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PubMed1985

Sino-orbital aspergillosis associated with total ophthalmoplegia.

Invasive aspergillosis of the paranasal sinuses involving the orbit is termed sino-orbital aspergillosis. Prognosis of sino-orbital aspergillosis, complicated by impaired visual acuity and neurological signs, is disastrous and usually fatal. We herein report two patients with sino-orbital aspergillosis associated with total ophthalmoplegia. One patient was successfully treated with surgical eradication including orbital exenteration. In contrast, the other died of cerebral infarction, probably due to fungal thrombosis of the middle cerebral artery, despite repeated local debridement followed by orbital exenteration and administration of antifungal agents. Experience with these cases strongly indicates the necessity of prompt surgical eradication, including orbital exenteration if necessary, in the treatment of sino-orbital aspergillosis.

Antifungal Agents↗

PubMed1989

Space-occupying orbital lesions: can critical increases in intraorbital pressure be predicted clinically?

Thirteen cadaver orbits were studied to determine whether noninvasive clinical measurements of globe excursion could be used to predict intraorbital pressure. Intraorbital pressure measurements, exophthalmometry, and orbitonometry (which measures resistance to globe retrodisplacement) were performed at 1-ml increments to 12 ml of added orbital volume. Orbitonometry, performed with forces of 100, 200, and 300 g, yielded both E (global position) and Y (retrodisplacement) values. Plots of orbital pressure against percentage of excursion, a function of orbital retrodisplacement (that is, orbital pressure versus [(E0 - E300)/E0] x 100), for 131 paired values over all orbits yielded a function with low percentage of excursion values associated with high intraorbital pressures. This relationship reflected both the proptosis and the increased orbital tension produced by added volumes. Comparison of clinical orbitonometry data with such experimental data may allow predictions about which patients are threatened by critical intraorbital pressure levels and may benefit from orbital decompression surgery to preserve vision.

Adult↗

PubMed1993

[Orbital wall fractures: a comparison of computed tomography and conventional views].

A total of 59 cases of mild facial fractures (simple orbital wall fractures, 34 cases, other facial fractures, 25 cases) with the clinical suspects of orbital wall fractures were evaluated both by conventional views (Waters' and Caldwell views) and coronal CT scans. Conventional views were obtained, as an average, after 4 days and CT after 7 days of injuries. Both the medial wall and the floor were evaluated at two sites, i.e., anterior and posterior. The ethmoid-maxillary plate was also included in the study. The degree of fractures was classified as, no fractures, fractures of discontinuity, dislocation and fragmentation. The coronal CT images in bone window condition was used as reference and the findings were compared between conventional views and CT. The correct diagnosis was obtained as follows: orbital floor (anterior, 78%, posterior, 73%), medial orbital wall (anterior, 72%, posterior, 72%) and ethmoid-maxillary plate (64%). The false positive diagnosis was as follows: orbital floor (anterior only, 13%), medial orbital wall (anterior only, 7%) and ethmoid-maxillary plate (11%). The false negative diagnosis was as follows: orbital floor (anterior, 9%, posterior, 10%), medial orbital wall (anterior, 21%, posterior, 28%) and ethmoid-maxillary plate (21%). The results were compared with those of others in the past.

Adolescent↗

PubMed1994

Significance of orbital measurements in the fetus.

Orbital imaging is not performed routinely during obstetrical sonography, but the discovery of abnormal orbital diameters provides evidence of fetal dysgenesis. This study was designed to establish the validity of a previously developed orbital nomogram for a high-risk population and to determine whether proved cases of hypotelorism and hypertelorism fell outside the normal ranges. Inner and outer orbital measurements of 422 fetuses were obtained prospectively during routine obstetrical sonography in a high-risk patient population. Comparison of these measurements to the previously established nomogram demonstrated that the nomogram is still accurate with current equipment and in a population at high risk for anomalies. In addition, sonograms and autopsy and clinical data from six cases of hypotelorism, two of cyclopia, and three of hypertelorism were reviewed retrospectively. Both inner and outer orbital measurements fell clearly below two standard deviations of the mean in all six cases of hypotelorism. The three cases of hypertelorism had inner orbital measurements above the 95th percentile and outer orbital distances within normal limits but near the 95th percentile. All cases with abnormal orbital distances had associated intra- or extracranial abnormalities, including holoprosencephaly, encephalocele, cleft palate, cardiac anomalies, imperforate anus, diaphragmatic hernia, and digit anomalies.

