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PubMed1988

Orbital lipoma.

A patient who had a huge orbital lipoma with extension to the muscle cone is described. The lipoma was 42 x 34 x 32 mm in size, and there was no visual disturbance following removal of the tumor and iliac bone grafting. Diagnosis of orbital lipoma is difficult to make. This is particularly true of a lipoma with an obvious capsule, which cannot be easily differentiated from a dermoid cyst. However, computed tomography scanning is useful in ascertaining the location, size, and relationship with orbital contents. A review of the literature concerning orbital lipoma revealed only a few reports, and the features of the orbital lipoma are summarized. In addition, the possible mechanism of orbital enlargement and the approach to the muscle cone are described.

Adult↗
PubMed1998

Osteosarcoma of the orbit associated with Paget disease.

Osteosarcoma is a common primary bone malignancy most often involving the long bones and occurring in the second decade of life. Orbital involvement in this disease process is rare and is usually due to extension of the tumor from an adjacent sinus cavity. Orbital osteosarcoma arising from preexisting Paget disease is exceedingly rare. We report the case of a 78-year-old female patient with Paget disease of the forehead who presented with rapidly increasing bilateral proptosis and visual loss for several months. Examination showed bilateral aphakia, decreased motility, proptosis with resistance to retropulsion, and tumorous infiltration of the eyelids and periorbital soft tissue. Fundus examination showed marked bilateral scleral indentation without overlying serous retinal detachment. A computed tomographic (CT) evaluation of the orbits demonstrated extensive soft tissue involvement of the paranasal sinuses, nasal cavity, periorbital soft tissue, and orbits, with compression of the optic nerve and globe bilaterally. Biopsy of the periorbital soft tissue demonstrated osteosarcoma. Radiation therapy failed to stem the progression of the disease process, and the patient died approximately 4 months later. Although osteosarcoma of the orbit associated with Paget disease is unusual, it should be considered in the differential diagnosis of older patients with a rapidly progressive orbital mass.

Aged↗
PubMed2000

The bioceramic orbital implant: a new generation of porous implants.

PURPOSE: The authors describe a new generation of porous orbital implant made of aluminum oxide (Al2O3) and compare it with the hydroxyapatite orbital implants (Bio-Eye and FCI hydroxyapatite). METHODS: The authors examined the new implant macroscopically, with chemical analysis and microscopically with scanning electron microscopy. Animal implantation studies were performed using six adult male New Zealand albino rabbits. Implant vascularization was evaluated by means of magnetic resonance imaging and histopathologic sectioning. RESULTS: The Bioceramic orbital implant was found to have very uniform pore structure with an average pore size of 500 microm. The implant was 99.9% aluminum oxide on x-ray diffraction. Magnetic resonance imaging in vivo vascularization studies demonstrated enhancement of the implant to its center by 4 weeks after implantation in the rabbit. Histopathologically, fibrovascularization occurred uniformly throughout the implant and was noted by 4 weeks. CONCLUSIONS: The Bioceramic orbital implant represents a new porous orbital implant that has a very regular and extensive interconnected pore system, is as biocompatible as hydroxyapatite, is easy to manufacture, structurally strong, and free of contaminants. It is manufactured with no disruption to marine life ecosystems as may occur in the harvesting of coral for other orbital implants. It is less expensive than currently available hydroxyapatite implants and was approved by the U.S. Food and Drug Administration in April 2000.

Aluminum Oxide↗
PubMed2002

Orbital and adnexal trauma associated with open-globe injuries.

