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PubMed1989

[Post-operative cyst and orbital walls: a CT image analysis].

A set of coronal CT images obtained by 118 side (109 cases) of post-operative cysts of maxilla, seen from 1982 to 1988, was analyzed as to the orbital wall affections. Coronal images were grouped into five consecutive planes, i.e. the first plane being the one which is 5mm posterior to the nasion, and the other planes in successive orders each being 5mm apart. The orbital walls were classified into inferior, medial, and transition of these two. The orbital wall affections were classified into dehiscence, thinned-out (less than 1mm), and normal. The orbital signs and symptoms (epiphora, pain, asthenopia, visual loss, diplopia, and exophthalmos) were analyzed based upon the questionnaires by patients. The inferior wall affections (dehiscence and thinned-out) were seen most often (57%) at the third plane (2cm posterior to the nasion). The orbital signs and symptoms in general were seen in half of the cases of which 20% were of grave (visual loss, diplopia and exophthalmos). These signs and symptoms were the more often, the more anterior the site of affections located. Grave signs and symptoms were seen at 2 to 2.5cm posterior to the nasion when the orbital floor was affected and the inferior rectus were either pushed up or in direct contact with the cysts.

Adolescent↗
PubMedDate not supplied

Osteogenic sarcoma of the sella after radiation treatment of a pituitary adenoma.

OBJECTIVE: To report an uncommon case of osteogenic sarcoma of the sella turcica after radiation treatment of a pituitary adenoma. METHODS: We present the clinical history, physical findings, laboratory data, imaging studies, and pathologic findings in a patient found to have osteogenic sarcoma of the sella after radiation therapy for a nonfunctioning pituitary adenoma. RESULTS: Six years after transsphenoidal resection and postoperative fractionated radiation therapy for a nonfunctioning pituitary adenoma that extended to the cavernous sinus, a 45-year-old man presented with a sinus infection, diplopia, and ophthalmoplegia of the right eye. A computed tomographic scan of the head showed a mass in the sella with involvement of the optic chiasm and right cavernous sinus. Transsphenoidal resection and debulking of the tumor revealed an osteogenic sarcoma. The patient was discharged from the hospital with residual diplopia and ophthalmoplegia. He was treated with levothyroxine, testosterone, and hydrocortisone. Six weeks later, the patient was readmitted after he was found unresponsive, and computed tomographic scans disclosed a massive cerebrovascular accident. He died a few days later. CONCLUSION: Osteogenic sarcoma is a rare, late complication of radiation treatment of pituitary adenoma. Although radiotherapy remains an effective adjunctive treatment in patients with pituitary adenomas, particularly those with residual or recurrent tumor, potential complications must be acknowledged.

Adenoma↗
PubMed1999

Orbital fibrous histiocytoma: case report and literature review.

BACKGROUND: Fibrous histiocytomas are a diverse group of soft tissue tumors classified histiologically as benign, locally aggressive, and malignant. These tumors are found throughout the body, but seem to have an affinity for the periorbital area. They account for one percent of all ocular masses and are the most common primary mesenchymal tumor of the orbit. Associated ocular signs and symptoms include decreased visual acuity, proptosis, diplopia, pain, restricted extraocular muscle movement, swelling of the eyelids, and conjunctiva, as well as disk edema. CASE REPORT: A case of a benign orbital fibrous histiocytoma is presented. The patient reported intermittent pain and occasional diplopia; severe edema of the right upper eyelid; and proptosis and inferior vertical displacement of the right globe were observed. Computed tomography revealed a well-defined mass that was subsequently surgically removed and histopathological results from the Armed-Forces Pathology Institute confirmed the diagnosis. CONCLUSIONS: Orbital fibrous histiocytomas are rare periocular tumors that can manifest multiple ocular signs and symptoms. Careful histologic examination is necessary for diagnosis, since these tumors have a wide range of morphology. Differential diagnoses include orbital masses with similar radiologic or histologic findings.

Diagnosis, Differential↗
PubMed1999

[Chiari malformation (type I) associated with bilateral abducens nerve palsy: case report].