Anthropometry↗

PubMed1999

[Attempts of orbit irradiation after enucleation of the eye with malignant choroidal melanoma. Part I].

PURPOSE: The problem of orbit irradiation after enucleation of the eye with choroidal melanoma is controversial. We have decided to analyse our own material in order to estimate the effectiveness of this method. MATERIAL AND METHODS: The clinical material comprised 202 patients, 97 women and 105 men, in the age of 15-84 years, whose eyeballs were enucleated because of choroidal melanoma. In 72 patients the orbit was irradiated after enucleation with 60Co applicator (CKA4). The dose was about 50 Gy, 5 mm deep. The height of tumour, its location, histological type, infiltration of the sclera or beyond the eyeball and the treatment of tumour before enucleation were analysed. The follow-up time was 5-20 years. RESULTS AND CONCLUSIONS: The survival time of patients in the age below 30 years (p < 0.05) and of patients with choroidal melanoma of the height above 3 mm (p < 0.01) was significantly longer when the orbit was irradiated. Also the survival time of patients with scleral infiltration and with spindle-cell type of tumour was longer (but statistically not significantly) in those, whose orbits were irradiated after enucleation. Exenteration of the orbit was necessary in 4 cases not irradiated after enucleation, only in 1 case after irradiation. The probability of survival after irradiation of the orbit was significantly higher than in cases not irradiated (0.6971 vs. 0.6219). The estimated mean survival time (in months) was longer, but not significantly, in patients after irradiation of the orbit (197.017 vs. 181.409). We conclude that irradiation of the orbit after enucleation of the eye with choroidal melanoma should be recommended. Further investigations will be continued with collaboration of Institute of Oncology in Cracow.

Adolescent↗

PubMed2000

[Results of therapy for orbital malignant lymphoma].

PURPOSE: To elucidate the clinical and histopathological features of orbital malignant lymphoma, and to develop a protocol for effective treatment. MATERIALS AND METHODS: The present study analyzed 18 cases of orbital lymphoma which were treated at Yamagata University Hospital over the last 14 years. The tentative strategy for choosing the treatment was to treat the cases of clinical stage I (Ann Arbor criteria) with curative intent and the cases of stage II-IV with palliative intent. RESULTS: Six patients had primary orbital lymphomas, 2 had secondary orbital lymphomas, and 10 had metastatic orbital lymphomas. Histopathologically, all the cases of primary lymphoma were of low-grade malignancy and all the cases of secondary lymphoma were of intermediate-grade malignancy. Of the metastatic lymphoma cases, 3 were of low-grade and 7 of intermediate-grade malignancy. The cases of primary lymphoma were Stage I and were treated by radiation or chemotherapy. The cases with secondary lymphoma were Stage II and were treated by both radiation and chemotherapy. The cases with metastatic lymphoma were Stage III or IV and were treated by chemotherapy and/or radiation. Control of orbital lymphoma was achieved in all 6 cases with primary lymphomas. Although the survival rate was 0% for secondary lymphomas and 50% for metastatic lymphomas, ocular complications were improved during the remainder of the patients' life. CONCLUSIONS: All the primary orbital lymphomas were treated effectively by radiation or chemotherapy. For secondary and metastatic orbital lymphoma, our strategy for treatment was beneficial by improving ocular complications and the quality of life.

Adult↗

PubMed2001

[Use of autogenous cranial bone grafts for orbital floor reconstruction].