PURPOSE: To describe the incidence and patterns of orbital and adnexal injuries in patients with open-globe injuries. METHODS: Charts of 300 consecutive patients with open-globe injuries presenting to the Massachusetts Eye and Ear Infirmary were retrospectively reviewed. The data were analyzed with respect to the type of open globe (penetrating, perforating, or rupture) and location (zone) of globe injury. Each of these subgroups was then evaluated for the absence (group 1) or presence (group 2) of coexisting orbital and/or adnexal injury. Visual acuity at presentation was compared between the two groups. RESULTS: Orbital and adnexal injuries were present in 25.7% of patients with open globes. The most common concurrent injuries were lacerations of the eyelid, orbital fracture, and retrobulbar hemorrhage. The mechanisms of globe injury differed significantly between groups 1 and 2. Penetrating injuries accounted for 82.1% of group 1 but only 49.3% of group 2 patients, whereas rupture occurred more frequently in group 2 (48.1%) than in group 1 (17.0%) patients. Orbital and adnexal injuries were associated with poorer visual acuity at presentation, probably because of the high incidence of posterior globe injuries in these patients. CONCLUSIONS: Orbital and adnexal injuries were observed in 25.7% of patients who sustained trauma that resulted in open globes. Concurrent injury to these extraocular structures is associated with worse visual acuity at presentation and an increased likelihood of posterior globe injuries.

Eye Injuries↗
PubMed2000

Orbital drainage from cerebral arteriovenous malformations.

OBJECTIVE: To describe the neuro-ophthalmic findings in patients with orbital drainage from cerebral arteriovenous malformations (AVMs). METHODS: We reviewed the records of 100 consecutive adult patients with cerebral AVMs who presented to our institution during a 4-year period. All patients with orbital drainage were identified, and their neuro-ophthalmic evaluations were reviewed. RESULTS: Three patients (3%) were identified with orbital drainage from a cerebral AVM. The first patient presented with typical chiasmal syndrome (reduced visual acuity, bitemporal hemianopia, and optic atrophy). Magnetic resonance imaging demonstrated a large left temporal and parietal lobe AVM with compression of the chiasm between a large pituitary gland and a markedly enlarged carotid artery. The second patient presented with headaches and postural monocular transient visual obscurations. Examination revealed normal visual function with minimal orbital congestion and asymmetrical disc edema, which was worse in the left eye. Magnetic resonance imaging revealed a large right parietal and occipital lobe AVM without mass effect or hemorrhage and an enlarged left superior ophthalmic vein. The third patient had no visual symptoms and a normal neuro-ophthalmic examination; a right parietal lobe AVM was discovered during an examination for the cause of headaches. CONCLUSION: Orbital drainage from cerebral AVMs is rare. Manifestations may include anterior visual pathway compression, dilated conjunctival veins, orbital congestion, and asymmetrical disc swelling.

Adult↗
PubMed2001

Non-Hodgkin's orbital lymphoma.

BACKGROUND: The non-Hodgkin's lymphomas (NHL) are a group of neoplasms characterized by proliferation of malignant lymphocytes. Patients with NHL have a wide variety of presenting signs and symptoms, depending largely on the site of involvement and aggressiveness of the disease. Many organs in the body may be affected, including the eye and orbit. CASE REPORT: A 47-year-old male with a 3-year history of stage IV non-Hodgkin's lymphoma who had undergone recent monoclonal antibody therapy presented with a complaint of blur in the left eye with occasional diplopia. Significant ocular findings of the left eye included ptosis, mild proptosis, increased intraocular pressure, and choroidal folds. Magnetic resonance imaging of the orbit revealed an orbital lymphoma that completely resolved after 2400 rads of external beam irradiation therapy. Eight months later, the patient developed a secondary radiation retinopathy. CONCLUSION: The prevalence of NHL is on the rise, and orbital involvement may occur at any time during the course of the disease. The standard treatment for non-Hodgkin's orbital lymphoma is external beam irradiation therapy, although the optimal dose for obtaining local tumor control without complications remains to be determined. Non-Hodgkin's lymphoma, orbital lymphoma, and various treatment options are discussed.

Exophthalmos↗
PubMed1992

Orbital diagnosis and imaging.