There are still many questions concerning the pathology and therapeutic strategy for Chiari malformation. We recently encountered a case of Chiari malformation associated with only bilateral abducens nerve palsy which was successfully treated by foramen magnum decompression. The pathology and mechanisms of Chiari malformation (type I) were evaluated in this case. The patient was a 12-year-old girl who had visited our institute 1 month previously complaining of diplopia. She had no particular past or family history and her general appearance was also normal. Bilateral abducens nerve palsy was the only neurological deficit. Her cerebrospinal pressure was 9 cm H2O. Neuroradiological findings revealed basilar impression, C4-6 syringomyelia and Chiari malformation (type I), but no hydrocephalus or meningocele. Foramen magnum decompression with lateral extension, upper cervical laminectomy and open duraplasty were performed. The position of both eyes recovered fully shortly after surgery, and diplopia occurred only when the patient looked sideways. Eye movements also returned completely to normal 3 months after surgery. MRI showed no syringomyelia 4 months after surgery, the upward shift of the pendulous portion of the cerebellar tonsil, and the expansion of the subarachnoidal space of the pons-oblongata junction. In conclusion, it was thought that the mechanism of bilateral abducens nerve palsy in this case was due to the strangulation and the downward traction of the pons-oblongata junction. The nerve was relieved from this traction by foramen magnum decompression.

Abducens Nerve Diseases↗
PubMedDate not supplied

Anterior segment ischemia and retinal detachment after vertical rectus muscle surgery.

PURPOSE: The authors describe the clinical course of a woman who developed two complications following vertical strabismus repair: anterior segment ischemia (ASI) and retinal detachment. METHODS: A 62 year-old woman is described. She presented with new onset proptosis and left hypertropia with significant diplopia in all fields of gaze. This presentation, her 15 year history of thyroid disease, and preoperative computed tomography (CT) of the orbits were consistent with Graves' ophthalmopathy. Vertical strabismus repair was carried out by recessing the left superior rectus muscle and resecting the left inferior rectus muscle. RESULTS: The diplopia was eliminated. The patient developed significant postoperative ASI and iatrogenic rhegmatogenous retinal detachment in the left eye due to unsuspected globe perforation. She was treated with systemic corticosteroids and radial scleral buckling. CONCLUSIONS: Severe ASI following strabismus surgery is a well recognized complication, with age, thyroid ophthalmopathy, and manipulation of the vertical rectus muscles as risk factors. The retinal detachment soon after strabismus surgery was difficult to detect, possibly due to diminished visualization of the posterior segment as a result of ASI.

Anterior Eye Segment↗
PubMed1999

[Orbital decompression in Grave's disease: comparison of techniques].

Grave's ophthalmopathy is an inflammatory, autoimmune disorder often associated with Grave's disease. The inflammatory infiltration involves the retrobulbar fatty tissue and the extrinsic eye muscles, causing proptosis, extraocular muscle dysfunction and often diplopia. Orbital decompression is an effective treatment in such cases, particularly when resistant to drugs and external radiation therapy. This work compares the results of orbital decompression performed by removing: a) the medial and lateral walls (Mourits technique) in 10 patients (19 orbits) and b) the medial and lower walls (Walsh-Ogura technique) in 17 patients (31 orbits). The results show that removing the floor of the orbit enables better reduction of proptosis but more easily leads to post-operative diplopia. Thus it proves necessary to combine the two techniques, modifying the surgical approach on a case-by-case basis.

Decompression, Surgical↗
PubMed2000

[A case of severe stenosis of bilateral distal vertebral artery successfully treated with anastomosis operation].

A 65-year-old male complained of loss of consciousness for several minutes, transient diplopia and dizziness. He had no neurological deficits nor abnormalities in MR imaging. However, flow velocity of bilateral vertebral artery on ultrasonography indicated severe stenosis of bilateral distal vertebral artery. Brain angiography revealed severe stenosis of bilateral distal vertebral artery as well as occlusion of right middle cerebral artery (MCA). Single photon emission CT (SPECT: ECD-RVR method with acetazolamide loading) showed decreased cerebral blood flow and poor perfusion reserve in bilateral cerebellar hemisphere and right MCA territory. Superficial temporal artery-superior cerebellar artery (STA-SCA) anastomosis was performed. The patient turned out to have no episodes of unconsciousness attack, transient diplopia and dizziness after operation. Cerebral blood flow (CBF) in the posterior circulation was also improved. Evaluating quantitative CBF measurement by means of ECD-RVR method was useful for evaluating CBF. In cases who have severe stenosis of bilateral distal vertebral artery with complaints of vertebrobasilar insufficiency, STA-SCA anastomosis may be one of the most effective treatments.

Aged↗
PubMed2000

Xanthoma of the temporal bone: a unique case of this rare condition.

Xanthoma of the temporal bone is extremely rare; we describe only the fourteenth reported case. Our case is further remarkable because it is the first report of such an occurrence in a patient with familial type III hyperlipoproteinemia. Moreover, while otalgia, infection, hearing loss, and tinnitus were the most common initial symptoms in the previous 13 cases, our patient reported only diplopia, vertigo, and unstable gait. The patient underwent a simple mastoidectomy and debulking, and his diplopia, vertigo, and unstable gait resolved.

