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At least 1,099 records · Page 61Linked to original sources
PubMed2002

[Emergencies in nontraumatic orbital diseases].

INTRODUCTION: Nontraumatic orbital diseases only exceptionally require emergency treatment. In this paper an emergency is considered when the diagnosis and/or treatment must be done within a maximal period of 1 week. MATERIALS AND METHODS: All patients with nontraumatic orbital diseases from the Department of Ophthalmology of the University of Lausanne and from the office of one of the authors (N.D.) over the last 35 years were studied, in view of their degree of emergency. Data from 77 patients (28 females and 49 males), aged from birth to 85 years, were collected. RESULTS: Idiopathic inflammations of the orbit (pseudotumors) were the most frequent diagnoses seen as an emergency, followed by rhinological diseases with orbital consequences (exteriorized sinusitis or mucoceles), dysthyroid orbital pathologies, bleeding in lymphangiomas and varices, rhabdomyosarcoma, and acute dacryoadenitis. Fast progressive proptosis, oculomotor disorders, and pain are the most frequent alarm signals. After the diagnostic procedure, a surgical or medical treatment is frequently proposed. CONCLUSION: Although rare, emergencies in orbital diseases are a challenge for the general ophthalmologist. The morbidity and sometimes the mortality due to these diseases are often reduced by proper management. Patients generally have to be referred to a specialized unit.

Acute Disease↗
PubMed1999

[Noso-orbital related disease: an analysis of 39 cases].

OBJECTIVE: To enhance the Diagnostic and therapeutic levels of naso-orbital diseases. METHOD: Thirty-nine cases of naso-orbital diseases were analyzed retrospectively. RESULT: Among the 39 cases, 7 had no nasal symptoms. 9 had their symptoms mainly confined to eyes and were initially consulted with ophtalmologists. 1 case was consulted with neurologist at first. The main pathologies were as following: bony absorption of orbit wall in inflammatory disorders; compression, displacement and bony absorption of orbit wall in benign tumors and mucoceles; bony destruction in malignant tumors. Tranmatic fractures might involve multiple bony structures. CONCLUSION: Nosal and orbital organs are closely related anatomically. Imaging investigations are important in diagnosis of naso-orbital related diseases. CT is helpful for early diagnosis. Treatment for benign tumors is mainly by operation, while malignant tumors should be treated by operation and radiotherapy together.

Adolescent↗
PubMedDate not supplied

[Principles of treatment of traumatic orbit deformations during the late period (a 40-year experience)].

The treatment results of 1000 patients with traumatic orbit deformations covering a 40-year experience gathered by personnel of the chair for eye diseases of Sechenov's Moscow Medical Academy are presented. The authors define the key clinical symptoms of orbit trauma during the late period, i.e. enophthalmos, hypophthalmos and diplopia; pathogenetic motivations for the onset of the above symptoms are described. A scheme of complex treatment is suggested for patients with fractures in the orbit walls, including, with respect to individual indications, conservative therapy, restoration of the osseous orbit skeleton and myoplastic correction of residual diplopia. It is pointed out that, provided the scope and peculiarities of surgical treatment are correctly determined, the efficiency of treatment of patients with traumatic orbit deformations reaches 99.7%. Subsequent methods of optimizing the complex treatment of patients with fractures in the orbit walls are defined.

Adult↗
PubMed2004

[Inferior orbital fissure and groove: axial CT findings and their anatomic variation].

OBJECTIVE: To show imaging findings of inferior orbital fissure (IOF) and groove (IOG) on axial CT scans and to discover their anatomic variations, so as to avoid misdiagnosing them as orbital fracture. METHODS: 25 normal skull were used to investigate the configurations of IOF and IOG. Five skulls were performed axial CT scans. 20 normal orbital axial scans were studied as well. MPR and RT-3D reconstructions were used in this study. RESULTS: Skulls scans and normal orbital images on axial CT showed three sorts of findings: (1) single bony dehiscence between lateral and inferior walls; (2) first type of double bony dehiscence between lateral and inferior walls, among the dehiscence interposing a small bone. The long axis of the small bone was parallel to orbital wall; (3) second type of double bony dehiscence between lateral and inferior walls, but the long axis of the small bone was in anteroposterior direction. Anatomy and variation of three sorts of CT findings were corresponded respectively to: (1) a baseball club-shaped IOF; (2) a "V"-shaped IOF, that is composed of both of lateral and internal ramus, lateral ramus situates between the zygoma and the lateral portion of greater wing of sphenoid, and internal ramus between the maxilla and the internal portion of greater wing of sphenoid, both rami intercross caudally and open upwards in a "V"-shaped configuration; (3) a deep IOG with a protuberant lateral wall. CONCLUSION: Familiarity of imaging features on the axial CT scans and understanding of their anatomy of IOF and IOG would be helpful for avoiding misdiagnosis of orbital fracture.

