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PubMed2003

[A case of primary lung cancer with initial symptoms due to orbital metastases].

We encountered a case of lung cancer in which symptoms due to orbital metastasis were recognized. A 55-year-old man presented with a chief complaint of double vision. Orbital MR image demonstrated a right intraorbital mass with bone destruction, which resulted in oculomotor nerve palsy and optic nerve disturbance. Chest CT scan showed a 4 cm mass in the right S6, which was diagnosed on biopsy as a poorly differentiated adenocarcinoma. A whole-body scintigram revealed multiple bone metastases: the right orbital wall, the lower cervical spine, the left knee joint, and so on. Based on the clinical findings, we believed that the orbital tumor was a metastasis from the lung. Systemic chemotherapy and irradiation of the right orbital tumor and the left knee joint were performed. Though a favorable response was achieved in ocular movement, the patient died 3 months after initial treatment because of progression of the primary lesion. Including this case, seventeen reported cases in which lung cancer metastasized to the orbit in Japan were also reviewed.

Adenocarcinoma↗
PubMedDate not supplied

Management of the orbital floor in silent sinus syndrome.

BACKGROUND: Enophthalmos in a patient with an opacified hypoplastic maxillary sinus, without sinus symptomatology, describes the silent sinus syndrome. A current trend is to perform endoscopic maxillary antrostomy and orbital floor reconstruction as a single-staged operation. A two-staged approach is performed at our institution to avoid placement of an orbital floor implant in the midst of potential infection and allow for the possibility that enophthalmos and global ptosis may resolve with endoscopic antrostomy alone, obviating the need for orbital floor reconstruction. METHODS: A retrospective review identified four patients with silent sinus syndrome evaluated between June 1999 and August 2001. Patients presented to our ophthalmology department with ocular asymmetry, and computerized tomography (CT) scanning confirmed the diagnosis in each case. RESULTS: There were three men and one woman, with ages ranging from 27 to 40 years. All patients underwent endoscopic maxillary antrostomy. Preoperative enophthalmos determined by Hertel's measurements ranged from 3 to 4 mm. After endoscopic maxillary antrostomy, the range of reduction in enophthalmos was 1-2 mm. Case 2 had a preoperative CT scan and a CT scan 9 months after left endoscopic maxillary antrostomy. Volumetric analysis of the left maxillary sinus revealed a preoperative volume of 16.85 +/- 0.06 cm3 and a postoperative volume of 19.56 +/- 0.07 cm3. This represented a 16% increase in maxillary sinus volume postoperatively. Orbital floor augmentation was avoided in two patients because of satisfactory improvement in enophthalmos. In the other two patients, orbital reconstruction was performed as a second-stage procedure. There were no complications. CONCLUSION: Orbital floor augmentation can be offered as a second-stage procedure for patients with silent sinus syndrome. Some patients' enophthalmos may improve with endoscopic antrostomy alone.

Adult↗
PubMed2003

[Clinical and pathologic analysis of orbital pseudotumor].

