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PubMed1988

Surgical approaches to orbital tumors.

Three approaches as used with modern technology, magnification with an operating microscope, and self-retained retraction have been presented. These approaches have allowed satisfactory exposure of difficult retrobulbar orbital areas from the various directions and have allowed us to more comfortably microdissect and remove orbital tumors. They also provide good exposure for the use of the carbon dioxide laser, which has been an aid in removing the intraorbital extensions of meningiomas, plexiform neurofibromas, and difficult lymphangiomas that occupy the intraconal compartments of the orbit. These approaches should only be undertaken by a skilled ophthalmic orbital surgical team in the case of the anterior medial and lateral approach, and definitely by a well-experienced neurosurgical/ophthalmic orbital team for tumors involving the orbital cranial junction and the superior orbital compartment. Experience gained over 17 years has convinced us that a team approach is mandatory for the difficult deep intraorbital tumors, even with the anterior medial or lateral approach.

Humans↗

PubMed1987

Complications of orbital trauma surgery.

This article considers the complications of orbital trauma surgery. In addition, ocular as well as nonocular complications of orbital trauma are outlined. Knowledge of the workup of specific types of orbital fractures will help prevent common sequelae of unrecognized orbital fractures: (a) orbital contour abnormalities, and (b) late enophthalmos. Complications of orbital fracture repair that relate directly to the alloplastic implant include (a) orbital cellulitis due to an infected implant, (b) anterior extrusion of the implant, (c) compression of the optic nerve by the implant, (d) dacryocystitis due to obstruction of the lacrimal sac by the implant, and (e) late proptosis due to hemorrhage into the fibrous capsule that surrounds the implant. Surgical techniques that minimize such complications are emphasized.

Adult↗

PubMed1987

Deep orbital reconstruction for correction of post-traumatic enophthalmos.

Post-traumatic enophthalmos is a complex orbital deformity resulting from an injury disrupting orbital bone and ligament support, allowing displacement and a change in shape of the orbital soft-tissue contents. Clinically, this is manifested by inferior and posterior displacement of the globe, pseudoptosis, and deepening of the supratarsal fold. Soft-tissue changes such as canthal malposition and shortening of the horizontal dimension of the palpebral fissure are present when unreduced nasoethmoidal orbital fractures exist. The essential principles of surgical correction include full dissection of the bony orbital soft tissues including the posterior orbit with restoration of bony orbital volume by the judicious insertion of bone grafts to correct the vertical as well as the anteroposterior position of the ocular globe. The combination of techniques of craniofacial exposure, osteotomy, and bone grafting allow the condition of post-traumatic enophthalmos to be greatly improved with minimal complications.

Adipose Tissue↗

PubMed1979

Orbital decompression.

A new technique for exposure of the orbit for decompression of the orbit is described. It may be used for other purposes such as orbital fracture repair, orbital exploration for tumors in the inferior orbit, or reconstruction of the orbit by a variety of methods. The technique provides ready, broad exposure. The approach also avoids not uncommon complications of the eyelid, approaches to the orbit such as skin shrinkage and ectropion of the lower lid. It also results in minimal cosmetic deformity.

Fractures, Bone↗

PubMed1984

Blow-in and blow-out fractures of the orbit: clinical correlations and proposed mechanisms.

Various theories have been proposed regarding the exact etiology of blow-out fractures of the orbital floor and blow-in fractures of the orbital roof. These include the role of increased intraorbital pressure causing a downward fracture of the orbital floor, and the role of a buckling force transmitted by the orbital rim to the thinner orbital walls. This paper presents two case histories that illustrate the roles of these mechanisms in the production of such fractures. One is a classic blow-out fracture while the other is a unique case of orbital roof blow-in fracture which may shed additional light on the role of buckling forces in the creation of these fractures. A review of experimental and clinical data supporting these mechanisms is presented and suggests that more than one factor may be involved in the production of such orbital fractures.

Adolescent↗

PubMed1981

Computed tomography of the orbit.

In less than a decade computed tomography (CT scanning) had a profound impact on diagnostic radiology. Radiology of the orbit is no exception. As early as 1973, reports published in the radiological literature indicated that this new noninvasive imaging method was a highly effective way of demonstrating intraorbital mass lesions. As CT scanners became widely available, computed tomography became a significant adjunct to ophthalmological diagnosis. Today the main indications for CT scanning of the orbit are (1) suspected mass lesions, most frequently presenting as exophthalmos, (2) orbital trauma, including foreign bodies, (3) some congenital anomalies, and (4) suspicion of extension into the orbit of extraorbital disease processes. Along with ultrasonography, another new noninvasive imaging technique, CT has replaced a number of more invasive and often less effective diagnostic methods, such as orbital pneumography, venography, and arteriography as major imaging techniques in orbital pathology. The paper discusses current practices in the technique of CT scanning of the orbit including the important aspect of radiation dosimetry and the clinical applications, using a number of cases to illustrate its use.

