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At least 973 records · Page 54Linked to original sources
PubMed1998

Orbital blow-out fractures: correlation of preoperative computed tomography and postoperative ocular motility.

BACKGROUND/PURPOSE: Although the management of orbital blow-out fractures was controversial for many years, refined imaging with computed tomography (CT) helped to narrow the poles of the debate. Many orbital surgeons currently recommend repair if fracture size portends late enophthalmos, or if diplopia has not substantially resolved within 2 weeks of the injury. While volumetric considerations have been generally well-served by this approach, ocular motility outcomes have been less than ideal. In one series, almost 50% of patients had residual diplopia 6 months after surgery. A fine network of fibrous septa that functionally unites the periosteum of the orbital floor, the inferior fibrofatty tissues, and the sheaths of the inferior rectus and oblique muscles was demonstrated by Koornneef. Entrapment between bone fragments of any of the components of this anatomic unit can limit ocular motility. Based on the pathogenesis of blow-out fractures, in which the fibrofatty-muscular complex is driven to varying degrees between bone fragments, some measure of soft tissue damage might be anticipated. Subsequent intrinsic fibrosis and contraction can tether globe movement, despite complete reduction of herniated orbital tissue from the fracture site. We postulated that the extent of this soft tissue damage might be estimated from preoperative imaging studies. METHODS: Study criteria included: retrievable coronal CT scans; fractures of the orbital floor without rim involvement, with or without extension into the medial wall; preoperative diplopia; surgical repair by a single surgeon; complete release of entrapped tissues; and postoperative ocular motility outcomes documented with binocular visual fields (BVFs). Thirty patients met all criteria. The CT scans and BVFs were assessed by different examiners among the authors. Fractures were classified into 3 general categories and 2 subtypes to reflect the severity of soft tissue damage within each category. "Trap-door" injuries, in which bone fragments appeared to have almost perfectly realigned, were classified as type I fractures. In the I-A subtype, no orbital tissue was visible on the sinus side of the fracture line. In the I-B subtype, soft tissue with the radiodensity of orbital fat was visible within the maxillary sinus. In type II fractures, bone fragments were distracted and soft tissue was displaced between them. In the II-A subtype, soft tissue displacement was less than, or proportional to, bone fragment distraction. In the II-B subtype, soft tissue displacement was greater than bone fragment distraction. In type III fractures, displaced bone fragments surrounded displaced soft tissue in all areas. In the III-A subtype, soft tissue and bone were moderately displaced. In the III-B subtype, both were markedly displaced. Motility outcomes were quantified by measuring the vertical excursion in BVFs. The interval between trauma and surgical repair was also determined. RESULTS: Among the 15 patients with a motility outcome in BVFs which was poorer than the median (86 degrees or less of single binocular vertical excursion), 4 patients (27%) had type A fractures; 11 patients (73%) had type B fractures. Among the 15 patients with a better outcome than the median (88 degrees or more), 10 patients (67%) had type A fractures; 5 patients (33%) had type B fractures. These differences became more defined as analysis moved away from the median. Among 5 patients with type B fractures and better than the median result in BVFs, 3 patients (60%) had surgical repair during the first week after injury. Among the 11 patients with type B fractures and less than the median result, 1 patient (9%) had repair during the first week. CONCLUSIONS: When the CT-depicted relationship between bone fragments and soft tissues is considered, a wide spectrum of injuries is subsumed under the rubric of blow-out fractures. In general, greater degrees of soft tissue incarceration or displacement, with presumably greater intrinsic damage and subsequent fibrosis, appear to result in poorer motility outcomes. Although this retrospective study does not conclusively prove its benefit, an urgent surgical approach to selected injuries should be considered.

Eye Movements↗
PubMedDate not supplied

[Early treatment of secondary muscle restriction due to orbital blow-out fractures].

