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PubMed2004

The diagnostic value of ultrasonography in the detection of orbital floor fractures with a curved array transducer.

The aim of the study was to investigate the diagnostic value of ultrasonography (US) in orbital floor fractures and orbital rim fractures with a curved array scanner. Over a period of 10 months, 60 patients with an orbital trauma have been investigated. Orbital trauma was defined by clinical and ophthalmologic investigation. Computed tomography (CT) was used as the reference method to evaluate the diagnostic value of US in the determination of an orbital floor fracture and was performed by a well-experienced radiologist. Coronal and sagittal images were made. The US investigation was performed with a 7.5 MHz curved array transducer.The US investigation of the infraorbital rim showed a sensitivity of 94% and a specificity of 92% with a diagnostic accuracy of 92%. The positive predictive value (PPV) reached 91% and the negative predictive value (NPV) reached 92%, while the US investigation of the orbital floor showed a sensitivity of 95% and a specificity of 100% with a diagnostic accuracy of 98%. PPV reached 100% and NPV reached 77%. Ultrasonography is a cost-effective and widely available method without disadvantages such as radiation exposure. The results in the current study imply that ultrasonography can be used as an alternative method in the investigation of orbital floor fractures.

Adolescent↗
PubMed2004

[Orbital volume in congenital clinical anophthalmos].

INTRODUCTION: The purpose of this study is to report orbital volume measurement results in patients with congenital clinical anophthalmia before and after therapy and to compare them with normal values. PATIENTS AND METHOD: Normal values were obtained from 35 healthy children (22 boys, 13 girls; aged 3 month to 7 years) in whom MRI was done for non-ophthalmological reasons. 18 patients with congenital anophthalmos could be included, 9 with bilateral, 8 with unilateral disease and 1 microphthalmos. 6 of them had MRI follow-up (more than one examination). RESULTS: Orbital volume at birth is 7 ml and it increases with age: Orbital volume = 7.701 x age (month) (0.2484) ml. It is around 14.2 ml at the age 1 year, 17 ml with 2 years and reaches 23 ml with 7 years. In unilateral clinical anophthalmos orbital volume is 35 to 58 % compared with the healthy side and 31 to 65 % compared with the normal values. In bilateral cases the volume is 43 to 70 % of the normal value. During treatment it develops in parallel to the normal values. CONCLUSIONS: The normal values measured by our group are in accordance with the only published study by Bentley . MRI orbital volumetry is a reliable method without using radiation. It allows us to quantify the bony asymmetry and is suitable for therapy control when using orbital expanders. The congenital missing eye might be the most important reason why the orbit does not develop in the normal way to a normal size. Self-inflating high, hydrophilic hydrogel expanders do not seem to be able to compensate this, in spite of the fact that they work very well to prepare the socket for a prosthesis.

Aging↗
PubMed1996

[Ultrasound diagnosis of orbital floor fractures: an alternative to computerized tomography?].

BACKGROUND: Plain radiography of the paranasal sinuses (Water's view) may fail to demonstrate typical signs of orbital floor fractures. To resolve questionable cases, computed tomography (CT) is performed. B-mode ultra-sonography (US) is investigated concerning its reliability and as a possible alternative to CT. The replacement of standard radiological techniques in primary evaluation will be discussed. METHODS: A skull was used to assess the visualization of the bony floor in the ultrasound-technique. Fifteen patients with suspected fractures of the orbital floor were investigated with plain radiographs, ultrasound of both orbits in closed-eyelid technique, and CT scans. The findings were compared. RESULTS: Thirteen patients were found to have apparent fractures in CT scans. These fractures were also diagnosed on ultrasound. In three patients, ultrasonographic localization was imprecise. These fractures were located behind the lower orbital rim or far posteriorly. Plain radiographs showed positive fracture signs only in five patients. Localization was not possible. The application of the ultrasound probe was well tolerated. CONCLUSIONS: B-mode ultrasonography is a valuable and inexpensive technique to visualize orbital floor fractures. It should be employed in primary evaluation patients with suspected isolated orbital floor fractures prior to taking plain radiographs of the paranasal sinuses. Computed tomography should be used in suspected complex fractures and questionable orbital fractures.

Adult↗
PubMed1997

Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach.