Cadaver↗
PubMed2004

[Surgical treatment of orbital and periorbital fibrous dysplasia].

OBJECTIVE: To explore the surgical approaches to obtain good aesthetic and functional results in the management of orbital and periorbital fibrous dysplasia and related deformities. METHODS: Ten cases of orbital and periorbital fibrous dysplasia were treated surgically. The location, extension and shape of the lesions were identified based on X-ray examination and two and three dimensions CT examinations preoperatively. According to the type of the lesion, different approaches were used to excise the lesion and to reconstruct the orbit. The lesions were radically or partially excised through bicoronal, intraoral and subciliary approach; the orbit was reconstructed with autogenous outer or inner table of calvarium, outer table of mandible, Medpor and prefabricated individual titanic implants. RESULTS: In 10 cases treated surgically, radical excision was employed in 4 cases and partial excision in 6 cases. Autogenous inner table of calvarium was used in 2 cases, Medpor in 2 cases, outer table of mandible in 1 case, and titanic meshwork and prefabricated individual titanic implants in 4 cases to reconstruct the orbit. After the treatment, all patients obtained satisfactory aesthetic and functional results. CONCLUSIONS: Carefully planed surgical approaches with methods for preventing the complications can be used for the treatment of orbital and periorbital fibrous dysplasia and obtaining satisfactory aesthetic and functional results.

Adolescent↗
PubMed1987

[Echographic diagnosis in orbital complications of inflammatory diseases of he paranasal sinuses].

A- B-scan sonography was performed in a consecutive series of 123 patients with acute orbital complications of inflammatory paranasal sinus diseases. Orbital edema was correctly diagnosed by echography in 100% orbital periostitis in 81%, subperiosteal abscesses in 100%, and orbital cellulitis in 92%. In a second series, 40 mucopyoceles were all correctly diagnosed by sonography. Furthermore echography revealed a collateral subperiosteal edema and a moderate thickening of extraocular muscles and bone periostitis, a massive swelling of muscles and bone defects in subperiosteal abscesses as well as encapsulated abscesses of the orbit and a concomitant retrobulbar neuritis in orbital cellulitis.

Abscess↗
PubMed1987

The use of Teflon in orbital floor reconstruction following blunt facial trauma: a 20-year experience.

A myriad of materials have been used for reestablishing continuity of the orbital floor following blunt facial trauma. Traditionally, autogenous grafts have been the material of choice for orbital floor reconstruction; however, alloplastic materials have gained popularity because of their availability and ease of use. A large clinical experience with long-term treatment results has never been reported for any substance used in orbital floor reconstruction. The purpose of this study was to review our long-term treatment results using Teflon for orbital floor reconstruction following blunt trauma, with emphasis on the incidence of infection, extrusion, and implant displacement. This report presents a 20-year review of 230 Teflon implants for reconstruction of traumatic orbital floor defects. With a mean follow-up period of 30 months, there was only one implant infection and no complications of extrusion or implant displacement. These findings support the use of Teflon as a safe and effective material for the reconstruction of orbital floor defects following blunt facial trauma.

Adolescent↗
PubMed1982

Evaluation of orbital and eye lesions by radiographic examination, ultrasound, and computerized tomography.