A myriad of imaging modalities now exists to aid in the diagnosis of orbital disease. Most of the recent advances in orbital diagnosis are based on refinements of established techniques, although several represent the application of new technology. Invasive techniques, such as orbital arteriography and venography, have been supplanted with computed tomography, which has become the mainstay of orbital diagnosis. The use of magnetic resonance imaging in the assessment of orbital pathology has also increased. Color Doppler, a recent development in ultrasonography, has now been applied to the eye and orbit.

Biopsy↗
PubMed1995

Orbital trauma and reconstruction.

This article reviews the most recent topics of investigation concerning orbital trauma and reconstruction. During the past year there have been many articles of interest regarding management of the sequelae to orbital trauma, pathophysiologic process in orbital injury, diagnostic techniques, as well as operative methods, materials, and complications. Recent research has focused on the pathophysiology of traumatic optic neuropathy and visual compromise in orbital hemorrhage. Theories regarding the etiology of atraumatic spontaneous enophthalmos are described. In the realm of orbital reconstruction, rigid fixation systems have ben extensively investigated for use in orbital and facial trauma. Investigators have begun to address the question of potential complications from rigid fixation in children.

Eye Injuries↗
PubMed1998

Orbital trauma.

In this review, a number of current issues on the management of orbital trauma are discussed including the indications for orbital exploration in zygomatic complex fractures, the utility of transantral endoscopy in orbital trauma surgery, and preferred implant materials in orbital reconstruction. We emphasize the need for a classification system to define some of the clinical terms used in describing orbital trauma, to improve communication between clinical services, and to standardize the clinical literature on orbital trauma.

Endoscopy↗
PubMed2005

Ethmoido-orbital tumors: our experience.

No data in the literature report the specific invasion of the orbit from ethmoidal tumors, although such a pattern of involvement of the orbit frequently occurs because of the thin lamina papyracea separating the two structures. From January 1986 to January 2003, 38 patients with untreated primary ethmoidal malignancies were observed at the Unit of Maxillo-Facial Surgery of the University "La Sapienza" in Rome. Personal data were obtained from review of the personal clinical file of each. Orbital invasion was present in 24 patients with ethmoidal malignancy. Three stages of orbital invasion were identified. The average overall survival, with the Kaplan-Meyer method, was 61.4% after 1 year and 51.1% at 5 and 10 years. Intracranial involvement is the main element for short-term negative prognosis. Orbital exenteration is fundamental if grade III orbital invasion occurs because it ensures an improvement of the disease-free survival.

Adenocarcinoma↗
PubMed1994

Prediction of enophthalmos by computed tomography after 'blow out' orbital fracture.

In 11 patients with blow out fracture of the orbit, measurement of orbital volume using computed tomography (CT) more than 20 days after injury correlated well with enophthalmos measured from the same scans (r = 0.87, p < 0.001, SEE 0.63 mm), with a 1 cm3 increase in orbital volume causing 0.8 mm of enophthalmos. This confirms the cause of enophthalmos after blow out fracture to be increase in orbital volume rather than fat atrophy or fibrosis. In a further 25 patients scanned within 20 days of injury the degree of enophthalmos was less marked than would be predicted from the orbital volume measurement. This was probably because of the presence of oedema, haemorrhage, or both behind the globe which would prevent immediate development of enophthalmos. CT measurement of orbital volume within 20 days of injury may predict the final degree of enophthalmos and identify those patients at risk of late enophthalmos, allowing appropriate early surgical intervention.

Enophthalmos↗
PubMed1983

Sclerosing orbital pseudotumor.