OBJECTIVE: To investigate the relationship between the histopathology and the imaging analysis of orbital pseudotumor to judge the histopathological types of these tumors before treatment according to imaging analysis, in order to search for different therapeutic approaches for different pathologic types and to predicate prognosis. METHODS: Fifty-six cases (58 eyes) of orbital pseudotumor that had been operated in Tongren hospital were studied. The clinical manifestations of these patients were reviewed. Changes in the imaging analysis and histopathologic examination were observed and their relationship was studied. Methods of treatment and their prognosis were also analyzed. RESULTS: Historically, the lymphocytic infiltrated type of orbital pseudotumor composed of large amounts of chronic inflammatory cells, only a small amount of collagen was found, so the imaging features of the lymphocytic infiltrated type presented as low or none reflecting areas with a clear posterior demarcation on B scan, and the signals were low or equal on T(1)WI and high on T(2)WI, which could be enhanced by contrast. Oppositely, the fibrotic type was composed of large amounts of fibrotic tissue, and few chronic inflammatory cells were found, so that only the anterior border of the lesion could be identified and the posterior demarcation was blur on the B scan, and the signals were low or equal on T(1)WI and low on T(2)WI, which could not be enhanced or could be enhanced only slightly by changing the contrast. The mixed type presented as an admixture of chronic inflammatory cells and fibric hyperplasia, and the imaging of the mixed type was midway between the lymphocytic infiltrated type and the fibrotic type. Forty-two patients of lymphocytic and mixed types which were identified by histopathology and imaging analysis received a local and systemic corticosteroid therapy. The effect was unstable, and recurrence occurred easily. Therefore, operations were performed on these patients, thirteen of them were treated with low-dose radiotherapy (2 000 - 3 000 cGy) two weeks after operation. Fifteen cases recurred after the operation and 4 cases recurred after the radiotherapy. The fibrotic type of orbital pseudotumor was identified in 12 cases in which no effect could be observed after conservative therapy and operations were performed subsequently. Two cases recurred and were operated again. Exenteration was performed in 2 cases of 56 cases. The cure rate of the composite treatment in the present series was 68.5%. CONCLUSIONS: Different types of orbital pseudotumor present different imaging exhibition, and imaging features are closely related with histopathological changes. Lesions can be localized by CT scan, and also can be localized by B scan and MRI. While it is difficult to obtain a cure result in the orbital pseudotumor, the cure rate can be improved by composite treatment.

Adolescent↗
PubMed2003

[Microbial inflammations of the orbit in children].

The author evaluates in a retrospective study the incidence, diagnosis and causal agent and therapeutic results of microbial inflammations of the orbit. During the period from Jan. 1 1997 till Dec. 31 1999 66 children were hospitalized with the diagnosis of inflammation of the orbit. The mean age of the children was 6.2 years, the mean period of hospitalization 10.2 days. Chandler's classification of inflammations of the orbit was used. The diagnosis was established in collaboration by an ophthalmologist, otolyryngologist and roentgenologist. The main cause of inflammations of the orbit was inflammation of the paranasal sinuses. The most frequent microbial agents were streptococci, staphylococci and Haemophilus influenzae. All patients were treated during hospitalization by antibiotics administered by the i.v. route. Surgery was necessary in 8 patients--in 4 patients with an orbital abscess and in 4 patients with a subperiostal abscess not responding to conservative treatment. The operation was performed by an otolaryngologist using always the endonasal approach. The authors did not record in their group any permanent ophthalmological complications resulting from the inflammation of the orbit.

Abscess↗
PubMedDate not supplied

[Panoramic zonography in the diagnosis of orbital fractures].

A total of 453 patients with acute injuries of the upper and median zones of the facial skull were examined. The most frequent injury was that to the orbital entrance, fractures of the inferior wall; fractures of the exterior, interior, and anterior walls were less incident, and fractures of the orbital apex were the most rare. Types of the skull bone fractures, associated with injury to the orbital walls, were distinguished. The x-ray semeiotics of injuries to the orbital walls was specified making use of panoramic sonography. Panoramic zonography [correction of sonography] with the use of the Zonark [correction of Sonarc] apparatus helps identify the volume and extension of the injuries on all the orbital walls and is altogether an effective method for the diagnosis of the orbital wall fractures.

Adolescent↗
PubMed1975

[Experimental investigation concerning the substitution of the orbital floor of the cat (author's transl)].

In 12 cats the floor of the orbit including the infraorbital margin had been totally resected on both sides. The 24 orbital defects were substituted by complete homologous floors of the orbit which had been preserved in thiomersalate, autologous bone from the tegmen of the sinus frontalis of cats, autologous and homologous cartilage and lyophilizised human dura. All implants healed well. It was found that both autologous and homologous bone implants gave the most stable mechanical connection to the orbital wall. Histological new bone formation was present at 6 months in the homologous bone transplant. This work raises the probability of the use of homograft orbital floor in surgical management of trauma to the orbit.