INTRODUCTION: Orbital blow-out fractures can result in chronic oculomotor restriction. This is the consequence of orbital fasciae or muscle trapped within the fracture. A delayed treatment usually results in incomplete repair. However, when the extrapped tissues are freed by reconstruction of the orbital floor, oculomotor sequelae can be prevented or at least limited. PATIENTS AND TREATMENT: Twelve adults and 2 children were treated for blow-out fracture in the past two years at the Eye Department of Geneva University Hospital. All of these patients had a non regressive oculomotor restriction, an enophthalmus and/or an infraorbital hypoesthesia with evidence of a blow-out fracture on the CT-scan. They were operated on between the second and the sixth week following trauma. Extrapped fasciae were freed under microscope and the orbital floor was reconstructed with a thin plate of biomaterial (PDS). RESULTS: Tissues could be entirely removed and kept separated from the underlying structures by the biomaterial used for reconstruction. Ocular motility returned to normal in 13 cases within 1 to 3 months, without further intervention. Only one patient had to wear a low grade prism with vertical action. DISCUSSION: In case of blow-out fractures, the long term prognosis of the ocular motility depends on immediate management following the trauma. Orbital floor reconstruction is indicated when consecutive oculomotor restriction is likely avoiding in the majority of the cases any residual oculomotor restriction. On the contrary when delayed, treatment is often difficult generally with limited mobility. CONCLUSION: From an ophthalmological point of view, microsurgical extraction of incarcerated orbital fasciae and reconstruction of the orbital floor is indicated for early treatment of oculomotor restriction.

Adult↗
PubMed1999

Optic nerve and orbital tumors.

The close proximity of the orbit to the brain and the high frequency of ocular symptoms in patients with neurosurgical disease make it mandatory for neurosurgeons to be familiar with manifestations of orbital disease. Tumors of the optic nerve and orbit are important causes of vision loss and eye movement abnormalities. Similarly, intracranial tumors frequently present with eye movement abnormalities, vision loss, and optic nerve swelling. This overlap in the clinical characteristics of patients with orbital tumors and patients with neurosurgical problems makes familiarity with the types of clinical presentation of various orbital tumors important to the neurosurgeon. The history and examination of patients with orbital tumors are discussed and the clinical presentation of various orbital tumors is presented.

Carcinoma, Adenoid Cystic↗
PubMed2000

Transnasal endoscopic orbital decompression and Graves' ophtalmopathy.

AIM OF THE STUDY: To assess the validity and the limits of endoscopic endonasal orbital decompression for Graves' ophtalmopathy resistant to the medical theapy. MATERIAL AND PATIENTS: Between September 1994 and May 1998, 16 patients with Graves' ophtalmopathy resistant to the medical treatment underwent an orbital decompression transnasally. 27 orbits were decompressed. The surgery was bilateral in 11 patients. In the 5 remaining cases, the surgery was unilateral. It was carried out on the left side in 2 cases and on the right side in 3 cases. RESULTS: Preoperatively, the average visual acuity was 8/10. Postoperatively, the visual acuity was 9.5/10. The average preoperative exophtalmometry measurement was 25.04 mm and the average postoperative measurement was 21.83 mm. The average retrodisplacement was 3.17 mm (range: 2-8). Preoperatively, 3 patients had mild diplopia whereas 5 others had moderate to severe extraocular muscle dysfunction. Postoperatively, 6 patients had mild diplopia whereas 10 patients required squint surgery for moderate to severe extraocular muscle dysfunction. CONCLUSION: Endoscopic orbital decompression improve all the symptoms of Graves' ophtalmopathy but one: the extraocular muscle dysfunction. Its cardinal indication is the treatment of compressive optic neuropathy whereas this surgical approach provides an excellent control of the medial wall of the orbit and the orbital apex. But the average reduction of proptosis of 3.17 mm is not high enough to propose this approach alone for the treatment of disfiguring proptosis. In such cases, a 2 or 3 wall orbital decompression should be performed to get marked cosmetic and functional improvement. In all cases, the patient should be informed about the risk of postoperative diplopia.

Adult↗
PubMed2000

[Orbital endoscopic surgery: experimental model for foreign bodies extraction].

PURPOSE: Endoscopy is a useful technique that may be applied to study orbital pathology because it is safe. In this paper we describe the surgical technique using endoscopy for orbital foreign body extraction. METHODS: In an experimental model in the dog we inserted a spheric metallic foreign body into the intraconal portion of the orbit. After general anesthesia we performed a 2 mm. peritomy in the conjuntiva. Then we introduced the optic system connected to a TV monitor. Associated to the optic system we fixed a 14-G Abbocath to introduce a 1.7 mm foreign body forceps. RESULTS: After a complete endoscopic exam of the orbit we identified the metallic foreign body. With the 1.7 mm forceps we could take out the foreign body. The extractions were very simple and the technique was not traumatic for the orbit. CONCLUSIONS: Endoscopic surgery of the orbit is a useful and safe technique to extract orbital foreign bodies in this experimental model.