Adult↗
PubMedDate not supplied

[Pseudotumor cerebri associated with maxillary sinusitis: clinico-pathological study].

INTRODUCTION: The pseudotumor cerebri is characterized by increased intracranial pressure in the absence of a space occupying lesions or obstruction to the circulation of cerebrospinal fluid (CSF). Increased pressure but normal composition of the CSF is the diagnostic criterion. Ear infections and other infections such as sinusitis have been cited as possible, but rare, causes. CLINICAL CASE: A 12 year old girl presented with diplopia 10 days after starting treatment for sinusitis. On examination there was paresia of the VI cranial nerve to the left eye and marked bilateral papilledema. She had normal visual acuity with visual field measurements showing increased blind spot field in both eyes. Resonance studies only showed maxillary sinusitis. CSF pressure was 35 cm H2O, with 40 lymphomonocytes and normal biochemical findings. After 15 cm of CSF had been removed treatment was started with acetazolamide, dexamethasone and cefotaxime. A week later the diplopia had disappeared and the CSF pressure was 25, with no cells present. Two months later the visual fields and fundus oculi were normal. After follow-up for one year there was no recurrence. CONCLUSIONS: We describe a case of pseudotumor cerebri associated with maxillary sinusitis. We do not know whether this is a chance association or whether there was a pathophysiological basis. The possibility should be considered so as to treat the cause or predisposing factor. The initial CSF pleocytosis would support the possibility of a relationship of the pseudotumor with an infectious condition (meningeal irritation or para-infectious pleocytosis meningeal irritation or para-infections pleocytosis in the context of an ENT infection), which might have precipitated the problem by interfering with the reabsorption of CSF.

Acetazolamide↗
PubMed2000

Giant cavernous carotid aneurysms: clinical presentation in fifty-seven cases.

OBJECTIVES: To review the presenting symptoms and ophthalmic findings of 57 patients with cavernous carotid aneurysms of giant size (> or = 2.5-cm diameter). MATERIALS AND METHODS: Hospital charts of 57 patients with giant cavernous carotid aneurysms who presented to University Hospital in London, Ontario, Canada between 1961 and 1993 were reviewed. All patients were proven by cerebral angiography to have unruptured giant cavernous carotid aneurysms. RESULTS: Forty-six patients (81%) were women (mean age, 54 years). The most common presenting symptoms were diplopia (89%), retroorbital pain (61%), headache (19%), diminished or blurred vision (14%), and photophobia (4%). The most common clinical sign was partial or complete ophthalmoplegia (93%). Trigeminal nerve involvement was found in 37% of patients. Other clinical signs included ptosis, decreased visual acuity, proptosis, and visual field defects. CONCLUSIONS: This study characterizes a large group of patients with giant cavernous carotid aneurysms seen over a 30-year period at a single institution. As in previous studies, diplopia and retroorbital pain were the most common symptoms. The high incidence of ophthalmoplegia observed in this study may be explained by a greater compressive and/or ischemic effect of giant aneurysms compared with their smaller counterparts.

Adolescent↗
PubMed2000

[Surgical treatment in a case of chronic progressive external ophthalmoplegia].

PURPOSE/METHODS: The purpose is to discuss the surgical result in a case with chronic progressive external ophthalmoplegia (CPEO) associated with strabismus and diplopia. The authors present a patient with mitochondrial myopathy and CPEO who was treated using adjustable recessions with local anaesthesia. RESULTS/CONCLUSIONS: Five months after surgery improvement in ductions were maintained and there was no diplopia or torticollis. We support operating these cases with CPEO associated with strabismus. The adjustable suture technique allowed us a satisfactory result in immediate postoperative.

Adult↗
PubMed2000

Surgical correction of blepharoptosis in patients with myasthenia gravis.

