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At least 1,189 records · Page 66Linked to original sources
PubMed2000

Relationship between the extent of fracture and the degree of enophthalmos in isolated blowout fractures of the medial orbital wall.

PURPOSE: This study investigated the relationship between the extent of fracture and enophthalmos in blowout fractures of the medial orbital wall. PATIENTS AND METHODS: Nine patients with isolated blowout fractures of the medial orbital wall, confirmed by computed tomography scans, were evaluated. The area of fracture and the volume of herniated orbital tissue were determined from computed tomography scans using simple linear measurements. Each of the calculated values for area and volume were compared with the degree of enophthalmos to determine whether there was any significant relationship between them. RESULTS: Enophthalmos increased proportionally as the area of fracture or the volume of herniated orbital tissue increased (P < .05). The area of fracture and the volume of herniated orbital tissue associated with 2 mm of enophthalmos were 1.9 cm2 and 0.9 mL, respectively, as calculated from the regression curve. CONCLUSION: Enophthalmos of 2 mm or more, which is a frequent indication for surgery, can be expected when the area of fracture is 1.9 cm2 or more, or the volume of herniated orbital tissue is 0.9 mL or more.

Adult↗
PubMed2004

The roles of orbital frontal cortex in the modulation of antisocial behavior.

This article considers potential roles of orbital frontal cortex in the modulation of antisocial behavior. Two forms of aggression are distinguished: reactive aggression elicited in response to frustration/threat and goal directed, instrumental aggression. It is suggested that orbital frontal cortex is directly involved in the modulation of reactive aggression. It is argued that orbital frontal cortex does not "inhibit" reactive aggression but rather may both increase or decrease its probability as a function of social cues present in the environment. Early dysfunction in this function of orbital frontal cortex may be linked to the development of Borderline Personality Disorder. Instrumental aggression is linked to a fundamental failure in moral socialization. However, the available data suggest that the amygdala, but not orbital frontal cortex, is required for functions such as aversive conditioning and passive avoidance learning that are necessary for moral socialization. Psychopathic individuals who present with significant instrumental aggression, are impaired in aversive conditioning and passive avoidance learning and show evidence of amygdala dysfunction. Orbital frontal cortex and the amygdala are involved in response reversal where instrumental responses must be reversed following contingency change. Impairments in response reversal are also seen in psychopathic individuals. However, it remains unclear whether impairment in response reversal per se is associated with antisocial behavior.

Adult↗
PubMed1981

Experience with various procedures in the treatment of orbital floor fractures.

Experience gained in the treatment of 75 patients with orbital floor injuries is presented. These injuries occurred independently or in association with mid-face fractures. In fractures of the zygomatic bone and the zygomatic part of the orbit repositioning of the zygomatic bone by a traction hook is the simplest method. In recent multiple fractures of the mid-face it is most suitable to use a lamina from the anterior or medial wall of the maxillary sinus for bridging the orbital floor defect. Osteoplasty of the orbital floor using an iliac bone graft is the method of choice in the treatment of neglected blow-out fractures fo the orbital floor. In cases with recent blow-out fractures of the orbital floor the defect can be bridged by bone taken from the hip or a lamina from the anterior wall of the maxillary sinus. It is not necessary to perform intranasal antrostomy of gauze packing of the sinus.

Bone Transplantation↗
PubMed2002

Curative radiotherapy for primary orbital lymphoma.