We report two patients who underwent orbital exploration yielding the diagnosis of sclerosing orbital pseudotumor. The presenting symptoms were exophthalmos, visual loss, abnormal ocular mobility, and ocular pain. Computed tomographic (CT) scans showed masses in the orbital apex. Steroids were ineffective. Orbital pseudotumor is a heterogeneous diagnostic category of lymphoid infiltrations of the orbit with a wide spectrum of pathological conditions and intraorbital locations. The clinical presentation typically includes the sudden onset of pain, diplopia, lid edema, and exophthalmos. Visual loss is uncommon. Most cases resolve spontaneously or respond to steroid treatment. Although fibrosis may be a prominent histological finding, the literature contains little information concerning its significance. We discuss the evidence for considering the sclerosing pseudotumors to be a significant variant with unique clinical behavior. Although features suggestive of pseudotumor were present in our case, the presence of visual loss and an apical mass shown on the CT scan led to the presumptive diagnosis of tumor and exploratory operation. Neurosurgeons should be aware of this entity as a cause of visual loss and orbital mass. Proper suspicion may in some cases permit transorbital biopsy and avoid craniotomy, inasmuch as operation is of no therapeutic benefit in this disease.

Adult↗
PubMedDate not supplied

Endoscopic management of orbital apex lesions.

Lesions of the orbital apex often present a diagnostic dilemma. Clinical assessment and imaging studies are helpful but a tissue biopsy is often required. The morbidity associated with transcranial approaches to the orbital apex may outweigh the benefits of obtaining a biopsy by these routes. Fine needle aspiration cytology of orbital apex lesions can be performed but there are disadvantages with this method. We describe a transnasal endoscopic technique to biopsy the orbital apex. The technique was used successfully to obtain a tissue diagnosis in six patients with orbital apex lesions. This enabled commencement of definitive treatment. There were no significant complications. The transnasal approach to the orbital apex using the endoscopes is reliable. Endoscopes provide excellent illumination, magnification, and a panoramic view of the operative field.

Adenocarcinoma↗
PubMed1999

[Growing fracture of the orbital roof. A case report].

We report a case of growing fracture of the orbital roof in a 5-year-old child. The presenting sign was a pulsatile orbital mass. This child had a history of a minor head injury with orbital impact 2 years ago. Cerebral CT scan revealed a diastatic fracture of the right orbital roof. On MRI a leptomeningeal cyst extending in the orbital cavity was shown. Frontal craniotomy with direct repair of the dural and bone defects was performed. The outcome was excellent. In the literature the exact pathophysiology of the growing fractures is still debated but a dural laceration along the fracture line is noted in all the cases. They are mostly located in the cranial convexity, and rarely affect the skull base. Only 5 similar cases were found in the relevant literature. Growing fracture of the orbital roof should be suspected if ocular symptoms appears in childs who have sustained a head injury several months or years ago.

Accidental Falls↗
PubMedDate not supplied

Orbital leiomyosarcoma after retinoblastoma.

Patients with the inherited, bilateral form of retinoblastoma have an increased incidence of osteogenic sarcoma such that the mortality from the secondary tumor exceeds that of the initial bilateral retinoblastoma. We report a 29-year-old male survivor of bilateral retinoblastomas originally diagnosed at 8 months of age, whose treatment eventually included bilateral enucleation, bilateral orbital radiation, and systemic chemotherapy. At age 26, a tumor removed from his right maxillary sinus was diagnosed as fibroma. At age 29, he developed an inferior orbital mass that extended into the right maxillary sinus. A biopsy and comparison with the previous maxillary sinus mass revealed both lesions to be leiomyosarcoma. Both light and electron microscopy supported the diagnosis. The patient has survived treatment with orbital exenteration and maxillectomy combined with postoperative radiation to the right orbital-maxillary area. This appears to be the fourth case of leiomyosarcoma in the third decade of life in a male patient with a previously irradiated orbit after enucleation for bilateral retinoblastoma. Leiomyosarcoma appears to be another orbital tumor associated with bilateral retinoblastoma.

Adult↗
PubMed2001

[The value of color Doppler imaging ultrasound in diagnosis of orbital diseases].