PURPOSE: To describe the results of surgical correction of blepharoptosis in a series of patients with myasthenia gravis. METHODS: We reviewed the medical records of all patients with myasthenia gravis who underwent surgical correction for blepharoptosis at the Mayo Clinic between 1985 and 1999. The primary outcome measure was change in interpalpebral eyelid fissure height. RESULTS: Eighteen blepharoptosis procedures were performed on 11 patients with myasthenia gravis. Eight of the 11 patients had ocular myasthenia gravis, and 3 had systemic myasthenia gravis. Of the 18 procedures performed, 11 were external levator advancements (ELA), 6 were frontalis slings, and 1 was a tarsomyectomy. Patients were followed up postoperatively for an average of 34 months (range, 9 to 126 months). The amount of ptosis was quantified preoperatively and postoperatively for 9 of the 11 eyelids that underwent ELA. For these eyelids, there was a statistically significant improvement in the mean interpalpebral eyelid fissure height, from 4.2 mm preoperatively to 8.1 mm postoperatively, with a mean difference of 3.9 mm (95% confidence interval, 2.3 to 5.5 mm; P = .0005). Postoperative complications included worsened diplopia in 1 patient who underwent ELA and exposure keratopathy in 1 patient who underwent a frontalis sling procedure. Two of the eyelids that underwent ELA developed recurrent ptosis, requiring additional surgery more than 2 years after the initial procedure. CONCLUSION: Surgical correction of blepharoptosis is an appropriate treatment option in patients with myasthenia gravis who fail medical therapy. Potential complications include worsened diplopia and exposure keratopathy.

Adult↗
PubMed2001

[Treatment of paralysis of cranial nerve VI: evaluation of the Hummelsheim method of transposition surgery of the oculomotor muscles].

The authors evaluated in a retrospective study the results of surgery in 28 patients with paralysis of the VIth cranial nerve. The standard surgical procedure which was selected as primary achieved orhtophoria in 21 patients. In 7 patients with persisting esotropia and diplopia transposition of the oculomotor nerves according to Hummelshein was indicated. After stabilization of the postoperative finding in all patients parallel position of the eyes and a improved compensatory position of the head was found. Markedly restored motility in abduction was observed only in patient. The method of first choice in treatment of paralysis of the sixth nerve but also of other oculomotor nerves are standard surgical procedures. By retro-position and resection of oculomotor muscles usually a satisfactory state in the primary position is achieved. Transposition operations are rather useful as supplementary operations in previously operated eyes. Indications are persisting diplopia and esotropia. Postoperative results as regards the primary position of the eyes are satisfactory but usually marked improvement of the motility cannot be foreseen.

Abducens Nerve Diseases↗
PubMed2001

[Orbital wooden foreign body].

A 76-year-old-female patient fell in her garden, inducing a right orbital wound in which no foreign body was primarily found. As pain and diplopia followed the orbital trauma, a CT-scan was performed, disclosing a linear external foreign body in the right orbit. An anterior orbitotomy was performed to remove an 18-mm-long wooden foreign body. Histopathology of the tissue surrounding the foreign body showed an inflammatory fibrous tissue with small granulomas around telluric particles. Improvement after the operation was dramatic with complete disappearance of diplopia the day following surgery. Antibiotics were prescribed and tetanus prophylaxis was performed.

Accidental Falls↗
PubMed2001

[Consecutive exotropia surgery].

PURPOSE: To evaluate the factors involved in the development of consecutive exotropia (XTc), and the surgical procedures used for its treatment. PATIENTS AND METHODS: A retrospective study on 30 patients who underwent surgery for XTc was carried out in our Department. The following characteristics were studied prior to surgery: anamnesis, refraction, deviation angle measurement, detection of amblyopia and diplopia prior to the operation, abnormal head posture rotations and presence of any vertical deviation and anisotropy. The surgical technique used was individually considered for each patient and included bilateral lateral rectus recessions and/or unilateral medial rectus advancement to its/their original insertion site. RESULTS: Before surgery, 53.33% of our patients showed amblyopia, 66.66% of them showed rotation limitation, 46.66% showed dissociated vertical deviation (DVD), 20% had abnormal head posture and 10% diplopia. < > results (residual deviation of 10 prism diopters or less) were obtained in 70% of our patients. More than half of our cases were corrected with one single procedure. CONCLUSIONS: The presence of amblyopia, rotation limitations and vertical deviations (DVD and/or alphabetical syndromes) were found to be the most common factors in the development of a XTc in our study. The results indicate that a residual angle less than 10 prism diopters is obtained in 70% of our patients. The technique of choice is a bilateral lateral rectus muscle recession for deviations up to 35 prism diopters. The association of an advancement of one or both medial rectus muscles is necessary when the initial deviation exceeds 35 prism diopters.

Adolescent↗
PubMed2001

Reconstruction of orbital floor blow-out fractures with silicone implant.

