary orbital aspergillosis survived after exenteration. CONCLUSIONS: Sinonasal aspergillosis with orbital extension and primary orbital aspergillosis have a precipitous clinical course that mimics that of mucormycosis and may be fatal despite early exenteration. Computed tomography and magnetic resonance imaging of the sinuses, orbit and head provide complementary diagnostic signs. While results of potassium hydroxide preparations and tissue biopsy guide treatment of fungal infection, definitive diagnosis requires fungal culture. Relatively good vision may be associated with massive orbital and secondary intracranial extension.

Aged↗
PubMed1995

Metastatic orbital tumors.

A review was made of the clinical data of 28 patients with metastatic orbital disease diagnosed in our clinic between 1972 and 1993. Fifteen were men and 13 were women. The average age at diagnosis was 58.7 years. The right orbit was involved in 12 and the left orbit in 14 cases. Two cases had bilateral orbital involvement. Breast carcinoma was the most frequent tumor (8 of 28, 28.6%) followed by neuroblastoma (7 of 28, 25.0%), lung carcinoma (6 of 28, 21.4%), prostate carcinoma (3 of 28, 10.7%), gastrointestinal carcinoma (2 of 28, 7.1%), renal cell carcinoma and thyroid carcinoma (1 of 28, 3.6% each). Proptosis (67.9%), motility disturbance (57.1%) and mass (50.0%) were the three most common presenting signs. Enophthalmos was noted in two cases with breast carcinoma. Nine cases presented with ophthalmic signs and metastatic tumor was recognized later. In the remaining 19 cases, the diagnosis of the primary tumor preceded the onset of orbital metastasis. The time interval between the detection of the primary malignancy and metastatic orbital tumor was shortest for lung carcinoma (mean: 2 months) and longest for breast carcinoma (mean: 34 months). Radiotherapy and chemotherapy were applied in 12 cases. Improvement in orbital signs and visual acuity was noted in 5 cases. Radiotherapy, chemotherapy and hormonal therapy were used in 8 patients and improvement in orbital signs was noted in 4 of these patients. Four of 28 patients (2 with breast carcinomas, one with prostate carcinoma and one with thyroid carcinoma) survived longer than 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Mechanism of the formation of orbital floor fractures. Holographic interferometry studies].

To date, it has not been possible to answer the question of whether in the classic blow-out fracture the orbital floor is fractured by hydraulic force exerted by the orbital contents or by force transmission within the bony structures of the skull. The aim of our investigation was therefore to reveal the nature of orbital deformation mediated solely by the bone. In holographic interferometry the holographic image of the unstrained object is superimposed on the image of the same object after deformation. The resulting image of the object contains a pattern of interference lines representing the extent of the deformation. This image can be visualized on a TV screen after digital processing of a picture registered by a video camera. This method was used to analyze the deformation of the bony orbit by contact force applied to several points along the orbital rim (each application consisting of 1 N) and by strain distributed evenly upon the orbital rim of the human skull. In all cases maximal deformation occurred in the medial part of the orbital floor no matter where the stress was applied. This finding coincides with the fact that the majority of clinically diagnosed fractures are found in this area. In conclusion, force transmission within the bone is considered as being one determining factor for occurrence of orbital floor fractures.

Biomechanical Phenomena↗
PubMed1996

[Lipogranuloma of the orbit. Apropos of a case].

We present a case of orbital lipogranuloma with a supero-nasal retrobulbar localisation associated with axial proptosis and major choroidal thickening. No clinical sign of inflammation, neither orbital nor in the posterior segment, was revealed. The systemic work-up as well as paraclinical data were within normal limits. The diagnosis was made after histopathologic examination of the biopsy taken via superior orbit. Outcome was favorable following long-term systemic corticotherapy. Orbital lipogranuloma is a rare particular form of orbital pseudotumour of unknown etiology. It is characterized, histologically, by orbital fat necrosis. Pathogenesis remains controversial. The differential diagnosis includes iatrogenic lipogranulomas secondary to sinus surgery (paraffinoma), orbital granulomas in sarcoidosis and Wegener's disease and orbital lymphomas. The prognosis is usually good following treatment with steroids.