Animals↗
PubMed1992

[Minimally invasive surgery of sinugenic orbital complications in childhood].

Orbital complications of acute sinusitis are classified into inflammatory edema, orbital cellulitis, subperiostal abscess and orbital abscess. The diagnosis is based on endoscopy of the nose, computed tomography of sinuses and orbit and an ophthalmological examination. Endonasal sinus surgery improves drainage and ventilation of sinuses and is free of long-term complications as observed with previous surgical techniques. Thus, the early surgical treatment of orbital complications is indicated even in children. Inflammatory edema and orbital cellulitis will still be treated conservatively. Subperiostal abscess and orbital abscess are treated surgically.

Child↗
PubMed2003

[The inhibition effect of interleukin-1 receptor antagonist on interleukin-1 alpha-induced intercellular adhesion molecule-1 expression on orbital fibroblasts and adhesion of peripheral blood mononuclear cells].

OBJECTIVE: The aim was to identify whether interleukin-1 receptor antagonist (IL-1ra) inhibits interleukin-1 alpha (IL-1 alpha)-induced intercellular adhesion molecule-1 (ICAM-1) expression on cultured orbital fibroblasts, and adhesion of peripheral blood mononuclear cells (PBMC) to orbital fibroblasts, and to investigate the clinical application potential of IL-1ra in the treatment of Graves' ophthalmopathy (GO). METHODS: Cultured orbital fibroblasts from patients with GO and controls were challenged with IL-1 alpha or/and IL-1ra. Immunocytochemical staining was used to examine the changes of ICAM-1 in response to IL-1ra treatment; fluorescent photomicroscope was used to measure the adhesion between the labeled PBMC and orbital fibroblasts. Neutralizing antibody against ICAM-1 was used to demonstrate the role of ICAM-1 in the IL-1 alpha-induced adhesion. RESULTS: IL-1ra inhibits IL-1 alpha-induced ICAM-1 expression in cultured orbital fibroblasts both from GO patients and controls; IL-1ra inhibits IL-1 alpha-induced adhesion of PBMC to orbital fibroblasts in a concentration and time dependent manner. Moreover, a monoclonal anti-human ICAM-1 antibody produced a concentration dependent inhibition of the IL-1 alpha-induced adhesion of PBMC to the fibroblasts. CONCLUSIONS: IL-1ra inhibits IL-1 alpha-induced ICAM-1 expression in cultured orbital fibroblasts and the adhesion of PBMC to fibroblasts. IL-1 alpha-induced ICAM-1 expression may play an important role in the adhesion process. IL-1ra may be useful in the prevention or treatment of GO.

Cell Adhesion↗
PubMed2003

[A comparison of early and late reconstruction and repositioning of orbital blow-out fracture].

OBJECTIVE: To study and compare the operative results of the early and late treatment of orbital blow-out fracture. METHODS: Orbital blow-out fractures were reconstructed and repositioned. Three dimensional measurements, CT scanning, diplopia analysis, Medpor filling of the orbit were used for the operation and the study. The operative results were compared between 15 cases of early and 16 cases of late reconstruction of blow-out fracture. RESULTS: In the early treatment group, there were 8 cases of diplopia, 15 cases of orbital invagination and 10 cases of disesthesia of the infraorbital nerve. After surgery, diplopia was corrected in 7 cases; invagination was corrected in all the 15 cases; disesthesia of the infraorbital nerve was corrected in 8 cases. In the late treatment group, there were 10 cases of diplopia, 16 cases of orbital invagination and 9 cases of disesthesia of the infraorbital nerve. After surgery, diplopia was corrected in 3 cases, unimproved in 4 cases, aggravated in 2 cases. 5 of them received reoperation of extraocular muscle for diplopia. Orbital invagination was uncorrected in 3 cases. 2 of them were re-operated on. Disesthesia of the infraorbital nerve was unimproved in 2 cases. By comparing the operation results, of the two groups using FISHER accuracy inspection, the significant difference was only in the correction of the double visions (chi 2 = 4.865, P < 0.05). CONCLUSION: Early operation for orbital blow-out fracture is easier, with better results, fewer complications and reoperations than the late operation.