PURPOSE: To review our institutional experience with primary orbital lymphoma and determine the prognostic factors for survival, local control, and distant metastases. In addition, we also analyzed the risk factors for complications in the radiotherapeutic management of this tumor. METHODS AND MATERIALS: Between 1973 and 1998, 47 patients (29 women [62%] and 18 men [38%], median age 69 years, range 32-89) with Stage IAE orbital lymphoma were treated with curative intent at one department. Five had bilateral orbital involvement. The tumor was located in the eyelid and extraocular muscles in 23 (44%), conjunctiva in 17 (33%), and lacrimal apparatus in 12 (23%). The histologic features according to the World Heath Organization classification of lymphoid neoplasms was follicular lymphoma in 25, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type in 8, diffuse large B-cell lymphoma in 12, mantle cell lymphoma in 6, and peripheral T-cell lymphoma in 1. For the purposes of comparison with the existing literature on orbital lymphomas, the grading system according to the Working Formulation was also recorded. The histologic grade was low in 33 (63%), intermediate in 18 (35%), and high in 1 (2%). All patients were treated with primary radiotherapy alone. The median dose for low-grade tumors was 3000 cGy (range 2000-4020); the median dose for intermediate and high-grade tumors was 4000 cGy (range 3000-5100). A lens-sparing approach was used in 19 patients (37%). Late complications for the lens and cornea were scored according to the subjective, objective, management, and analytic (SOMA) scale of the Late Effects of Normal Tissue (LENT) scoring system. The median follow-up was 55 months (range 6-232). RESULTS: The local control rate was 100% in the 52 orbits treated. The 5-year overall survival and relapse-free survival rate was 73.6% and 65.5%, respectively. Tumor grade and location did not predict for overall survival or relapse-free survival. Seven patients (15%) developed distant recurrence (brain 2, extremity 2, mediastinum 1, liver 1, and retroperitoneum 1). One patient (2%) developed cervical node metastasis. The 5- and 10-year cataract-free survival rate was 56.7% and 32.9%, respectively. Of the 12 lens complications, 8 were LENT Grade 1 and 4 were Grade 3 toxicity. Only male gender predicted for an increased risk of cataract formation. Radiotherapy dose and technique did not predict for cataract formation; however, none of the patients who underwent the lens-sparing technique developed Grade 3 lens toxicity or required surgical correction. Of the nine corneal events, two were Grade 1, four Grade 2, and three were Grade 3 toxicity. Ten dry eyes were recorded; all were mild, and no patient had severe dry eye syndrome. Neovascular glaucoma was seen in 1 patient. No injury to the retina or optic nerve was reported. CONCLUSION: Radiotherapy alone is a highly effective modality in the curative management of primary orbital lymphoma. Most complications were minimal and did not require medical or surgical intervention. Although the use of the lens-sparing technique did not influence the incidence of cataractogenesis, we continue to recommend this approach whenever possible, because our experience indicates a higher grade of toxicity occurs and a higher incidence of corrective surgery is needed in patients treated without lens protection.

Adult↗
PubMed1997

Electron/photon matched field technique for treatment of orbital disease.

PURPOSE: A number of approaches have been described in the literature for irradiation of malignant and benign diseases of the orbit. Techniques described to date do not deliver a homogeneous dose to the orbital contents while sparing the cornea and lens of excessive dose. This is a result of the geometry encountered in this region and the fact that the target volume, which includes the periorbital and retroorbital tissues but excludes the cornea, anterior chamber, and lens, cannot be readily accommodated by photon beams alone. To improve the dose distribution for these treatments, we have developed a technique that combines a low-energy electron field carefully matched with modified photon fields to achieve acceptable dose coverage and uniformity. METHODS AND MATERIALS: An anterior electron field and a lateral photon field setup is used to encompass the target volume. Modification of these fields permits accurate matching as well as conformation of the dose distribution to the orbit. A flat-surfaced wax compensator assures uniform electron penetration across the field, and a sunken lead alloy eye block prevents excessive dose to the central structures of the anterior segment. The anterior edge of the photon field is modified by broadening the penumbra using a form of pseudodynamic collimation. Direct measurements using film and ion chamber dosimetry were used to study the characteristics of the fall-off region of the electron field and the penumbra of the photon fields. From the data collected, the technique for accurate field matching and dose uniformity was generated. RESULTS: The isodose curves produced with this treatment technique demonstrate homogeneous dose coverage of the orbit, including the paralenticular region, and sufficient dose sparing of the anterior segment. The posterior lens accumulates less than 40% of the prescribed dose, and the lateral aspect of the lens receives less than 30%. A dose variation in the match region of +/-12% is confronted when an unmodified photon field edge is matched with the fall-off of the electron field at the 50% isodose lines. By modifying the penumbra, the dose variation is reduced to +/-2%. Treatment setup accuracy is essential. CONCLUSIONS: The electron/photon matched field technique offers a uniform isodose distribution for treatment of the orbit that has not been previously achieved. With this technique a homogeneous dose can be delivered to the entire orbit while avoiding a significant dose to the anterior segment and minimizing the risk of morbidity.