OBJECTIVE: To evaluate the effects of autogenous calvarial bone grafts on treatment of the patients with defect of orbital floor from facial trauma. METHODS: During a 5-year period from April 1994 to April 1999, 34 patients ranging in age from 16 to 68 years (twenty males and fourteen females), who presented with orbital floor defects associated with other facial fractures were reconstructed by autogenous calvarial bone grafts. The surgical approach to the orbital floor involved a transconjunctival incision in 31 patients and a subciliary incision in 3 patients. After the orbital floor exploration, the bone graft was harvested through the coronal incision in 29 patients and the parietotemporal region incision in 5 patients. The bone graft was then fashioned to the appropriate size and configuration and fixed to the stable bone of the orbital floor with microplates or screws. RESULTS: The surgical incisions healed well with a minimal scar. There were no infection, extrusion or other complications associated with autogenous calvarial bone graft. There were no cases of optic neuropathy, diplopia and enophthalmos. There was no morbidity in donor sites. One patient had slight ectropion, which lasted three months and became inconspicuous in six months. 8 cases with hypoesthesia of the infraorbital region returned the sensory function within 6 months. 6 patients with enophthalmos were partly corrected. The follow-up period ranged from 6 months to 5 years. CONCLUSION: The orbital floor defects should be managed by early exploration to avoid later complications. The sequel, such as enophthalmos and dystopia or diplopia are much more difficult to correct after bony union. A vast array of autogenous and alloplastic materials have been used to reconstruct the defect of orbital floor. Autogenous bone graft reduces the risk of infection and extrusion. Cranial bone graft produces less donor site morbidity compared with other sites, non-visible scar as the incision is placed within the hair-bearing skin and the conjunctiva. The membranous bone from the skull has been shown to undergo less resorption and greater graft volume survival as compared to endochondral bone of the iliac crest or rib. Skull bone is an ideal source of bone graft in orbital reconstruction.

Adolescent↗

PubMed1975

Orbital corrections with the use of alloplastic material.

After a severe trauma of the face, e.g. fractures involving the zygoma, the upper jaw or other orbital bone alteraions and deviations of the bony orbital contours and also of the orbital contents can subsist, even after primary operative correction. The patients have functional as well as cosmetic complaints. In consequence of eyeball dislocation and incarceration or fibrosis of the external eye muscles, the patients also complain of diplopia in one or more directions. Due to the bony orbit enlargement and reduction of the orbtial contents, the eye is moved inferiorly and backwards, also causing diplopia, ptosis and a deep sulcus of the upper lid. The treatment consists in closing and sufficient raising of the orbital floor correction of the enophthalmos. To cover the floor fracture, we apply 1-8 perforated Teflon implants which are placed under the periost of the orbital floor. To correct the enophthalmos, we use 30-50 Teflon beads with a diameter of 5 mm, and placed them in a sub-periorbital pocket laterally above and behind the eyeball, thus ensuring that the eye will be forced forwards in the cone-shaped orbit and so diminish or eliminate the enophthalmos. The operation is performed in close cooperation between an ophthalmologist and a plastic surgeon. Most of our cases also needed operative muscle correction. Although not all deviations could be totally corrected, we always achieved a clear improvement, and all 36 patients obtained a useful field of binocular single view. Until now we have had no implant infections or rejections. We should like to consider that this method of correction will have its own place in the treatment of orbital deformities.

Diplopia↗

PubMed1992

[Clinical and neuroradiological studies on orbital myositis and Tolosa-Hunt syndrome].

Tolosa-Hunt syndrome and orbital myositis have common features such as ocular pain, ophthalmoplegia and exophthalmos. Both syndromes are thought to be caused by a granulomatous inflammation involving the cavernous sinus area in the former and the orbital cavity in the latter. The question whether these two conditions represent different presentations of a single disease, or they belong to different entities has not been settled. To address this question, we reviewed our cases having clinical diagnosis of either Tolosa-Hunt syndrome or orbital myositis. Six cases were diagnosed as Tolosa-Hunt syndrome, and 7 orbital myositis. In the thin-slice enlarged orbital CT, hypertrophic and high-density changes of at least one of the extraocular muscles were found in all cases with orbital myositis, but in none of the patients with Tolosa-Hunt syndrome. The age of onset was younger and the duration of the disease before admission was shorter in Tolosa-Hunt syndrome. They responded to steroid therapy better than those with orbital myositis. These findings lead us to conclude that Tolosa-Hunt syndrome and orbital myositis belong to different syndromes, although clinical manifestations have many similarities. Then we studied the relationship between the hypertrophic change of the extraocular muscle and the direction of the oculomotor restriction. For this purpose four additional cases with dysthyroid ophthalmopathy were also studied. We found that the presence of hypertrophic change was frequently associated with the restriction of ocular movement to the direction not only of the hypertrophic muscle but also of the opposite muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2004