Adult↗
PubMed2005

Technetium tc 99m-labeled red blood cells in the preoperative diagnosis of cavernous hemangioma and other vascular orbital tumors.

OBJECTIVES: To evaluate technetium Tc 99m (99mTc) red blood cell scintigraphy as a diagnostic tool for orbital cavernous hemangioma and to differentiate between orbital masses on the basis of their vascularization. METHODS: We performed 99mTc red blood cell scintigraphy on 23 patients (8 female and 15 male; mean age, 47 years) affected by an orbital mass previously revealed with computed tomography (CT) and magnetic resonance imaging (MRI) and suggesting cavernous hemangioma. In our diagnosis, we considered the orbital increase delayed uptake with the typical scintigraphic pattern known as perfusion blood pool mismatch. The patients underwent biopsy or surgical treatment with transconjunctival cryosurgical extraction when possible. RESULTS: Single-photon emission tomography (SPET) showed intense focal uptake in the orbit corresponding to radiologic findings in 11 patients who underwent surgical treatment and pathologic evaluation (9 cavernous hemangiomas, 1 hemangiopericytoma, and 1 lymphangioma). Clinical or histologic examination of the remaining 22 patients revealed the presence of 5 lymphoid pseudotumors, 2 lymphomas, 2 pleomorphic adenomas of the lacrimal gland, 1 astrocytoma, 1 ophthalmic vein thrombosis, and 1 orbital varix. CONCLUSIONS: The confirmation of the preoperative diagnosis by 99mTc red blood cell scintigraphy shows that this technique is a reliable tool for differentiating cavernous hemangiomas from other orbital masses (sensitivity, 100%; specificity, 86%) when ultrasound, CT, and MRI are not diagnostic. Unfortunately, 99mTc red blood cell scintigraphy results were positive in 1 patient with hemangiopericytoma and 1 patient with lymphangioma, which showed increased uptake in the lesion on SPET images because of the vascular nature of these tumors. Therefore, in these cases, the SPET images have to be integrated with data regarding clinical preoperative evaluation and CT scans or MRI studies. On the basis of our study, a complete diagnostic picture, CT scans or MRI studies, and scintigraphic patterns can establish the preoperative diagnosis of vascular orbital tumors such as cavernous hemangioma, adult-type lymphangioma, and hemangiopericytoma.

Adolescent↗
PubMed1991

Orbital decompression in Graves' disease. The predictability of reduction of proptosis.

We studied 42 orbits of 23 patients with Graves' disease who had proptosis secondary to the orbitopathy of their disease and had undergone decompressive operations. The patients were evaluated preoperatively and underwent computed tomography. They were also examined frequently during the first postoperative year and the computed tomography was repeated at 6 months. Three variables correlated well with the reduction in proptosis: the percentage of increase in orbital volume after surgery, the absolute increase in orbital volume, and the degree of orbital "stiffness" as measured preoperatively. The first two variables have an inverse correlation with the third. We refer to the loss of resilience of orbital tissues and the increase in adherence between tissue planes, collectively, as orbital "stiffness." While other factors, such as the size of the anterior opening of the orbit, the resistance of the lid diaphragm, and pressure changes within the orbit, may affect the resultant reduction in proptosis, we did not attempt to measure these factors.

Exophthalmos↗
PubMed1996

Sympathetic nerve trajectories to rat orbital targets: role of connective tissue pathways.