This article examines three imaging procedures for the evaluation of orbital and eye lesions. In the radiographic section we discuss the normal anatomy, the projections to show the anatomy, and the interpretation of bone changes caused by benign and malignant lesions. In the next section we describe the equipment employed in the ultrasonic evaluation of the eye and orbit and the principles applied in the diagnosis of lesions of the eye and orbit by ultrasound. We introduce the CT section by explaining the methodology of computerized tomography of the orbit. The criteria for evaluating lesions of the eye and orbit are presented with appropriate cases for illustration. The discussion and summary detail the relative merit of these imaging procedures ad their usefulness in the diagnosis work-up of pathological conditions of the eye and orbit.

Adult↗
PubMed1994

[Analysis of orbital diseases].

Orbital diseases, in view of the special situation and anatomic structure of the orbit require greater attention and wide cooperation of doctors of many specialities, being an interdisciplinary problem. The analysis of the presented material showed that almost half the treated orbital diseases were bone fractures (48.4%), resulting mainly from traffic trauma (67.4%). The remaining diseases were orbital inflammations and tumours, and their numbers were similar. The fact is worth attention of decreasing number of orbital inflammations in successive years and increasing tendency for orbital tumour occurrence.

Adolescent↗
PubMed1995

[Coronal incision as the surgical approach to the orbits].

The coronal incision of the skin extends from the ipsilateral preauricular region to the other side parallel to the coronal suture. The skin flap can then be mobilized down to nearly the floor of the orbits. We routinely use this incision in the following diseases and surgical procedures of the orbit: (1) osteo- and orbitotomies in premature synostosis of skull bones and craniofacial dysplasias; (2) frontobasal midface traumatology involving the orbit; (3) removal of fronto-ethmoidal mucoceles and tumors with orbital involvement; (4) bilateral medial three-wall and lateral one-wall decompression in Graves' disease; (5) removal of tumors from the upper and medial level of the orbit via a transperiostal incision or an extended supraorbital resection. The major advantages of the coronal incision are the excellent exposure of normal and pathological structures of the (peri-)orbital region and the highly satisfying late cosmetic results.

Craniotomy↗
PubMed1997

Orbital neuroendocrine tumors in three horses.

Three horses were examined because of exophthalmos and others signs indicative of a space-occupying orbital mass. In 2 horses, exenteration was used to remove the orbital mass. In a third horse, an orbital tumor and lung metastases were found at necropsy. Routine histologic and Grimelius' histochemical staining were used on fixed tissues; immunohistochemical staining for chromogranin and electron microscopy also were performed. Masses were orbital neuroendocrine tumors. Horses that underwent exenteration were alive 19 and 24 months after surgery. Hypotension was encountered at surgery in both horses and may have been a consequence of manipulating the tumor. The orbital neuroendocrine tumors in these horses seem comparable to orbital paragangliomas found rarely in people.

Animals↗
PubMed1997

[Enophthalmos caused by orbital metastasis of breast carcinoma].

BACKGROUND: Orbital metastatic disease usually leads to exophthalmos but rarely to enophthalmos. We report a case of a metastasis causing enophthalmos. PATIENT: A 68-year-old woman had mastectomy for breast cancer six years prior to presentation. She complained of double vision when looking sideways. The right eye showed a motility reduction in all directions and a slight ptosis. She had 4 mm enophthalmos, and the eyelids were sunk into the orbit. There were no signs of optic nerve damage. Magnetic resonance imaging showed a retrobulbar mass surrounding the optic nerve and infiltrating the muscles. The space of the orbital fat was reduced. A biopsy confirmed the diagnosis of metastatic breast carcinoma. Histologically, the connective tissue was infiltrated by lymphocytes, and the nuclei of the tumor cells where aligned in a linear "indian file" pattern. 30% of the tumor cells contained the estrogen-receptor protein, 40% the progesterone-receptor protein. The CA-15/3 and CEA levels were elevated. The patient underwent orbital radiation with 50 Gy. During the following 2 months, the enophthalmos increased to 6 mm. DISCUSSION: We suggest the following hypothesis as the cause of enophthalmos in orbital metastases: The tumor growth goes along with fibrosis. Subsequent shrinkage of the connective tissue pulls the eye back into the orbit. The ensuing elevation of tissue pressure leads to atrophy of the retrobulbar fat. The increase of tumor volume is too slow to compensate for the fat atrophy. Slowly progressive enophthalmos with reduced motility is nearly pathognomonic of metastatic scirrhous breast carcinoma. In rare cases, a diffusely infiltrating carcinoma of the gastrointestinal tract may cause a similar picture.