AIM: To evaluate the outcome of orbital floor blow-out fractures treated surgically with silicone implant. METHODS: The patients were examined in a prospective study from October 1993 to December 1999. Over this period 11 patients were diagnosed as having orbital floor blow-out fractures. The study was restricted to those who were both treated surgically and followed-up at least three months after the discharge from hospital. Only six patients (five males and one female), ranging in age from 6 to 30 years, fulfilled the inclusion criteria. The fractures occurred during brawls in 3 patients, car accidents in 2 patients and child's play in 1 patient. The diagnosis was based on history, clinical grounds and coronal computed tomography. The surgical procedure was the same in all patients, using silicone implant to reconstruct the defects. The mean follow-up time after surgery was 4.8 months. RESULTS: The interval between injury and diagnosis ranged from 6 to 85 days (mean: 34.8 days). Limitation of vertical eye movements was present in all 6 patients, diplopia in 4 patients, enophthalmos in 3 patients and hypoesthesia in the distribution of the infraorbital nerve in 1 patient. The mean interval time between injury and surgery was 55.3 days and the majority of the patients (83%) had late repairs (> 14 days) after injury. Postoperatively, satisfactory results were obtained with regard to limitation of vertical eye movements, diplopia, enophthalmos and hypoesthesia. Only one patient had a persistent and partially reduced enophthalmos. Silicone implant was well tolerated in all 6 cases since complications such as infection, tissue reaction and extrusion were not observed. CONCLUSION: Satisfactory results may be obtained after late repair of orbital floor blow-out fractures. Silicone implant has the potential to be used successfully in orbital floor fractures.

Adolescent↗
PubMed2001

[Use of autogenous cranial bone grafts for orbital floor reconstruction].

OBJECTIVE: To evaluate the effects of autogenous calvarial bone grafts on treatment of the patients with defect of orbital floor from facial trauma. METHODS: During a 5-year period from April 1994 to April 1999, 34 patients ranging in age from 16 to 68 years (twenty males and fourteen females), who presented with orbital floor defects associated with other facial fractures were reconstructed by autogenous calvarial bone grafts. The surgical approach to the orbital floor involved a transconjunctival incision in 31 patients and a subciliary incision in 3 patients. After the orbital floor exploration, the bone graft was harvested through the coronal incision in 29 patients and the parietotemporal region incision in 5 patients. The bone graft was then fashioned to the appropriate size and configuration and fixed to the stable bone of the orbital floor with microplates or screws. RESULTS: The surgical incisions healed well with a minimal scar. There were no infection, extrusion or other complications associated with autogenous calvarial bone graft. There were no cases of optic neuropathy, diplopia and enophthalmos. There was no morbidity in donor sites. One patient had slight ectropion, which lasted three months and became inconspicuous in six months. 8 cases with hypoesthesia of the infraorbital region returned the sensory function within 6 months. 6 patients with enophthalmos were partly corrected. The follow-up period ranged from 6 months to 5 years. CONCLUSION: The orbital floor defects should be managed by early exploration to avoid later complications. The sequel, such as enophthalmos and dystopia or diplopia are much more difficult to correct after bony union. A vast array of autogenous and alloplastic materials have been used to reconstruct the defect of orbital floor. Autogenous bone graft reduces the risk of infection and extrusion. Cranial bone graft produces less donor site morbidity compared with other sites, non-visible scar as the incision is placed within the hair-bearing skin and the conjunctiva. The membranous bone from the skull has been shown to undergo less resorption and greater graft volume survival as compared to endochondral bone of the iliac crest or rib. Skull bone is an ideal source of bone graft in orbital reconstruction.

Adolescent↗
PubMed2000

[The characteristics and curative effects of strabismus following retinal detachment surgery].

OBJECTIVE: To describe the clinical characteristics and evaluate the surgical results in strabismus eyes which all had undergone retinal detachment surgery. METHODS: This study covered 24 strabismus cases (28 eyes) following retinal detachment operations. For these, examinations involving prism with alternative cover test or Krimsky test, eyeball movement, and diplopia analysis were performed. Strabotomy was carried out combined with or without scleral buckling removal or secondary intraocular lens implantation. The post-operative follow-up period ranged from 1 month to 24 months. RESULTS: (1) The main clinical feature in 16 strabismus cases (19 eyes) having managed by rhegmatogenous retinal detachment surgery was that the character of strabismus was related to the location of scleral explants. (2) Diplopia completely disappeared in 40.9% and partly disappeared in 54.5% of the cases. Strabismus was completely corrected in 63.6% of 27 eyes and partly corrected in 31.8% of them. CONCLUSIONS: (1) The strabismus following retinal detachment surgery is a restrictive strabismus, the clinical characteristics of which are different from that of palsy strabismus. (2) Strabotomy is effective in the treatment of restrictive strabismus.

Adolescent↗