Electrons↗
PubMed2001

Barotraumatic blowout fracture of the orbit.

We report a rare case of a barotraumatic blowout fracture of the orbit. A 32-year-old woman presented with sudden swelling of the right orbital region after vigorous nose blowing. Computed tomography scan revealed a blowout fracture of the medial wall of the right orbit with orbital emphysema and herniation of the orbital soft tissue. She was treated with prednisolone and an antibiotic, and did not show diplopia or visual disturbance. Three different theories have so far been proposed to explain the mechanism of blowout fractures, globe-to-wall contact theory, hydraulic theory, and bone conduction theory. The present case indicates that blowout fractures of the orbit can be induced solely by a sudden change of pressure, thereby suggesting the validity of the hydraulic theory.

Adult↗
PubMed1998

[Acute orbital myositis and idiopathic inflammatory pseudotumor in children: three cases].

UNLABELLED: Orbital pseudo-tumors account for approximately 8% of the orbital tumors. They are scarcely described in children and raise diagnostic dilemas, especially when they present as an isolated extra-ocular muscle swelling called idiopathic orbital myositis (IOM). CASE REPORTS: A diagnosis of inflammatory orbital pseudotumors (IOPT) was made in three children aged 7, 13 and 14 years from clinical and CT scan and/or MRI findings associated with histological data in two of them. Two of these IOPT presented as IOM. Analysis was made in a effort to eliminate intra-orbital tumors, especially rhabdomyosarcoma. CONCLUSION: The abrupt onset of the orbital signs, often related in the literature, was not a specific diagnostic criterion regarding to embryonic rhabdomyosarcoma. The inconstant presence of inflammatory signs and the absence of local osseous defect could be more discriminating. Although diagnostic procedure, including histological documentation, was difficult, even dangerous, surgical biopsy should be recommended. Eventually, considering the mandatory multidisciplinary care, steroid therapy response should be evaluated as a diagnostic test.

Adolescent↗
PubMed1997

Retro-orbital autoimmunity.

What causes Graves' ophthalmopathy is still a mystery, but the disease process results from a complex interplay of genetic and environmental factors. Genes such as those encoding for human leukocyte antigens, cytokines or putative target antigens may determine a patient's susceptibility to the disease and the disease severity, but environmental factors may determine its course. During the last 5 years, significant progress has been made towards a more in-depth understanding of the initiating events of the orbital immune process which occur in the context of autoimmune thyroid disease. Once established, the chronic inflammatory process within the orbital tissues appears to take on a momentum of its own. The work of many investigators has recently helped to extend our knowledge about the effector and target cells, and their reciprocal interaction, in the evolution and perpetuation of the orbital immune process. This chapter's focus is on the more recent aspects of retro-orbital autoimmunity, discussing new developments concerning orbital T-cell repertoires, candidate orbital antigens, potential target and effector cells, and their role in the extrathyroidal manifestations of autoimmune thyroid disease.

Autoimmunity↗
PubMed1999

Orbital and globe rotation: the role of the periorbita.