[Orbital tumors in the material of Department of Ophthalmology of Medical University of Gdańsk in years 1991-2002].

PURPOSE: Aim of the study was to determine the types and frequency of orbital tumors and to assess the method of treatment relevant to patient, orbital and tumor data. MATERIAL AND METHODS: Current classification of orbital tumors is presented. The retrospective analysis of 127 patients with orbital tumor treated in the Ophthalmology Clinic in Gdańsk in years 1991-2002 was carried out. The diagnosis was made with orbital biopsy in available cases, the clinical findings, imaging studies and histopatological examination. RESULTS: There were 91 cases of primary tumors, 33 of secondary lesions and 3 metastatic neoplasms. The surgical treatment was involved in 87 cases. 14 of them required the synergic action with radiotherapy and 4 with chemotherapy. CONCLUSIONS: The age of the studied group is an important factor affecting relative incidence of orbital tumors. With increasing age, malignant orbital tumors become more common. Orbital lesion may manifest the systemic neoplastic disease.

Adolescent↗

PubMedDate not supplied

[Meningo-orbital fold (MOF) as a guiding point in extradural approach to the anterior clinoid process].

BACKGROUND AND PURPOSE: The essential stage of Dolenc's approach to the cavernous sinus is the incision of the meningo-orbital fold (MOF) without damaging nervous structures in the superior orbital fissure. The goal of the research is to perform a topographic and morphometric study of the meningo-orbital fold. MATERIAL AND METHODS: Formalin preserved central cranial base specimens from twenty adults (40 sides) were dissected for this study. The dissection was based on Dolenc's epidural approach to the cavernous sinus. RESULTS: The average width of MOF is 8.4 mm on the right side and 8.3 mm on the left side. The meningo-orbital artery (MOA) is an important reference point in recognizing the superior orbital fissure. In 75% (15 specimens) of cases the meningo-orbital artery passes by the superior fissure at a distance of a few millimeters. In 25% (5 specimens) of cases the MOA passes through the lateral margin of the superior orbital fissure. CONCLUSIONS: The MOF is an inset of the external layer of the dura mater of the middle cranial fossa which passes through the superior orbital fissure and joins the periorbita at the level of the sphenoparietal sinus. The average width of the MOF is 8.4 mm on the right side and 8.3 mm on the left side. The new approach to the safe incision of the MOF relies on the medial margin identification by splitting both layers in the lateral wall of the cavernous sinus between V1 and V2. After identification of the medial margin, it is possible to separate the margin from the superficial layer of the cavernous sinus, from the side anterior and middle cranial fossae. It is then possible to perform a safe incision of the MOF without any danger of damaging the nerves.

Adult↗

PubMedDate not supplied

Endoscopic power-assisted orbital exenteration.