OBJECTIVE: To study the useful value of color Doppler imaging (CDI) ultrasound in the diagnosis and differential diagnosis of orbital diseases. METHODS: By using the technique of CDI ultrasound, 288 cases with orbital diseases were examined to show color Doppler flow imaging and pulsed wave Doppler (PWD) spectrum. RESULTS: Among 288 cases of the orbital diseases, 38 cases of malignant tumors and 23 cases inflammatory pseudotumors showed the signals of blood flow. From CDI ultrasound examination, there were 18 in 23 cases with benign mixed tumors of the lacrimal gland showing artery blood flow and 22 in 28 cases with neurilemoma showing signals of blood flow. No blood flow was obtained in 62 among 74 cases with cavernous hemangioma, in 16 cases of dermoid cysts or epidermoid cysts and 1 case of lipoma. From CDI, rich blood flow was seen in 4 and scarce in 3 cases with meningioma, and in 6 cases of optic nerve gliomas, there were 5 cases without any blood flow signals. Other 2 cases with benign hemangioendothelioma, 2 hemangiopericytoma and 1 neurofibroma showed rich or scarce blood flow signals. Among 29 cases of venous hemangiomas, 16 cases showed venous flow. Three cases with arteriovenous aneurysms showed artery blood flow in the CDI. Fifteen cases with varicosis exhibited a dynamic blood flow changes in the CDI. Six cases with infantile hemangioma, the decreased blood supply was shown in the CDI after treatment. In the thirteen cases with carotid artery cavernous sinus fistula, including 8 cases of internal carotid artery cavernous sinus fistula (CCF) and 5 dural cavernous sinus fistula (DCF), dilated superior ophthalmic vein (SOV) with arterialized blood flow was seen. In the mean time, PWD showed that the SOV of CCF had a higher velocity and a higher flow volume than that of DCF, while its resistance index was lower than that of the DCF. In 1 case with thrombophlebitis, its SOV showed dilated superior ophthalmic vein without blood flow. CONCLUSIONS: CDI can provide the information of color blood flow in orbital diseases, especially the tumors with rich vascular tissue and orbital vascular diseases. It is important in the diagnosis and differential diagnosis of the orbital diseases in combination with B-mode ultrasound, CT or MRI.

Adolescent↗
PubMed2001

One-stage reconstruction of the eye socket with vascularized temporalis muscle flap in orbital exenteration.

AIM: Two cases of one-stage reconstruction of exenterated orbit with vascularized temporalis muscle flap in oncological patients are presented. The anatomical characteristics of the temporalis muscle flap and the choice of one-stage or delayed reconstruction of the exenterated orbit are discussed. METHODS: Two patients were operated for malignancy recurrence during the period May-November 2000. One patient suffered recurrent squamous cell carcinoma in the left nasolabial region that infiltrated the lower eyelid and periorbit. The other patient had recurrence of previously operated primary rhabdomyosarcoma of the orbit. Both patients underwent orbital exenteration. In the first patient it supplemented the tumor excision and partial maxillary excision resulting in large orbitomaxillary defect communicating with the nasal meatuses. RESULTS: In both patients good filling effect and isolation of the orbit from the neighbouring nasal meatuses and cranial cavity were obtained using vascularized temporalis muscle flap. CONCLUSION: The vascularized muscle flap appears a reliable technique and method of choice in one-stage as well as in delayed reconstruction in orbital exenteration.

Female↗
PubMed1996

Classification of orbital floor fractures.

A retrospective series of orbital, axial, and coronal computed tomography scans from 24 orbital floor fractures was studied to define the anatomic location of the fracture. Floor fractures without rim involvement, which are referred to clinically as blowout fractures, were located medial to the infraorbital nerve or extended on both sides of the nerve. Floor fractures with rim involvement were associated with zygomatico-orbital or Le Fort II or III fractures, and were located either lateral to or on both sides of the infraorbital nerve. No blowout fractures were confined to the lateral half of the orbital floor and no floor fractures with rim involvement were confined to the medial half of the orbital floor. The authors propose a classification system for describing orbital floor fractures based on their anatomic location relative to the infraorbital nerve.

Adolescent↗