Adolescent↗
PubMed2004

Endoscopic orbital decompression for Graves' ophthalmopathy.

BACKGROUND: In patients with Graves' ophthalmopathy, orbital decompression surgery is indicated for compressive optic neuropathy, severe corneal exposure, or for cosmetic deformity due to proptosis. Traditionally this has been performed through a transantral approach, but the associated complication rate is high. More recently, endoscopic orbital decompression has been performed successfully with significantly fewer postoperative complications. OBJECTIVE: To report our experience of endoscopic orbital decompression in patients with severe Graves' ophthalmopathy. METHODS: Three patients (five eyes) underwent endoscopic orbital decompression for Graves' ophthalmopathy at Soroka Medical Center between the years 2000 and 2002. The indications for surgery were compressive optic neuropathy in three eyes, severe corneal exposure in one eye, and severe proptosis not cosmetically acceptable for the patient in one case. An intranasal endoscopic approach with the removal of the medial orbital wall and medial part of the floor was performed. RESULTS: In all five eyes an average reduction of 5 mm in proptosis was achieved. Soon after surgery, visual acuity improved in the three cases with compressive optic neuropathy, and exposure keratopathy and cosmetic appearance also improved. The diplopia remained unchanged. No complications were observed postoperatively. CONCLUSIONS: Endoscopic orbital decompression with removal of the medial orbital wall and medial part of the floor in the five reported eyes was an effective and safe procedure for treatment of severe Graves' ophthalmopathy. A close collaboration between ophthalmologists and otorhinolaryngologists skilled in endoscopic sinus surgery is crucial for the correct management of these patients.

Adult↗
PubMed2005

[Biocompatibility of a special hydrogel orbital implant (PHEMA and MMA) in rabbits].

OBJECTIVE: To investigate the biocompatibility of a hydrogel orbital implant and its rate of vascularization in an experimental study. METHODS: The implant was made of copolymerization of 2-hydroxyethyl methacrylate (HEMA) and methyl methacrylate (MMA). Thirty-two hydrogel orbital implants were implanted into the right orbit of 32 New Zealand albino rabbits. The rate of vascularization was examined by SPECT, immunohistochemistry and electron microscopy. RESULTS: Single Positron Emission Computerized Tomography (SPECT) examination showed that a radiotracer could be found locally concentrated on hydrogel orbital implants in vivo along with time. On light microscopy, implants fibro vascular tissue invade the pores of the hydrogel orbital implant after 2 weeks and gradually invaded the implant deeper and deeper from 4 to 8 weeks, almost all implants were fully vascularized after 12 weeks with a relatively spare inflammatory reaction. Only one case needed additional surgery. CONCLUSIONS: The hydrogel orbital implant has many advantages, such as well biocompatible, fast vascularization, simple operation and low complication of surgery. It is safe and applicable for clinical use as a new type of orbital implant material.

Animals↗
PubMed2005

Development of the human eyeball and orbit during the fetal life.

PURPOSE: The aim of this paper was to describe the development of the human eyeball and orbit during fetal life. MATERIAL AND METHODS: Eighteen human fetuses (36 eyes and 36 orbits) with gestational age ranging from 17 to 28 weeks were examined. Fetuses died in the first hours of life due to immaturity and did not reveal any developmental anomalies. The axial and equatorial diameters of the eyeballs as well as the depth and width of the orbits were measured. The data was analyzed statistically with Student's t-test and Pearson's correlation coefficients. RESULTS: It was found that the axial length (p < 0.005) and equatorial diameter (p < 0.001) of the eyeballs, as well as the depth (p < 0.001) and width (p < 0.001) of the orbit increase with age. Furthermore, growth of the axial length of the eye is paralleled by increase in orbital depth (p < 0.001) while growth of the equatorial diameter coincides with increasing orbital width (p < 0.001). It was ascertained that growth of the human eye during fetal life is correlated with growth of the orbit.

Eye↗
PubMed2006

[Ocular and orbital symptoms in benign sinonasal neopasmas].