BACKGROUND: Orbital exenteration can be accomplished by either an external eyelid-sparing or eyelid-sacrificing approach. The purpose of this study was to describe an alternative technique for orbital exenteration and its specific advantages over traditional methods. METHODS: A retrospective analysis at a tertiary care referral center was performed. Three patients with sinonasal malignancy (two cases) and fulminant invasive fungal sinusitis (one case) are reported. Intraconal involvement was evident in all patients by imaging and surgical pathology. Advanced endoscopic techniques in conjunction with image guidance and soft-tissue shaver technology were used for resection in all cases. RESULTS: The orbit was successfully exenterated via an eyelid-sparing endoscopic approach with minimal blood loss in all three patients. Exenteration was completed within 30-45 minutes. Uninvolved superior and lateral orbital periosteum was preserved in all patients, which permitted cavity "mucosalization" within 8 weeks. Two patients are alive without disease at 15-month follow-up. One patient with persistent cavernous sinus malignant peripheral nerve sheath tumor died 4 months after resection despite proton beam therapy. CONCLUSION: This preliminary experience showed endoscopic power-assisted orbital exenteration to be an effective technique for exenteration of the orbit. Endoscopic power-assisted orbital exenteration offers two critical advantages: (1) direct transnasal control of the ophthalmic artery as it emerges from the optic foramen and (2) the ability to preserve the uninvolved superior and lateral periorbita. This can facilitate mucosal coverage of the exenterated space and obviate the need for tissue grafts and/or packing. Additionally, intraorbital pathology can be better visualized and blood loss and operative time are minimized. This technique may serve as an important adjunct for management of the orbit in patients with sinonasal malignancy or invasive fungal rhinosinusitis.

Adult↗

PubMed1984

Orbital dissection defatting technique for Graves disease.

Five patients with Graves disease and bilateral proptosis were treated with different incisional approaches. They all underwent orbital decompression by removal of the anterior medial orbital walls, the anterior ethmoidal sinuses, the orbital floors, and multiple incisions of the orbital periosteums . The defatting technique, which consists of applying manual anterior orbital pressure with alternate removing of small lobules of fat, was added when it was intraoperatively decided by Hertel exophthalmometer measurement that more decompression was needed. It is estimated that one-third more reduction in proptosis resulted. An average total decrease in proptosis of 9 mm per orbit occurred. Both visual accuities and visual fields returned to normal. The only important complication was the development of hypertropia in down gaze in one patient. A potential value of this technique is its use with orbital floor decompression alone. It may be possible to avoid removing the medial and lateral walls of the orbit, thereby decreasing complications. Defatting may also be a valuable addition in those rare cases where all decompression techniques available are needed to affect an adequate decompression.

Adipose Tissue↗

PubMed1992

CT and MR imaging of the pediatric orbit.

Orbital abnormalities encountered in the pediatric population differ substantially from those found in adult patients. Retinoblastoma, the most serious intraocular tumor, is often difficult to diagnose, but use of computed tomography (CT) (which reveals the characteristic focal calcification) and magnetic resonance (MR) imaging allows this tumor to be differentiated from pseudogliomas, such as Coats disease, and retrolental fibroplasia. CT and MR imaging help in the differentiation of orbital cellulitis from preseptal, lacrimal, and eyelid infectious processes and of orbital pseudotumor from Graves disease. In cases of orbital trauma, CT is excellent for detecting orbital fractures and metallic foreign bodies; MR imaging is better for depicting ocular and optic nerve injuries. Both modalities allow the differentiation of rhabdomyosarcoma from dermoid, cavernous hemangioma, and lymphangioma and provide helpful information for the diagnosis of many other tumors. Since CT and MR imaging have widely expanded the capabilities of orbital imaging, it is more important than ever before for radiologists to understand pediatric orbital disease.

Eye Abnormalities↗

PubMed1982

Idiopathic orbital myositis: report of six cases.

Idiopathic orbital myositis, a subgroup of inflammatory orbital pseudotumor, occurred in six patients with acute onset periorbital pain, diplopia, and in most cases, eyelid swelling. Proptosis, ductional restrictions, and responsiveness to oral prednisone administration were characteristic. Computed tomography and orbital ultrasonography showed enlargement of one or more extraocular muscles, with sparing of other orbital soft tissues. One patient had involvement of all recti muscles in both orbits. The distinction of orbital myositis from Graves' ophthalmopathy is made on clinical grounds, with acute orbital pain and corticosteroid responsiveness being uncharacteristic of the latter. The possibility of orbital myositis being an immune-mediated process is discussed.

Adult↗

PubMed2005

[Orbital stabilisation with suprabrow myofascial transposition flaps].