Utilizing the conceptual combination of brain protective skull base surgery and minimalism, a conventional frontal craniotomy for tumors in the subfrontal and parasellar regions is modified to an orbital roof craniotomy. Through a 4 to 5 centimeter (cm) long eyebrow incision an orbital roof craniotomy (measuring 2 cm by 3 cm), including the supraorbital arch, is made as a single piece bone flap. The orbital roof is opened up to the supraorbital fissure and to the optic canal by additional removal of the bone in the orbital roof. This will expose the globe and the orbitofrontal dura mater. When the dural incision is made at the orbital portion of the dura mater, the orbital contents are retracted by tack-up sutures. The tumor is removed utilizing the orbital space rather than the intracranial space. Brain retractors are not necessary and are not used to execute the tumor resection. This technique has been used in three patients with craniopharyngiomas, seven patients with meningiomas, and one patient with a subfrontal teratoma. Gross total resection was achieved in three patients with craniopharyngiomas and in five patients with subfrontal or parasellar meningiomas. Subtotal resection of the tumor was achieved in two patients with recurrent meningiomas and in the patient with a subfrontal teratoma. The surgeon's operating space through this exposure was sufficiently ample to achieve the goals of the operation. The direct eyebrow incision provides an additional vital working space with a width of more than 1 cm at the skull base by eliminating the scalp flap which a coronal incision employs. The surgical technique is described with a report of 11 cases.

Adult↗
PubMed2000

Extraocular muscle responses to orbital cooling (ice test) for ocular myasthenia gravis diagnosis.

BACKGROUND: As a result of clinical and laboratory investigations of temperature correlates of myasthenia gravis, orbital cooling (ice test) has been developed as a reliable test for ocular myasthenia diagnosis through blepharoptosis response. The test has not been utilized in a prospective manner for myasthenia diagnosis through extraocular muscle responses. METHODS: Fifteen patients with acquired motility disorders were studied with the use of orbital cooling and other tests for myasthenia gravis. Orbital cooling was performed in a standard fashion for all patients. In 14 of 15 patients, the diagnosis of myasthenia was not established at the time the ice test was performed. Fifteen non-myasthenic patients with acquired motility disorders were also studied with use of the ice test. Temperatures during orbital cooling were measured in the superior cul-de-sac of one patient and between the lateral rectus muscle and globe in 3 patients. RESULTS: All patients subsequently proven to have myasthenia gravis by other tests and by response to myasthenia therapy had a positive (diagnostic of myasthenia) response to the ice test. No patient had a false-positive or a paradoxical response to the ice test. No control patient had a positive blepharoptosis or motility response to orbital cooling. Temperature measurements demonstrated significant cooling effects in the superotemporal cul-de-sac and beneath the lateral rectus muscles after orbital cooling for 5 minutes. CONCLUSIONS: Orbital cooling, within certain parameters, can be a useful clinical test for myasthenia diagnosis through motility response, as well as blepharoptosis response.

Adolescent↗
PubMed2003

Metastatic tumors of the orbit: a retrospective study.

PURPOSE: To present the clinical features and facts on prognosis, therapy and diagnostics of orbital metastases treated in the Orbital Center Kiel. METHODS: We reviewed the records of 20 patients with orbital metastases (ca. 2% of all orbital patients seen in a 10-year period). RESULTS: The mean age at first manifestation of orbital symptoms was 64 years. On average, 64 months was the period of time between the onset of the primary disease and orbital manifestation. The sites of the primary tumors were breast (8), choroid (2), prostate (2), gastrointestinal tract (3), lung (2), urinary bladder (1), Schmincke tumor of the throat (1) and unknown origin (1). Eleven patients were female, 9 male. The main primary symptoms consisted of lid swelling (11), red eye (9), diplopia (10), and proptosis (7). Although the majority (16/20) were treated by chemotherapy, radiotherapy or surgery, 19 patients died after a mean survival time of 14.7 months. CONCLUSION: Orbital metastases remain an unfavorable prognostic factor, but the diagnosis and treatment are still important in order to prevent loss of vision and improve the patient's quality of life. As previous studies have shown, the overall survival rate is still as limited as nearly half a century ago.

Adult↗
PubMed1985

The effects of dietary restriction and exercise on the volume of adipocytes in two intra-orbital depots in the guinea-pig.

The volume of adipocytes in two intra-orbital sites and fourteen superficial and intra-abdominal sites, and the total adipocyte complement have been measured in virgin and reproductive guinea-pigs maintained on several different regimens of diet and exercise. The adipocytes around the ocular muscles at the back of the orbit (peripheral fat) are always larger than those just behind the eyeball (orbital fat). The adipocytes in both the intra-orbital sites are significantly larger in guinea-pigs whose total adipocyte complement is smaller than one standard deviation from the mean, than in those which have a normal-size or large adipocyte complement. The volume of intra-orbital adipocytes correlates very significantly with the volume of adipocytes in superficial and intra-abdominal sites in guinea-pigs which have large adipocyte complements, correlates weakly in those with normal adipocyte complements and not at all in those with small adipocyte complements. It is suggested that there may be fewer intra-orbital adipocytes in animals which have small adipocyte complements, and that, because the intra-orbital adipose tissue occupies a constant volume, the adipocytes in these sites become larger when they are less numerous.