Eye Foreign Bodies↗

PubMed1994

[Exenteration of the orbit].

The authors evaluate the number and results of exenterations of the orbit on account of malignant neoplasms originating in intraocular structures and penetrating into the orbit or malignant processes originating in structures of the orbital contents and tissues surrounding the orbit. These operations were made in a group of 156 patients with orbital disease hospitalized at the First Ophthalmological Clinic, Faculty Hospital and Medical Faculty, Comenius University, Bratislava in 1980-1992. During the mentioned 13-year period exenteration of the orbit was indicated in 22 patients, i.e. 14.1% from the total number of 156 hospitalized patients with orbital disease.

Aged↗

PubMed1995

Orbital decompression for non-Graves' orbitopathy: a consideration of extended indications for decompression.

Orbital decompression is typically indicated for Graves' orbitopathy. Other causes of proptosis can also be safely and effectively addressed surgically with orbital decompression. Patients with prominent globes can have significant discomfort related to exposure keratopathy, lagophthalmos, and inefficient function of the globe-eyelid interface. We present six cases of non-Graves' proptosis that were addressed with orbital decompression. Indications for surgery included hypoplastic malar eminence with scleral show, enlarged globes, and congenital shallow orbits. Successful reduction of proptosis was achieved by orbital decompression with subsequent relief of presenting symptoms. Graded balanced orbital decompression was used to minimize shifts of the muscle cone. In some cases osteotomies and advancement of the lateral wall and malar region were also employed. Complications included transient esotropia, esotropia requiring surgery, and microplate granuloma. Orbital decompression should be considered for patients with relative proptosis and related eyelid malpositions regardless of the underlying etiology.

Adult↗

PubMed1997

Frequency-selective fat suppression MR imaging. Localized asymmetric failure of fat suppression mimicking orbital disease.

Our objectives were to further characterize an artifact related to the localized failure of the frequency-selective (FATSAT) fat suppression magnetic resonance (MR) imaging technique. We constructed two phantoms simulating human orbital anatomy and imaged them on a 1.5-T MR scanner using (FATSAT) and short T1 inversion recovery (STIR) techniques of fat suppression. The first phantom resembled orbit structural configurations; it was imaged in coronal and axial planes and in varying orientations with respect to the main magnetic field (Z axis) to study the features of the artifact and to reproduce the asymmetry seen in clinical cases. We designed the second phantom to enable quantification of the change in artifact size with change in orientation. We imaged the orbits of a normal human volunteer in similar planes and orientations, and compared the results to clinical cases demonstrating the artifact and true orbital disease. The artifact identified with localized failure of FATSAT fat suppression manifested as regions of hyperintensity maximal at fat-air interfaces, with gradual fading of the increased signal with distance from the interfaces. The artifact was most prominent when the interfaces were perpendicular to the axis of the main magnetic field (Z axis). The regions of increased brightness obscured normal orbital structures but were not associated with alterations in the geometry of these structures. Changes in orientation of the interfaces with respect to the Z axis, both in the phantoms and normal volunteer, reproduced the asymmetry of fat suppression failure seen in clinical cases. The relationship of size of the artifact to change in orientation was non-linear. The artifact was not seen on STIR images. We concluded that failure of FATSAT fat suppression may mimic orbital disease, particularly if asymmetric. As predicted by the Maxwell electromagnetism equation, slight variations in orientation of the fat-air interface to the Z axis may produce large asymmetries in fat suppression failure in the orbit. Confirmation may require either comparison with additional pulse sequences [T1-weighted spin echo (T1W SE) or STIR] or repositioning the patient's head to check for persistence of the finding with varying orientations.

Adipose Tissue↗

PubMed1995

[Diseases of the orbit].

Diseases of the orbital cavity require more attention because of its specific anatomic structure and placement. Their curing requires cooperation of many medical specialties. Analysis consider orbital fractures, mainly caused by car accidents (69.2%). The next half of them consider inflammatory processes and tumor in equal numbers. Malignant tumors of orbital cavity occur most frequently (48.0%), less frequent are pseudotumors--pseudotumor orbitae (36.0%) and rare--malignant ones (16.0%). Malignant tumors more frequently infiltrate the orbit in neighborhood (63.3%), less frequently they come out from orbit tissue (16.7%). It should be emphasized that the number of orbit inflammations decreases in subsequent years, whereas occurrence of orbit tumors increases.