BACKGROUND: Common reasons for orbital defects are midfacial traumas or defects following tumor resection within the sinu-orbital region. In these cases, reconstruction of the medial or inferior orbital wall often is required. Common materials for orbital reconstruction, such as titanium-mesh, are used where epithelialisation problems are frequently encountered. METHODS: Three patients with extended resection of malignomas of the medial and inferior orbit wall were reconstructed with a myofascial transposition flap from the suprabrow region. RESULTS: Orbital tumor infiltration was present in 11 of the 54 patients treated from 1997 to 2003 for tumors of the nasal region. In three cases, tumor extension to the medial and caudal orbital wall required extensive tissue resection, including the periorbit. In these cases, we created a new horizontal fascial flap from the suprabrow-region which stabilized the bulbus by fixation to the lateral maxilla. Follow-up 12 months after surgery showed good epithelialisation of the reconstructed region without functional deficits. CONCLUSION: This previously undescribed fascial suprabrow-flap constitutes a valuable method in the reconstruction of large combined defects of the medial and caudal orbit wall profiting particularly from the autologous material used.

Facial Muscles↗

PubMed2005

Sustained orbital shear stress stimulates smooth muscle cell proliferation via the extracellular signal-regulated protein kinase 1/2 pathway.

OBJECTIVE: Nonlaminar shear stress stimulates smooth muscle cell (SMC) proliferation and migration in vivo, especially after an endothelial-denuding injury. To determine whether sustained shear stress directly stimulates SMC proliferation in vitro, the effect of orbital shear stress on SMC proliferation, phenotype, and extracellular signal-regulated protein kinase 1/2 (ERK1/2) phosphorylation was examined. METHODS: Bovine SMCs were exposed to orbital shear stress (210 rpm) for up to 10 days, with and without the ERK1/2 upstream pathway inhibitor PD98059 (10 microM) or the p38 pathway inhibitor SB203580 (10 microM). Proliferation was directly counted and assessed with proliferation cell nuclear antigen. Western blotting was used to assess activation of SMC ERK1/2 and SMC phenotype markers. RESULTS: SMCs exposed to sustained orbital shear stress (10 days) had 75% increased proliferation after 10 days compared with static conditions. Expression of markers of the contractile phenotype (alpha-actin, calponin) was decreased, and markers of the synthetic phenotype (vimentin, beta-actin) were increased. ERK1/2 was phosphorylated in the presence of orbital shear stress, and orbital shear-stress-stimulated SMC proliferation was inhibited in the presence of PD98059 but sustained in the presence of SB203580. Orbital shear-stress-induced changes in SMC phenotype were also inhibited in the presence of PD98059. CONCLUSION: Orbital shear stress directly stimulates SMC proliferation in long-term culture in vitro and is mediated, at least partially, by the ERK1/2 pathway. The ERK1/2 pathway may also mediate the orbital shear-stress-stimulated switch from SMC contractile to synthetic phenotype. These results suggest that shear-stress-stimulated SMC proliferation after vascular injury is mediated by a pathway amenable to pharmacologic manipulation.

Animals↗

PubMedDate not supplied

Ensuring of long operation life of the orbiting station EVA space suit.

Russia has gained a lot of experience in operating the space suits (SS) during the extravehicular activities (EVA) by the crews of SALYUT-6, SALYUT-7 and MIR orbiting stations. A total of 21 Orlan-type space suits of various models were operated onboard the orbiting stations (OS) during almost 20 years period. Some of these space suits served up to 3 years in orbit. The paper reviews special features of long SS operation (without return to the Earth) onboard an orbiting station as well as the problems associated with SS repeated use by several crews. An analysis of measures to support solving of the problems of SS long stay and reliable operation onboard the orbiting station is made: selection of a corresponding SS type and separate elements design; selection of the materials; routine and preventive maintenance; development tests. The advantages of the space suit of a semi-rigid type for solving the above problems are shown. The paper includes a short analysis of space suits' operation onboard the Russian orbiting station MIR, and some restuts of inspection of the Orlan-DMA space suit returned to the Earth from orbit by STS-79 alter long operation in orbit. Recommendations on further improvement of the space suits for EVA operations in the International Space Station (ISS) are given.

Decompression Sickness↗