We hypothesize that excyclorotation of the globe and extraocular muscle cone associated with external orbital rotation around each orbital axis in craniofacial conditions could be at least partially corrected by leaving the anterior periorbita (periosteum lining the orbit) attached to the surgically rotated portion of the orbit. This hypothesis was tested by comparing the degree of rotation of the globe in response to internal rotation of the anterior orbit, leaving the periorbita attached to the rotated portion of the orbit on one (study) side, and stripping the periorbita on the opposite (control) side, in nine fresh cadavers. There was a highly significant difference (P < 0.0001) between the study and control sides. The possible extrapolations of this finding to the clinical situation are discussed.

Analysis of Variance↗
PubMed2002

Ocular and periocular injuries from orbital fractures.

BACKGROUND: Orbital fractures are associated with ocular and periocular injuries. The role of the ophthalmologist in the evaluation and management of facial trauma, including orbital fractures, has not been clearly defined. The purpose of this study is to identify and characterize ocular and periocular injuries associated with orbital fractures to define the role of the ophthalmologist in the management of facial trauma. STUDY DESIGN: Retrospective case review. RESULTS: Three hundred sixty-five patients with orbital fractures who were evaluated by an ophthalmologist as part of their initial trauma evaluation were studied. The majority of the patients with orbital fractures (74%) did not have associated ocular or periocular injuries. Twenty-three of 104 (22%) ocular injuries in 23 of 95 (24%) patients required immediate intervention by an ophthalmologist. CONCLUSIONS: Facial trauma and orbital fractures are associated with significant ocular and periocular injuries, the minority of which require immediate evaluation and treatment by an ophthalmologist. These results differ from those previously reported.

Eye Injuries↗
PubMed1997

Implant brachytherapy: a novel treatment for recurrent orbital rhabdomyosarcoma.

BACKGROUND: Orbital rhabdomyosarcoma is the most common primary malignancy of the orbit in childhood. Tumor resection and exenteration were the preferred treatment modalities for rhabdomyosarcoma. In the past 20 years, however, combined local radiation and systemic chemotherapy have shown excellent survival results. Tumor recurrence after any of the aforementioned therapies is almost always fatal. We have developed a novel treatment for recurrent disease that has resulted in long-term survival for three patients. METHODS: Three patients with recurrent orbital rhabdomyosarcoma were previously treated with primary radiation and chemotherapy. At the time of recurrence, exenteration and localized brachytherapy were performed. An individually molded poly(methylmethacrylate) (Lucite; E. I. du Pont de Nemours & Co., Wilmington, Del.) device loaded with radioactive iodine seeds delivered localized high-dose radiation, 6000 cGy over 6 days, to the orbit without irradiating the brain. RESULTS: All patients are alive and free of disease with follow-up ranging from 4 years and 4 months to 8 years and 4 months. CONCLUSION: A novel technique of delivering localized radiation to the orbit of three children with recurrent orbital rhabdomyosarcoma appears curative.

Brachytherapy↗
PubMed1999

Clinical features of congenital absence of the superior oblique muscle as demonstrated by orbital imaging.

INTRODUCTION: Absence of an extraocular muscle was considered rare when demonstrable only by surgical exploration or necropsy. This study presents advances in orbital imaging to correlate clinical findings with absence of the superior oblique (SO) muscle. METHODS: We performed high-resolution coronal orbital imaging by magnetic resonance imaging (222 orbits) or computerized radiographic tomography (32 orbits) in 127 patients with strabismus. We reviewed the histories and ocular motility examinations in patients who had absence of 1 or both SO muscles. Findings were compared with patients who were clinically diagnosed with SO palsy but had demonstrable SO muscles on orbital imaging. RESULTS: SO muscles were absent in 6 patients. All had histories suggesting congenital strabismus. In patients old enough for quantitative testing who had unilateral SO muscle absence, visual acuity was a least 20/25 in all and stereopsis was better than 80 arc/s in one. Three patients were orthotropic in primary position. Five patients with unilateral SO muscle absence had clinical findings variably consistent with SO palsy, whereas a sixth patient with Duane syndrome had clinically unsuspected bilateral SO muscle absence. Versions and patterns of hypertropia in patients with SO muscle absence overlapped findings of 20 patients with SO palsy but demonstrable SO muscles. CONCLUSIONS: Imaging can frequently demonstrate absence of the SO muscle in patients with SO palsy. Such patients may have good vision and stereopsis and clinical findings indistinguishable from SO palsy without absence of the SO muscle. Orbital imaging should be considered in the evaluation of congenital SO palsy to facilitate planning of effective surgical correction.