The trajectories of sympathetic nerves projecting to orbital targets were determined in adult rats with intact innervation and following acute sympathetic denervation, neonatal unilateral superior cervical ganglionectomy, or unilateral ganglionectomy on postnatal day 30. Sympathetic nerves were identified by using immunofluorescence for the noradrenergic transmitter enzyme dopamine beta-hydroxylase and by using catecholamine histofluorescence. In rats with intact innervation, sympathetic fibers travel to the orbit in association with the abducens, trochlear, and Vidian nerves. Within the retroorbital and retroocular connective tissue, the fibers redistribute to become associated with sensory-nerve branches of the trigeminal nerve, the orbital vasculature, and the periorbital sheath. Fibers reach their targets by traversing variable amounts of connective tissue of the periorbitum, the orbital septa, and the striated muscle epimysia. Following neonatal ganglionectomy, intracranial fibers of contralateral origin enter the orbit by traveling through connective tissue of the optic nerve meninges and lining the anterior lacerated foramen. These fibers travel independent of the trochlear, abducens, and Vidian nerves, but, otherwise, they use the same orbital pathways as those employed in the intact animal. In animals ganglionectomized on postnatal day 30, fibers enter the posterior portion of the orbit primarily via the optic foramen; they travel only short distances and end blindly in the periorbital sheath. These findings indicate that fascial structures are a major component of the pathways that guide sympathetic fibers to their appropriate targets both in normal development and during reinnervation following neonatal ganglionectomy. Because orbital connective tissues are termination sites of abortive fiber sprouting in older rats, developmental changes in the properties of these tissues may contribute to the absence of pathway formation in the mature animal.

Adrenergic Fibers↗
PubMed1994

Orbital and adnexal involvement in systemic non-Hodgkin's lymphoma.

BACKGROUND: The orbit is rarely a secondary site of lymphoma dissemination, and only few reports exist on the course and characteristics of involvement in these sites. METHODS: The authors retrospectively reviewed the records of 187 consecutive patients with systemic non-Hodgkin's lymphoma (NHL) diagnosed and treated at Beilinson Medical Center between 1986 and 1992. RESULTS: Ten patients (5.3% of those with NHL) had orbital or adnexal involvement or both. Histologically, six had intermediate-grade lymphoma, three had diffuse small cleaved cell lymphoma, and one had nodular small cleaved cell lymphoma. In all 10 patients, the lymphoma was widespread, and in 6, there were two or more other extranodal sites of involvement, mainly, bone marrow (six) and skin (three). The orbital involvement was found either at presentation or as late as 53 months after primary diagnosis. Various therapeutic approaches were chosen, from local orbital irradiation to different mild to aggressive chemotherapeutic protocols. Complete regression of the orbital or adnexal involvement or both was observed in 9 of 10 patients, but in 6 the systemic disease either persisted or recurred at other sites. CONCLUSIONS: Orbital or adnexal involvement or both by NHL may appear at any time during the course of the disease. It responds well to either chemotherapy or radiation therapy with prolonged local remission. The results of this study strongly suggest that every patient with NHL in whom any periorbital or orbital mass, ptosis, proptosis or lid edema develops should be suspected of having orbital lymphoma involvement until proven otherwise.

Aged↗
PubMed1980

Orbital volume in young and adult rabbits.

One hundred and ninety-nine postnatal volumetric determinations were made of orbits from 159 young and adult rabbits (64 New Zealand, 95 Dutch) by means either of linear measurements or of removable permanent elastic rubber base imprints. The volumes were calculated from the weights and specific gravities of the orbital imprints. Orbital volume in the New Zealand albino rabbits ranged from 0.7 ml at 14 days to 7.8 ml at 302 days of age. By about 180 days of age orbital volume had reached about 6.5 ml, near its maximum, and was about nine times the size at 14 days of age. Orbital volume in the Dutch rabbits ranged from 3.6 ml at 98 days to 5.8 ml at 540 days of age and were smaller than the New Zealand rabbit orbital volumes. By about 180 days the Dutch rabbit orbital volume had reached its maximum of about 5 ml and was about 25 percent larger than at 100 days of age. Values of orbital volume for the Dutch rabbits correlated noticeably with weight.

Age Factors↗