Adipose Tissue↗
PubMed2006

Primary intraosseous hemangiomas of the orbit.

INTRODUCTION: Primary intraosseus orbital hemangiomas are rare vascular anomalies, of which only 23 cases have been previously reported in the literature. We here describe a further two cases. MATERIALS AND METHODS: An anterior approach was used to remove a mass located in the inferior orbital rim in one case, and in the orbital floor in the other. RESULTS: Good restoration of the orbital walls with no signs of recurrence. DISCUSSION: Intraosseous hemangiomas of the orbit are usually located anteriorly, and can be removed by anterior surgical approaches. The main surgical problem is due to the removal of the involved areas of the orbital walls because resection without reconstruction may cause functional impairments and secondary deformities that are more damaging for the patient than the tumour itself. In order to avoid defects, the integrity of the orbital walls must be immediately restored by means of autologous bone or alloplastic grafts.

Adult↗
PubMed2003

Glycosaminoglycans provide a binding site for thyroglobulin in orbital tissues of patients with thyroid-associated ophthalmopathy.

The presence of thyroglobulin (Tg) in orbital tissues of patients with thyroid-associated ophthalmopathy (TAO) supports a role of Tg in TAO pathogenesis. To search for Tg-binding sites in orbital tissues, because Tg is a heparin-binding protein, we investigated its binding to glycosaminoglycans (GAGs) that are abundant in orbital tissues: chondroitin sulfate B (CSB) and C (CSC) and hyaluronic acid (HA). Both in solid phase and solution phase assays purified human Tg bound to GAGs. In solid-phase assays, binding was increased by coincubation with heparin or GAGs in solution, or with an antibody against a Tg heparin-binding sequence (Arg2489-Glu2503), possibly suggesting crosslinking of Tg molecules induced by GAGs or by the presumably bivalent antibody. Orbital tissue extracts from TAO patients that contained Tg were subjected to high-salt treatment, which resulted in separation of Tg from GAGs, as observed by column chromatography. After separation from GAGs, the Tg in orbital tissue extracts acquired the ability to bind to immobilized CSB, and heparin enhanced binding, resembling the findings with purified human Tg. Therefore, we conclude that GAGs provide binding sites for Tg in orbital tissues, which may explain the presence of Tg in orbital tissues of patients with TAO.

Adipose Tissue↗
PubMed2005

Orbital gallium-67 scintigraphy in Graves' ophthalmopathy: a disease activity parameter that predicts the therapeutic response to immunosuppressive treatment.

In this study, orbital gallium-67 citrate ((67)Ga) scintigraphy was evaluated as a disease activity parameter that can predict the therapeutic response to immunosuppressive treatment in Graves' ophthalmopathy. Orbital scintigraphic analysis was performed on 32 patients demonstrating moderate to severe Graves' ophthalmopathy. Single-photon emission computed tomography (SPECT) images were obtained 48 hours after intravenous injection of 148 MBq of radioactive (67)Ga complex, and orbit/occipital (O/Occ) ratios were calculated to correct the background activity. Intravenous methylprednisolone was given as immunosuppressive treatment to 24 patients (group 1) and 8 patients were followed up without any treatment and evaluated as controls (group 2). Orbital (67)Ga scintigraphy was repeated in all patients after 6 months to analyze the changes in clinical findings and orbital (67)Ga accumulation. In Group 1, the mean +/- standard deviation (SD) (67)Ga O/Occ ratio of responders (2.23 +/- 0.2, 16 cases) was statistically different from nonresponders (1.49 +/- 0.1, 8 cases, p < 0.001). Additionally, the corticosteroid treatment provided a significant decrease in orbital (67)Ga accumulation in responders (p < 0.001), however, it did not change statistically in nonresponders (p:0.13). In group 2, the patients did not demonstrate clinical improvement and orbital (67)Ga uptake did not change after the follow-up period (p:0.81). The receiver-operator-characteristic curve showed that the best threshold for discriminating responder and nonresponder groups was 1.70 (sensitivity, 94%; specificity, 88%). This study demonstrated that orbital (67)Ga scintigraphy may be a useful imaging technique in predicting the therapeutic response to immunosuppressive treatment in Graves' ophthalmopathy.