Adenocarcinoma, Scirrhous↗
PubMed1998

Anophthalmic socket and orbital implants. Role of CT and MR imaging.

The role of CT and MR imaging examination of orbital implants and the anophthalmic socket is expanding constantly. As the imaging techniques gain refinement and resolution, the list of potential clinical application grows. Frequent clinical-radiologic queries regarding the anophthalmic socket include neuro-radiologic findings with congenital anophthalmia or bilateral microphthalmia, the vascularization or position of an orbital implant following enucleation, or orbital recurrence of tumor following enucleation. Common clinical-radiologic questions regarding orbital implants relate to the associated findings of trauma, infection, bleeding, or recurrence of tumor in relationship to the existing orbital implant.

Anophthalmos↗
PubMed1999

The use of polyglactin 910-polydioxanon in the treatment of defects of the orbital roof.

PURPOSE: This study evaluated the use of polyglactin 910-polydioxanon (PPP) for repair of orbital roof defects. PATIENTS AND METHODS: Between 1988 and 1996, 144 patients treated in the Department of Neurosurgery, Christian-Doppler-Medical-Center Salzburg, were operated on transcranially for fractures of the orbital roof or intraorbital tumors. In 85 of these 144 patients, PPP was used for reconstruction of the orbital roof or closure of the periorbita. The postoperative results in patients in whom the PPP patch was used for reconstruction of the orbital roof were compared with the results of a group treated without PPP. RESULTS: Even in severely injured patients, the reconstruction was judged to be very good in 71 patients (83.5%). CONCLUSION: PPP is a useful material for the reconstruction of the orbital roof.

Absorbable Implants↗
PubMed2005

Orbital exenteration: a 13 year Manchester experience.

BACKGROUND/AIMS: Orbital exenteration is a psychologically and anatomically disfiguring procedure reserved for the treatment of potentially life threatening malignancies or relentlessly progressive conditions unresponsive to other treatments. In this study the authors aimed to review their experience with exenteration, including indications, outcomes, and reasons for the increased rate of exenterations over the past 15 months. METHOD: This retrospective study reviewed operating department records via a computerised database to identify all patients who had undergone exenteration of the orbit from 1 January 1991 to 1 April 2004 inclusive, at the Manchester Royal Eye Hospital. Where case records were unavailable, attempts were made to obtain patient data from general practitioners, local health authorities, and referring hospitals. RESULTS: 69 orbits of 68 patients were identified. The mean age of the cohort was 68.2 years, with 33 males and 35 females having undergone exenterations. In total, 31 patients had previously undergone treatments undertaken by the referring specialty with a mean time from the primary procedure to exenteration of 115 months. 14 different tumours were encountered, of which basal cell carcinoma (28), melanoma (10), sebaceous cell carcinoma (nine), and squamous cell carcinoma (six) were the most common. An increasing incidence was observed in cases of BCCs requiring exenteration. 30 patients received orbital prosthesis within an 11 month period post-exenteration. CONCLUSION: Exenteration is a procedure performed with increasing frequency in this unit over the past 15 months, the majority the result of BCCs. A large proportion of these exenterations had undergone previous treatments under a variety of non-ophthalmic specialties in other units. Exenterations are disfiguring procedures that may, therefore, be reduced in incidence by aggressive removal at the time of primary removal. Once performed, the cosmetic rehabilitation is long, with multiple postoperative visits, independent of the method used to close the orbital defect.

Adolescent↗
PubMed1992

[Peri-orbital surgical approaches].