Animals↗
PubMed2004

[Diplopia and blepharoptosis associated with orbital emphysema following thoracotomy with lung cancer; report of a case].

BACKGROUND: Orbital emphysema is a common complication of trauma and fracture of orbital bones. However, subcutaneous emphysema also can rarely lead to orbital emphysema. We reported the clinical and radiological findings in a patient with diplopia and blepharoptosis following thoracotomy for lung cancer. CASE: A 76-year-old man had undergone left inferior lobectomy and ND 2 a in October 2002, based on the clinical diagnosis of stage IB lung squamous cell carcinoma. He presented with diplopia and blepharoptosis several days following thoracotomy. Chest X-ray demonstrated extensive subcutaneous emphysema, and physical examination also revealed diffuse subcutaneous emphysema including face and palpebrae. Head computed tomography (CT) revealed subcutaneous emphysema in the infratemporal fossa bilaterally. His diplopia and blepharoptosis gradually resolved, and he was discharged with no visual complaints on the fourteenth postoperative day. CONCLUSIONS: Subcutaneous emphysema can lead to diplopia and orbital emphysema in the absence of orbital trauma. Early surgical intervention for air leakage is highly recommended to avoid both the orbital emphysema and the visual complications in the event that subcutaneous emphysema should get to including face or palpebrae.

Aged↗
PubMed2004

[CT imaging analysis in 138 cases with orbital fractures].

PURPOSE: To investigate CT findings of orbital fractures in maxillofacial injuries in order to improve clinical diagnostic accuracy. METHODS: CT findings of 138 cases (145 orbits) with orbital fractures in maxillofacial injuries were analyzed. RESULTS: In maxillofacial injuries, orbital fractures of medial and posterolateral walls were most common,which often showed multiple walls fractures. In 145 orbital fractures, there were single wall fractures in 51 cases (35.17%), two-wall fractures in 48 cases (33.10%), three-wall fractures in 31 cases (21.38%) and four-wall fractures in 15 cases (10.35%). CONCLUSIONS: There were complex orbital fracture in maxillofacial injures, CT examination is a very important tool for diagnosis,which should be applied routinely.

Adolescent↗
PubMed2004

[The clinical significance of calcification in orbital computed tomography].

OBJECTIVE: To study clinic significance of ocular and orbital diseases with computed tomographic (CT) scans. METHODS: 2181 ocular and orbital photos of computed tomographic scans were reviewed. The relevance with pathogenesis, diagnosis criteria and differential diagnosis of calcification was analyzed. RESULTS: Of 2181 CT scans, 129 showed calcified densities. 40 cases (31%) with retinoblastoma, and 3 cases (1%) with chorodal osteoma were revealed intraocular lesions containing calcium. The massive calcification was demonstrated in orbital diseases including 58 cases (45%) with vascular lesions, 19 (15%) cases with other orbital benign tumors and 9 cases (8%) with orbital malignant tumors. CONCLUSION: The calcification number, location and shape within lesions are of great value in the diagnosis of ocular and orbital diseases.

Calcinosis↗
PubMed1992

Advances in the management of orbital fractures.

Great progress has been made in both the basic science and the clinical knowledge base used in orbital reconstruction. With this, increasing complex orbital reconstructive problems are better managed. The diagnosis, treatment plan, and the actual reconstruction have evolved to a higher level. Several areas of progress are of note: the greater appreciation of the intimate relation between the bony orbit's shape and the position of the globe; application of computer technology in orbital injuries; effect of rigid fixation on autogenous and alloplastic graft; and the use of advanced biocompatible synthetic materials in orbital reconstruction. Although this progress has great impact on treatment of orbital injuries, there are many unanswered challenges in the treatment of the fragile frame of the window to the human soul.