UNLABELLED: Osteoma (0.01-0.4%) and inverted papilloma (0.5-4%) are the most common benign tumours of the nose and paranasal sinuses, whereas heamangioma occurs very rare. Orbital and ocular symptoms are uncommon in these types of neoplasmas. AIM OF THE STUDY: Analysis of symtoms, diagnostic procedures and treatment options in 10 patients with diagnosed orbital and ocular complications of benign tumours of the nose and paranasal sinuses. MATERIAL AND METHODS: There are 4 cases of inverted papilloma, 3 cases of osteoma and 3 cases haemangioma. All patients had laryngological, ophtalmological examination, radiografic evaluation by plain film--4 cases, CT--9 patients and angiography in 1 case. Presenting orbital and ocular symptoms occured in 7 patients and in 3 left person orbital involvement was presented only radiographically and intraoperatively. In 5 cases there were correlation between orbital symptoms and radiologic findings. The most common presenting feature--orbital pain (6 patients) and proptosis (5 patients) were observed in papilloma and haemangioma. In 8 cases there were signs of bone destruction in CT, what was intraoperatively confirmed in 4 cases. RESULTS: Nine of the patients were operated: 4--lateral rhinotomies, 2--Denker's operations, 2--operations of sinus frontalis and/or ethmoidalis by external approach and in 1 case resection of maxilllary sinus's tumor were performed. In 2 patients with inverted papilloma there were recurrences 3 years followed operation. The rest of patients stay without recurrences of tumor. CONCLUSION: Orbital and ocular symptoms in benign tumors of nose and paranasal sinuses do not always correlate with radiologic and intraoperative findings.

Adult↗
PubMed2006

[Evaluation of the cosmetic effect of orbital endoimplantation after removal the eyeball].

The purpose of our study was to evaluate the cosmetic effect of endoimplantation after removal the eyeball. The removal of the globe creates anatomic and physiological alteration of the orbital tissue and orbital bones. A volume deficit occurs when an eye is enucleated. Deep upper lid sulcus, ptosis, lower lid laxity, and enophthalmus of the artificial eye together constitute the postenucleation socket syndrome, which creates an asymmetry of the face. The orbital prosthesis by placing it in the orbital cavity allows correcting volume deficit, so the implant with attached extraocular muscles, together with an artificial eye, creates an illusion of real eye. Forty patients were operated on in Clinic of Eye Diseases of Kaunas University of Medicine Hospital. Twenty patients underwent removal of the eye and procedure of orbital implant insertion (main group). Twenty patients had just an eyeball removal without insertion of an orbital implant (control group). There was a statistically significant difference in exophthalmometry data between main and control groups (14.20+/-2.73 vs. 10.35+/-1.23 mm, respectively; p<0.05). The motility of artificial eye laterally (4.30+/-1.66 mm), medially (3.65+/-1.23 mm), up (3.70+/-1.13 mm), and down (3.40+/-1.19 mm) in the main group was significantly better as compared to the control group (p<0.05), where motility of the artificial eye was 0.60+/-0.68 mm laterally, 0.70+/-0.92 mm medially, 0.30+/-0.66 mm up, and 0.30+/-0.47 mm down. Therefore, a much better symmetry, better movement of the artificial eye, and less severe form of postenucleation syndrome were observed in patients who underwent orbital endoimplantation after eyeball removal.

Adolescent↗
PubMed2006

[Clinical analysis of 11 cases of orbital Langerhans cell histiocytosis].

OBJECTIVE: To study the clinical and imaging features, the diagnosis and management of orbital Langerhans cell histiocytosis. METHODS: The symptoms, signs, imaging features, treatment and follow-up results of 11 cases of orbital Langerhans cell histiocytosis were reviewed and analyzed, including 7 cases of eosinophilic granuloma and 4 cases of Hand-Schueller-Christian disease. RESULTS: Eosinophilic granuloma occurred primarily in children and teenagers and appeared as orbital lesions only. Hand-Schueller-Christian disease occurred in children under 5 years old, with multiple lesions of histiocytosis. Typical cases showed the Hand-Schueller-Christian triad: exophthalmos, diabetes insipidus and bony skull defects. Patients usually complained of exophthalmos and orbital masses. B scan and color Doppler showed soft tissue masses in the orbit. CT showed soft tissue masses and bony skull defects. MRI showed orbital tumor and intracranial involvement. CONCLUSIONS: Characteristic imaging features are helpful for the diagnosis of orbital Langerhans cell histiocytosis. The treatment includes surgical excision, local radiotherapy or chemotherapy. The prognosis is related to the types of lesion, eosinophilic granuloma shows the best prognosis and infantile Hand-Schueller-Christian disease shows the worst prognosis.