Adolescent↗

PubMed1981

Radiotherapy for idiopathic inflammatory orbital pseudotumor. Indications and results.

Supervoltage radiotherapy was used in 21 orbits of 19 patients with idiopathic inflammatory orbital pseudotumor. Seventeen orbits (15 patients) were initially treated with systemic corticosteroids, but recurrence of orbital inflammation during dosage tapering was the most frequent indication for radiotherapy. Fifteen orbits (14 patients) responded favorably, as judged by reduced proptosis, decreased lid edema and conjunctival injection, improved ocular motility, and increased visual acuity. Six orbits (five patients) did not improve with radiotherapy. Patients who were successfully treated with radiotherapy have been free of recurrence for a mean follow-up period of 25.05 months; these patients have not required further corticosteroid treatment or additional radiotherapy. Low-dose (1,000 to 2,000 rad) supervoltage radiotherapy seems to have a definite role in the management of idiopathic orbital pseudotumor in the following instances: (1) when corticosteroids fail or systemic complications are unacceptable (2) when signs and symptoms recur during decreasing corticosteroid dosage, and (3) when systemic corticosteroids are medically contraindicated.

Adult↗

PubMed1986

Orbital exenteration with spontaneous granulation.

Excision of the orbital contents by orbital exenteration is required in the treatment of some eyelid and orbital carcinomas. Allowing the orbit to heal spontaneously with granulation tissue has several advantages over the popular technique of lining the orbital walls with a split-thickness skin graft. The use of granulation tissue is simpler, since it avoids the needs for obtaining a skin graft, and the final result is cosmetically more acceptable, because a shallower cavity occurs compared with the skin graft technique. The main disadvantages are that it takes longer for the orbit to heal and dressing changes are required more frequently. The spontaneous granulation technique has provided excellent results in 12 patients with exenterated orbits.

Adenocarcinoma↗

PubMed1982

Surgical treatment of orbital floor fractures.

This study retrospectively examines 551 patients with 597 orbital floor fractures for sequelae of enophthalmos and diplopia. Ocular injuries are associated with 6.9% of the fractures. Nondisplaced orbital floor fractures have been treated with observation alone, resulting in an incidence of sequelae of zero in 263 patients. Displaced fractures that had not undergone surgery have resulted in an incidence of sequelae of 18 (34%) in 53 patients. Displaced fractures that had undergone orbital floor exploration have resulted in an incidence of sequelae of 29 (10.3%) in 281 patients. Only one mild loss of visual acuity has complicated the 281 surgical procedures. It is concluded that orbital floor exploration is not indicated in patients with nondisplaced fractures of the orbital floor and that orbital floor exploration is a safe and effective means of reducing the complications associated with displaced fractures of the orbital floor.

Adolescent↗

PubMed1983

Nasal polyposis with invasion into the orbit.

Proptosis of the left eye developed in a 51-year-old man with a long history of nasal polyposis. Displacement of the orbit was associated with a palpable mass superior and lateral to the orbit. Roentgenographic studies, including a sinus series, computed tomographic scan, and axial tomogram of the left orbit, showed a soft-tissue mass in the superolateral compartment of the left orbit and left frontal sinus, suggesting a mucocele. The surgical and pathological findings disclosed polyps of the frontal sinus invading the orbit through a dehiscence of the lateral orbital roof. To our knowledge, this is the first reported case of invasion of frontal sinus polyp into the orbit through the superolateral wall.

Adult↗

PubMed1990

Endoscopic transnasal orbital decompression.

Orbital decompression for dysthyroid orbitopathy has traditionally been performed through either an external or a transantral approach. The advent of intranasal endoscopes allowed for the development of a transnasal approach for medial and inferior orbital wall decompression. Using this approach, orbital decompressions were performed on 13 orbits in eight patients with severe complicated dysthyroid orbitopathy. Simultaneous bilateral lateral orbitotomies were performed on five patients. Walsh-Ogura decompressions and lateral orbitotomies were performed on two orbits. When combined with lateral orbitotomy, Hertel measurements improved an average of 5.7 mm in orbits decompressed transnasally and 4.5 mm in orbits decompressed with a Walsh-Ogura approach. Transnasal decompression alone improved Hertel measurements an average of 4.7 mm. Visual acuity improved in three of four patients with optic neuropathy, and in all patients with exposure keratopathy. We conclude that the endoscopic transnasal approach provides comparable decompression to traditional methods while avoiding the morbidity of an external ethmoidectomy or Caldwell-Luc antrotomy.