Adult↗
PubMed1986

Treatment of orbital pseudotumors and lymphoma.

Thirty-seven patients were identified in a retrospective review at Hahnemann University and Wills Eye Hospital; they had been treated for pseudotumor or lymphoma of the orbit and had adequate follow-up (x = 61.5 months). Overall, 31 of 37 patients (83.8%) were cleared of their orbital disease. Of the nine patients treated for lymphoma, all were cleared of disease in the orbit. Twenty-two of 28 patients (78.6%) with benign disease were likewise cleared of orbital disease. Ten of 10 patients who received radiation as their initial therapy were cleared. Overall, 17 of 20 (85%) of patients who received radiation as part of their therapy were cleared of orbital disease, with mean dosages of 2,166 cGy (1 cGy = 1 rad) for benign disease and 3,547 cGy for lymphoma. Brief representative case studies and a review of the literature are presented. Two patients with benign disease were cured of disease in the orbit but went on to develop systemic lymphoma. Radiation therapy plays an essential role in the management of patients with orbital lymphomatous diseases.

Adolescent↗
PubMed1990

Techniques for improved visibility and lid protection in orbital explorations.

Visualization during exploration of the orbit is hampered by herniation of orbital fat around the malleable retractor in posterior orbital dissection. A thin stiff disc of plastic sheeting, placed between the dissected orbital soft tissue contents and the malleable retractor, reduces prolapse of fat around the edges of the orbital retractor. The technique is utilized in acute fracture treatment and in late orbital reconstruction. The malleable retractor, placed below the plastic disc, may be easily taken in and out of the orbit with reduced damage of fat and enhanced visualization. Retractor damage to fat is reduced and visualization enhanced. The plastic sheet may be inserted over an intact posterior bony "ledge" in floor fractures, allowing accurate placement of bone grafts under direct visualization. Additionally, the use of a segment of flexible rubber sheeting sewed over a subciliary incision margin reduces traction injury, drill and cautery damage to eyelid skin.

Eyelids↗
PubMed1997

Early and late surgical treatment of orbital dystopia in craniofacial malformation.

Orbital dystopia is one of the most frequent clinical signs of craniofacial malformation. The term dystopia indicates the mono- and bilateral asymmetry of the orbits at least in one of the three-dimensional planes. The diagnosis is based on the clinical test of the patient with the support of diagnostic instruments such as teleradiography in both standard projections, axial computed tomographic (CT) scans at a rate of 1:1 through the neuro-orbital plan, and the three-dimensional CT. Good results of the surgical treatment depend on the patient's age and on adequate programming, which should consider the anomalies in the three spatial planes. The VTO is obtained through a protocol of analysis on cephalometric graphics of the teleradiographics on the CT at a rate of 1:1. The surgical treatment of orbital dystopia is different depending on the age of the patient and the cause of the orbital anomaly. In the case of growing patients, it is preferable to use the fronto-orbital bandeau technique so as not to damage the dental buds, whereas in grown patients Tessier's orbital quadrant technique is used. Even the fixation is quite different between patients who are growing and those who are already grown. In still-growing patients, rigid internal fixation is used only in some cases to avoid the interference with the growth mechanisms.

Adolescent↗
PubMed2002

Solitary fibrous tumor of the orbit.

Painless unilateral proptosis is a frequent manifestation of numerous orbital neoplastic and non-neoplastic processes. Various mesenchymal tumors of both fibrohistiocytic and vascular origin are well-described causes. Solitary fibrous tumors (SFTs) are rare spindle-cell neoplasms usually found associated with serosal surfaces, especially the pleura, but they have recently been described in a number of extrapleural sites including the orbit. The authors describe the case of an 18-year-old man who presented with a 6-month history of painless proptosis in the right eye. A visible nontender mass in the right supermedial orbit producing ptosis of the upper lid was present. Magnetic resonance imaging (MRI) showed a well-circumscribed soft tissue mass located above the right globe with no obvious invasion of adjacent orbital structures. Uneventful surgical excision through a right frontal-orbitotomy approach was performed. Histological evaluation showed a solid, highly vascular tumor mass composed of spindle cells arranged in short ill-defined fascicles. Intense immunohistochemistry staining for CD34 and B-cell lymphoma 2 (BCL-2) differentiated the lesion from the more common hemangiopericytoma. Though considered benign, local recurrence and extraorbital extension of orbital SFTs have been described. Malignant behavior, including distant metastases, has been documented in as many as 20% of pleural cases with mortality rates as high as 50%. The natural history of this tumor in the orbit is unclear. The authors report the 35th case of orbital solitary fibrous tumor and discuss the differential diagnosis, histopathology, radiological features, and clinical course.