Adult↗
PubMed2004

[Pre-septal orbital cellulitis from odentogenic origin--combined surgical and endodontic approach: a case report].

Orbital abscesses are common infectious diseases. The etiology of orbital abscesses may vary from common sinusitis in most of the cases, to cocaine sniffing. As a result of the proximity to the brain, orbital abscesses may complicate to life threatening situations. The infectious process spreads to the orbit in several ways: hematogenous, via anatomic spaces in the maxillofacial region, direct invasion. The treatment philosophy combines surgical and Antibiotic therapy to resolve the acute phase of the disease, followed by elimination of the source. The purpose of this paper is to report a case of pre septal orbital cellulitis, that was treated surgically combined with endodontic therapy. To describe the different subtypes of orbital abscesses, differential diagnosis, imaging and treatment options.

Adolescent↗
PubMed2004

[Correction of hypoplastic orbit after eradiation therapy with the technique of ostectomy and flap transplantation].

OBJECTIVE: To introduce an effective method for reconstruction of hypoplastic orbit caused by eradiation therapy. METHODS: The orbital reestablishment was carried out by using the orbital ostectomy to enlarge the orbital cavity and a flap transferring for the socket reconstruction and the repair of the concave deformity around the orbit. RESULTS: Twelve treated patients demonstrated the satisfactory improvement. CONCLUSIONS: The ostectomy combined with the flap transplantation may be available for reconstruction of the hypoplastic orbit.

Child↗
PubMed2004

[Graves ophthalmopathy with coexisting tumor of the right orbit and hyperprolactinemia--case report].

Ophthalmopathy is a typical manifestation of Graves disease. Although most commonly ophthalmopathy affects both eyes, sometimes it is localized in only one orbit; neoplastic process must be considered then. The coexistence of a tumor of the orbital area and Graves ophthalmopathy is extremely rare. We present a case of a 42-years-old female with bilateral Graves ophthalmopathy, and a coexisting tumor of the right orbit. Magnetic resonance imaging of the orbits revealed a thickening of both rectus inferior extraocular muscles typical for Graves ophthalmopathy. An irregular low-signal mass was observed at the apex of the right orbit; it did not compress the optic nerve. The mass enhanced with gadolinium contrast, with its largest length of 4 cm, height of 2.5 cm, and the largest transverse diameter of 3 cm. It extended along the right trigeminal nerve into the right cavernous sinus, sella turcica, compressed the optic chiasm and penetrated into the right orbital inferior fissure. The tumor infiltrated the dura matter, and surrounded the intracranial part of the right optic nerve but did not cause its compression. Secondary amenorrhoea was present in this patient, probably due to hyperprolactinemia caused by the tumor (the plasma prolactin 1652 ulU/ml, RR 70.00-510.00). The patient was treated with radioiodine for hyperthyroidism and referred to neurosurgeons. Stereotactic therapy and surgery were considered in her case.

Adult↗
PubMedDate not supplied

[Diagnosis and treatment of children with acute inflammatory diseases of the orbit].

The role of computer tomography within the differential diagnosis of acute inflammatory lesions of orbit tissues as well as an appropriate tactics of treatment were evaluated. Computer tomography, "Somafom AR-T", 512 x 512 pix matrix, Siemens (Germany), was made in the axial and coronary projections to delineate the inflammatory zone. The findings of computer tomography denoted explicitly the spatial features of pathology within the orbit with anatomic structures. In periostitis and reactive edema in retrobulbar fat of the orbit, the treatment of patients was conservative made jointly with otolaryngologist. Orbitotomy with drainage or with lancing of affected sinuses was made in abscess and phlegmon of the orbit. There was a complete recovery in a majority of patients with acute diseases of the orbit; they preserved their functions of the organ of vision and of its appendages. Therefore, computer tomography is a valuable and highly effective examination tool within the differential diagnosis of acute inflammatory diseases of the orbit. The diagnosis and treatment of such diseases call for a board of doctors including ophthalmologist, otolaryngologist and oral surgeon.