Adult↗
PubMed1998

Solitary fibrous tumour of the orbit. Report of a new case.

PURPOSE: Solitary fibrous tumour (SFT) of the orbit is a very rare lesion that may be misdiagnosed as fibrous histiocytoma, haemangiopericytoma, or other orbital tumour. We studied a case of SFT of the orbit in a 35-year-old woman. METHODS: The patient, with a 1-year history, reported a 'pressure' sensation behind her right eye, but no pain, vision changes, or other associated symptoms. Ocular examination was normal. Magnetic resonance imaging (MRI) showed a well-circumscribed medial mass in the right orbit. The tumour was excised. RESULTS: The tumour was a cellular spindle-cell neoplasm with a storiform pattern. The tumour cells were spindle-shaped with bland nuclei and rare mitoses. Immunostaining was positive for vimentin and CD34, but negative for cytokeratin (AE1-AE3), EMA, desmin, smooth muscle actin, S-100, CD31, CD45 and bcl-2. CONCLUSION: SFT can infrequently involve the orbit. The tumour must be removed entirely to avoid recurrences. Careful and continued follow-up is important because orbital recurrence may occur several years after the excision of the primary tumour.

Adult↗
PubMed1999

An unusual case: bilateral orbital varices.

PURPOSE: To present a rare case of bilateral orbital varices. METHODS: An 18-year-old man showing bilateral orbital masses on magnetic resonance (MR) imaging was examined with color Doppler ultrasonography (US), computed tomography (CT) and digital subtraction venography. RESULTS: The presenting symptoms of the patient were pain and fullness in both orbits induced by bending forward. Ocular examination was normal with the exception of a two millimeter proptosis of both eyes during Valsalva maneuver. MR imaging demonstrated bilateral retrobulbar masses, but was not diagnostic. The comparison of CT images obtained before and after Valsalva maneuver revealed the diagnosis of orbital varices. Color Doppler US and orbital venography demonstrated a large venous connection between the lesions and systemic circulation. CONCLUSION: Clinical presentation of orbital varices is unusual. Different radiological methods may be necessary for the confirmation of the diagnosis and demonstration of the anatomic and the dynamic features of the lesions.

Adolescent↗
PubMed2000

Extramedullary plasmacytoma of the orbit.

PURPOSE: To report a case of extramedullary plasmacytoma of the orbit. METHODS: A 71-year-old patient presented with diplopia eyelid fullness and limitation of ocular motility in the left eye. Visual acuity was counting fingers, intraocular pressure 34 mmHg and fundus eye examination showed choroidal folds in the involved eye. RESULTS: CT scan showed a mass filling the superior and external left orbit without bone destruction. A biopsy was performed revealing that the tumour was composed of plasmacytoid cells positive with immunohistochemical stains for Kappa light chains and epithelial membrane antigen. Systemic work up was negative. The diagnosis of extramedullary orbital plasmacytoma was made. The patient was treated with external beam radiotherapy (40 Gy) and has remained disease free for four years (49 months). CONCLUSION: Extramedullary plasmacytomas of the orbit are extremely rare tumours. Accurate and early diagnosis is essential for the therapeutic approach. Extensive medical work up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving the orbit is needed when the diagnosis of orbital extramedullary plasmacytoma is suspected because treatment and prognosis are very different.

Aged↗
PubMed1998

Magnetic sensor data acquisition for three-dimensional ultrasound of the orbit.