Adolescent↗
PubMed1987

Leiomyosarcoma of the orbit. A case report and review of the literature.

Leiomyosarcoma has been rarely encountered in the orbit. Leiomyosarcoma may arise as a primary tumor in the orbit, metastasize from distant sites to the orbit, extend into the orbit from the paranasal sinuses, or appear after radiation therapy to the orbit. The 43-year-old female patient described in this paper underwent excision of a leiomyosarcoma in the subcutaneous tissue of the buttock. Seven years later, a leiomyosarcoma in the medial orbit was removed. The clinical course of this patient's disease was similar to that of other subcutaneous leiomyosarcomas documented in the literature. Gynecological history was remarkable for a leiomyoma of the uterus, an interesting association found in at least one other case in the literature. This was the third documented case of metastatic leiomyosarcoma in the orbit.

Adult↗
PubMed1996

Diplopia after surgical repair of orbital floor fractures.

Blowout fractures of the orbit are common sequelae to blunt facial trauma. Many aspects of this injury have been studied, in particular, the timing of and indications for surgical intervention. Although diplopia is often an indication for surgery and is presented to patients as a potential postoperative complication, the incidence of diplopia after surgical repair of orbital blowout fractures has not been well studied. We retrospectively studied 54 patients who underwent repair of an orbital blowout fracture. A minimum of 6 months follow-up was available for all patients included in the study. A total of 47 of 54 (86%) patients had clinically significant diplopia preoperatively, and 20 of 54 (37%) remained diplopic. A total of 17 of 54 (31%) fractures involved the medial wall and orbital floor, and 13 of these 17 patients (86%) had postoperative diplopia. Patients with combined orbital floor and medial wall fractures appear to be at higher risk for clinically significant diplopia postoperatively than those with fractures of the orbital floor only. The explanation for this observation may be related to a greater difficulty in restoring the preoperative contour of orbits with combined fractures.

Adolescent↗
PubMed1998

High-resolution magnetic resonance imaging of the orbital connective tissue system.

A complex system of connective-tissue septa within the orbit has previously been described in serial histologic sections. The present study describes the anatomy of the orbital connective tissue system on high-resolution magnetic resonance (MR) images in vivo. Five volunteers aged 26 to 35 year underwent magnetic resonance imaging of the orbit on a 1 Tesla unit (Impact, Siemens, Germany). T1-weighted coronal images were obtained using a surface coil. Anatomical structures on the MR images were identified by comparison with corresponding histologic sections. On MR images of the anterior orbit, the levator aponeurosis, Lockwood ligament, transverse intermuscular ligament, common sheath, check ligaments, Tenon capsule, intermuscular septa, and palpebral ligaments can be seen. In the mid- and posterior orbit, the intermuscular orbital septa, especially the superolateral septum, the superior ophthalmic vein hammock, and septa of the radial connective tissue system are visualized. High-resolution magnetic resonance imaging is capable of delineating the major septa of the orbital connective tissue system.

Adult↗
PubMed2001

Primary Ewing sarcoma of the orbit.

PURPOSE: To report the clinicopathologic features of a 17-year-old patient with primary Ewing sarcoma of the orbit. METHODS: The patient was evaluated clinically before surgery with computed tomography scans of the orbit. After surgery, the patient was staged with computed tomography scans and bone scan and was treated with systemic chemotherapy and radiation therapy to the orbit. The orbital biopsy was evaluated with conventional light microscopy and immunohistochemistry. RESULTS: Clinical evaluation revealed proptosis and limited upgaze. Computed tomography scans disclosed a mass involving the superior orbit, anterior cranial fossa, and temporal fossa. Microscopic examination revealed small, poorly differentiated cells with medium-sized nuclei containing finely granular chromatin and small nucleoli. The cytoplasmic borders of the cells were indistinct. A PAS stain revealed modest glycogen in many of the tumor cells. The tumor stained positive for O-13 and vimentin and was negative for neural, skeletal, and lymphoid cell markers. Computed tomography scan, bone scan, and blood chemistries revealed no other site of involvement. After treatment, the clinical symptoms and signs resolved, and there has been no evidence of residual orbital tumor or metastasis. CONCLUSIONS: Primary Ewing sarcoma of the orbit should be considered in the differential diagnosis of children or young adults with proptosis, diplopia, or periorbital swelling. Immunohistochemistry is essential to distinguish Ewing sarcoma from other small round cell tumors.

Adolescent↗