After having made a definitive diagnosis in patients with orbito-frontal pathology, the choice of incision is an important factor to achieve good intra-operative exposure of the region, as well as to obtain a good functional and aesthetic result. In the majority of cases we prefer to utilize the incisions commonly used for blepharoplasty, especially the transconjunctival approach popularized by Tessier. Other more classic accesses such as the superolateral, infra-orbital and intra-oral incisions, are reserved for treatment of cases of orbitomalar (communition) fractures. We feel there are limited indications for use of incisions through the eyebrows with medial extensions for exposure of isolated lesions of the medial orbital wall, orbital roof, and the anterior wall of the frontal sinus. However they may become very useful as the primary incisions in the treatment of open fractures of the orbital region. The bicoronal incision, a classical approach in neurosurgery, is also being used by us in cases of tumors and complicated middle face fractures which appear to extend to the orbito-frontobasal region in 40% of our patients. In addition it provides excellent access for post-traumatic reconstruction of orbito-frontal bone defects and impacted fractures. A combination of different incisions: bicoronal, peri-orbital and intra-oral, may be indicated for the correction of syndromal anomalies such as Treacher-Collins, for treatment of complicated facial fractures, or for pure aesthetic surgery procedures, such as the "mask-lift" introduced by Tessier.

Humans↗
PubMed1999

Nasolacrimal duct obstruction and orbital cellulitis associated with chronic intranasal cocaine abuse.

OBJECTIVE: To report the association of acquired nasolacrimal duct obstruction and orbital cellulitis in patients with a history of chronic intranasal cocaine abuse. METHODS: Retrospective, consecutive case series. Results of imaging, histopathologic examinations, and clinical courses of these patients were studied. RESULTS: Five women and 2 men (mean age, 41 years) with a history of chronic intranasal cocaine abuse (mean, 11 years; range, 5-20 years) presented with epiphora and in some cases acute onset of periorbital pain, edema, and erythema associated with fever. The suspicion of intranasal cocaine abuse was made on anterior rhinoscopy with the detection of an absent nasal septum and inferior turbinate. Computed tomographic and magnetic resonance imaging findings in 4 patients included extensive bony destruction of the normal orbital wall architecture, opacification of the sinuses, and the presence of an intraorbital tissue mass. Histopathologic examination of the nasolacrimal duct in 2 patients and of the orbital mass in a third patient revealed marked chronic inflammation with fibrosis causing secondary nasolacrimal duct obstruction. Six patients were treated with systemic antibiotics followed by dacryocystorhinostomy in 3 patients, and a pericranial flap to insulate the exposed orbit in 1 patient. CONCLUSIONS: Chronic intranasal cocaine abuse can result in extensive bony destruction of the orbital walls with associated orbital cellulitis, and should be included in the differential diagnosis of acquired nasolacrimal duct obstruction. Anterior rhinoscopy is very helpful in establishing the correct diagnosis in these patients.

Administration, Intranasal↗
PubMed2004

Orbital venous malformations: current multidisciplinary treatment approach.

OBJECTIVE: To evaluate the clinical, radiological, and histopathological features, treatment, and outcome of a series of orbital venous flow malformations (OVMs) with the aim of delineating a more systematic approach for treatment. METHODS: A 38-year retrospective review of 22 patients with OVMs followed up at 1 institute. RESULTS: Eighteen of 22 patients (13 women and 9 men) showed clinical or radiological evidence of distensibility. The mean age at the initial manifestation was 28.3 and 50.7 years in patients with distensible and nondistensible OVMs, respectively. Eight patients (36.3%) had deep orbital lesions, 6 (27.3%) had superficial orbital lesions, and 8 (36.3%) had combined orbital lesions. All 3 patients with deep nondistensible OVMs had a sudden onset of proptosis and pain or diplopia secondary to thrombosis or hemorrhage. Seventeen patients required treatment. All 4 nondistensible lesions were treated by surgical excision. A variety of techniques were used to treat distensible OVMs including carbon dioxide laser ablation, percutaneous alcohol sclerotherapy, or embolization with Guglielmi detachable coils after surgical exposure and surgical excision. Of the 14 patients with follow-up, 8 had complete resolution of the signs and symptoms and 6 patients showed marked improvement following surgery. Mean follow-up was 57.8 months. CONCLUSION: If intervention is indicated, less invasive methods such as carbon dioxide laser ablation and percutaneous alcohol sclerotherapy for superficial and combined orbital lesions and endovascular treatment by Guglielmi detachable coil embolization for deep orbital lesions should be considered before proceeding with more invasive procedures.

Adolescent↗