PURPOSE: Three-dimensional (3D) B-mode ultrasound imaging is now possible using a magnetic sensor data acquisition system to localise data points, allowing free-hand scanning. We report the first use of this freehand scanning system for insonation of the orbit. METHODS: We insonated 10 orbits in 5 volunteers (all men; mean age 37 years) with an Acuson 128XP ultrasound system and a 7.5 MHz transducer. Power-Doppler was used to image vascular structures. Data were acquired using a new magnetic sensor system with detectors mounted on the transducer. Free-hand scanning was done using sweeping or fan-like and linear movements over 20-30 s to cover the orbit, with retrospective measurements of orbital structures. A 3D reconstruction was performed via an external workstation. RESULTS: All orbits were adequately imaged by one data acquisition. Selected intraorbital structures were identified and their course followed, including optic nerve and central vessels, as well as short and long ciliary vessels. The mean transverse area of the optic nerve was 5.6 +/- 1.1 mm2; the diameter of the optic nerve was 3.0 +/- 0.3 mm. The lateral rectus muscle was clearly seen, with a mean diameter of 4.9 +/- 0.3 mm, at the level of optic nerve head. CONCLUSION: Three-dimensional ultrasound of the orbit allows imaging of the location, course and relationships of intraorbital vessels, the optic nerve and the lateral rectus muscles with one data acquisition, as well as quantitative measurements not possible with 2D images alone. This method allows rapid, free-hand data acquisition, with a multitude of potential clinical applications.

Adult↗
PubMed2001

Necrotising orbital cellulitis.

PURPOSE: To report 2 cases of severe necrotising orbital cellulitis which illustrate the need for aggressive surgical management to prevent blindness. METHODS: The case records of 2 patients with necrotising orbital cellulitis were reviewed. RESULTS: Both patients had orbital cellulitis associated with sinusitis. Each case was characterised by the rapid development of severe systemic toxicity, extensive soft tissue necrosis and abscess formation. One patient developed panophthalmitis and the eye had to be eviscerated. The other patient underwent repeated surgical drainage of multiple orbital abscesses. This led to resolution of the infection and preservation of vision. CONCLUSIONS: Atypical rapidly progressive necrotising orbital cellulitis may occasionally be encountered. In such cases, aggressive surgical drainage of orbital abscesses is crucial to prevent blindness and death.

Abscess↗
PubMed2004

Endoscopic sinus surgery for paranasal sinus mucocoele with orbital involvement.

PURPOSE: To evaluate the results of endoscopic sinus surgery (ESS) for paranasal sinus mucocoele with orbital involvement and assess the frequency with which a direct orbital approach is required in these cases. METHODS: Retrospective, consecutive series of sinus mucocoeles with orbital involvement treated by ESS by a single surgeon over a 4-year period (1998-2002). RESULTS: A total of 24 mucocoeles of 15 patients, including 10 frontal, eight frontoethomoidal, two ethmoidal, and four maxillary. All cases demonstrated radiological orbital extension. Globe displacement was seen in 73%. At a median follow-up of 15.5 months, the mean cumulative clinical score improved from 4.2 +/- 1.5 (range 1-7) to 0.4+/-0.7 (range 0-2). Ophthalmic symptoms and signs resolved in all patients but one who had complex sinus anatomy following neurosurgery. Minor, self-limiting complications including epistaxis and intranasal adhesions occurred in three cases. Additional endoscopic sinus surgery was required in four patients for revision of narrowed frontal sinus ostium (two), mucocoele recurrence (two), and sinus toileting (one). No cases required external sinus surgery and the average hospital in-patient stay was 2.5 +/- 1.6 days. At final follow-up, sinus ostia were patent in all excluding one case that required a stent due to disrupted anatomy. CONCLUSION: ESS is effective in improving ophthalmic symptoms and signs due to paranasal sinus mucocoele. ESS may be a viable treatment for paranasal sinus mucocoele with orbital extension, and a direct orbital approach is rarely necessary.

Adolescent↗