Abscess↗
PubMed2005

[Repair of orbital defects with implant-retained prostheses].

OBJECTIVE: To evaluate the clinical result of using osseointegrated implants to repair removable orbital prostheses in repairing orbital defects. METHODS: Two patients with orbital defects caused by orbital tumor were treated. Each of them got 4 implants. After average 6 months, we performed the secondary operation. After 7 weeks, we took impressions to make the implant-retained prostheses. The magnetic attachment was adopted. The prostheses were made of polysiloxane material (Factor II, Lakeside, Ariz). RESULTS: Both of the patients got the successful facial prostheses and were followed up 2 and 8 years respectively. All the implants were integrated well. There were no apparent inflammatory reactions in the soft tissue around percutaneous implants. The patients were satisfied with the facial appearance. CONCLUSION: Implant-retained orbital prostheses are safe and effective in repairing orbital defects.

Adult↗
PubMedDate not supplied

Retroscleral implantation technique for porous polyethylene orbital implant after evisceration.

The authors developed a technique for the retroscleral implantation of a porous polyethylene orbital implant after evisceration for the placement of an adequately large orbital implant without wound tension. The surgical results of the technique in 27 patients are reported. The technique involves the severance of the optic nerve after standard evisceration and the insertion of the orbital implant into the retroscleral and intraconal space through the side of the scleral shell. All patients received a 20-mm orbital implant. No complications such as infection, implant exposure, or worsened implant motility were observed during the average follow-up period of 22.4 months. Retroscleral implantation of the orbital implant after evisceration may be an appropriate procedure that allows placement of a large orbital implant without exposure or decreased implant motility.

Adolescent↗
PubMed2005

[Evaluation of classification and treatment for orbital malignant lymphoma].

Orbital malignant lymphoma is a common orbital tumor. Because various types of lymphomas have different degrees of malignancy and clinical manifestations, and each type has a distinct treatment and prognosis, the classification of orbital malignant lymphoma is very important. Up to now the opinions on the classification of orbital lymphoma have been conflicting. We collected related materials from abroad and domestic literature, and summarized our experience of clinical and pathologic work on orbital malignant lymphoma. The work was directed by the histopathologists. Here we propose our classification and treatment protocol of orbital malignant lymphoma. This classification is a tentative one, which needs the comments of our ophthalmic colleagues.

Humans↗
PubMedDate not supplied

Endoscopic orbital decompression for Graves' ophthalmopathy.

BACKGROUND: Graves' ophthalmopathy generates a volume excess for the orbital cavity, which may produce proptosis, pain, exposure keratitis, diplopia, and optic neuropathy. Endoscopic orbital decompression expands the orbital cavity into the ethmoid cavity and medial maxillary sinus. This retrospective study documents the outcomes after endoscopic orbital decompression for patients with Graves' ophthalmopathy. METHODS: Data collected included demographic information, symptom resolution, complications related to the surgery, reduction in proptosis, subsequent need for eye muscle surgery, and hospital length of stay. Between July 1989 and April 2003, 62 patients were referred for endoscopic orbital decompression (often unilateral). RESULTS: Three patients refused use of their medical records for research purposes. Seventy percent were women; the average age of the study group was 49 years. Preoperatively, 63% of the patients had diplopia and optic neuropathy was noted in 27%. Two patients had a cerebrospinal fluid leak identified and managed during the decompression. No postoperative leaks occurred. Twenty-five percent of patients did not require eye muscle surgery. Forty-eight percent of the patients underwent one procedure to manage diplopia. The average reduction in proptosis was 2.5 mm. Fifty-four percent were managed as an outpatient and 27% underwent a 23-hour observation period. CONCLUSION: This data supports the safety, efficiency, and efficacy of endoscopic orbital decompression for unilateral and bilateral Graves' ophthalmopathy. Eye muscle surgery frequently will be required to manage diplopia after decompression.

Adult↗