Adolescent↗
PubMed1991

[Sphenoid fissure syndrome in orbital fractures. Case presentation and literature review].

The superior orbital syndrome has been reported as a very rare complication of orbital fracture. In emergency clinical examination and computed tomography of the cranio-orbital region have provided diagnosis of the compression of the superior orbital fissure content by oedema and/or hematoma. These examinations have determined the type of cranio-orbital fractures and the absence of extra-dural haemorrhage, optical nerve damage or compression, which required emergency treatment. After surgical treatment of the cranio-orbital fracture by temporal and transconjunctival approach, the orbital fissure syndrome has required supervision. The recovery of ophthalmoplegia has taken several months. Minor after effects have been observed for the patient reported.

Humans↗
PubMed1990

[A case of tuberculoma of the orbit with sphenoidal origin].

We report the case of an orbital and sphenoidal tuberculosis observed in a young Indian man living in France. The orbital disease is presenting as an orbital mass with a radiologic bony lytic aspect, without systemic manifestation. A malignant process was suspected. The diagnosis was obtained by the culture for Mycobacterium tuberculosis of the biopsy specimen. Orbital involvement in tuberculosis is a rare manifestation in developed countries. Most cases reported in the literature were reported from Asia and Africa. Orbital tuberculosis may become established in one of two ways: primarily by heamatogenous spread to cause a periostitis or a tuberculoma of the orbital tissues, or secondarily by direct extension from neighbouring structures. It occurs in patients with or without associated pulmonary tuberculosis. Mycobacterium tuberculosis should be considered in the differential diagnosis of inflammatory orbital diseases. This diagnosis is based on clinical feature, positive tuberculin skin test and positive culture in resected tissues. The complete resolution of the disease with the specific antituberculous drugs emphasizes the point that tuberculosis must be evocated.

Adolescent↗
PubMed1989

Orbital roof fractures in the pediatric population.

Twenty-three patients aged 3.3 +/- 1.6 years (mean +/- SD) presented between January of 1984 and September of 1987 with fronto-orbital trauma resulting in fractures of one (N = 20) or both (N = 3) orbital roofs. All patients had computed tomography (CT) with axial and coronal sections that revealed three fracture patterns of the orbital roof (nondisplaced, superiorly displaced, and inferiorly displaced fractures). Orbital dystopia was exhibited in 35 percent (N = 8) of the patients. Exophthalmos was noted in 61 percent (N = 14) of the patients. Only 30 percent of the patients (N = 7) sustained associated maxillofacial fractures. Eight percent of fractures exhibited orbital encephaloceles. All patients lacked frontal sinus pneumatization. The majority of children with orbital roof fractures do not exhibit concomitant facial fractures. CT utilizing both axial and coronal sections is valuable in defining the extent and pattern of the fracture as well as in identifying associated neurologic injuries. Large, displaced orbital roof fractures, which occurred in 3 of 13 patients with displaced fractures in our series, should undergo early reduction to avoid late development of encephalocele.

Child, Preschool↗
PubMed1987

Dacryocystitis. Late complication of orbital floor fracture repair with implant.

Fifteen years after orbital floor fracture repair with a silicone implant, dacryocystitis unresponsive to medical management developed in a 66-year-old woman. On examination, the edge of the implant was palpable at the most medial aspect of the inferior orbital rim in the anatomic area of the nasolacrimal sac. Orbital computed tomography (CT) scan and intraoperative probing and irrigation of the nasolacrimal system confirmed that the implant obstructed the nasolacrimal sac at the floor of the orbit. Removal of the implant combined with dacryocystorhinostomy has led to resolution of the dacryocystitis. To the authors' knowledge, dacryocystitis as a late complication of orbital floor fracture repair with an orbital floor implant has not been previously reported. This case demonstrates that orbital floor implants should not be placed too anteriorly or too medially in the anatomic region of the lacrimal sac and that they should be fixed to prevent implant migration.

Aged↗