Adult↗

PubMed1994

Orbital decompression in Graves' disease.

OBJECTIVE: The authors' experience with surgical decompression of the orbits in patients with Graves' orbitopathy is reviewed. DESIGN: One hundred twenty-six consecutive primary orbital decompressions were retrospectively studied. SETTING: Tertiary care university hospitals. PATIENTS: All patients were referred by ophthalmologists for surgical decompression after failure of a trial of oral steroid therapy, and many had had orbital irradiation. INTERVENTION: Antral-ethmoidal or transconjunctival surgical decompression was accomplished in all. MAIN OUTCOMES: Measurements of visual acuity, ocular motility, and proptosis were accomplished preoperatively and a minimum of 3 months postoperatively. Surgical complications were tallied. RESULTS: Mean reduction of proptosis by antral-ethmoidal decompression was 5.3 mm, and 3.6 mm by the transconjunctival approach. Visual acuity improved in 34 orbits, was unchanged in 91 orbits, and decreased in one orbit. In a subgroup of 30 patients in whom ocular motility was quantified by prism cover test preoperatively, motility was unchanged or improved in 21 and was decreased in nine. Complications were infrequent. CONCLUSION: The antral-ethmoidal and transconjunctival approaches to orbital decompression are safe and effective.

Adolescent↗

PubMed1996

Management of the orbit during anterior fossa craniofacial resection.

OBJECTIVE: To determine the postoperative ocular function in patients undergoing anterior fossa craniofacial resection with preservation of the orbit. DESIGN: Retrospective medical chart review of patients treated from January 1, 1973, to July 31, 1994. Median follow-up was 38 months (range, 1-210 months). SETTING: Tertiary referral center. PATIENTS: Fifty-eight consecutive patients undergoing anterior fossa craniofacial resection with orbital preservation for tumors involving the anterior skull base. MAIN OUTCOME MEASURES: Assessment of orbital complications of treatment, need for further surgical intervention to correct these complications, and determination whether functional vision was retained at last follow-up examination, and tumor recurrence within preserved orbits. INTERVENTIONS: Anterior craniofacial resection with orbital preservation. Postoperative radiation therapy was administered to selected patients. RESULTS: Overall, 25 patients (43%) had some ocular sequelae of their treatment. This consisted of epiphora in 21 patients, diplopia in 8, vision loss in 6, and pain and enophthalmos in 2. Twelve patients required revision surgery consisting of dacryocystorhinostomy in 8, ectropion repair in 3, drainage of orbital mucocele in 1, and corneal transplant in 1. Ocular complications were more common and vision loss occurred only in patients treated with postoperative radiation therapy. Functional vision in the ipsilateral eye was retained in 50 of the 58 patients. CONCLUSIONS: When the orbit is preserved during anterior fossa craniofacial resection, ocular sequelae are frequent and may require revision surgery. Functional vision can be preserved in most patients.

Adolescent↗

PubMed2003

Access of autonomic nerves through the optic canal, and their orbital distribution in man.

The notion that autonomic nerves from the internal carotid plexus are transmitted to the orbit with the ophthalmic artery through the optic canal has been variously assumed, disregarded, or denied, but never demonstrated. The objective of this study was to examine the contents of the canal, identify any autonomic nerves, and follow their passage within the orbit. The soft tissues of the optic canal, and the apical tissues of the orbit were removed and examined histologically using 10 cadaver preparations. Additionally, tissues from an orbital exenteration and 10 ocular enucleation or donor specimens were prepared. Some of the latter material was examined with an electron microscope. Numerous autonomic nerves (four to 25, ranging in diameter from 23 to 130 microm) entered the orbit from the internal carotid plexus in the periosteum of the optic canal, the optic nerve dura mater, or the adventitia of the ophthalmic artery. In the orbit they advanced in the loose connective tissue covering the optic nerve dura and joined ciliary nerves close to the eye or entered the eye directly. None were observed to penetrate the dura, apart from a nerve accompanying the central retinal artery. Others were distributed with the ophthalmic artery and its branches. It is concluded that the optic canal is a regular, and often major, route for autonomic nerve distribution to the eye and orbit.

Autonomic Pathways↗