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PubMed2006

[Orbital schwannoma developing from the superior branch of the oculomotor nerve--case report].

Orbital schwannoma accounts for 1-6% of all orbital tumors and it is not easy to identify the origin of the tumor because of the anatomy of the orbit. A case of orbital schwannoma developing from the superior branch of the oculomotor nerve is reported. A 74-year-old female was admitted to our hospital with the chief complaint of left exophthalmus. MR imaging revealed a space-occupying lesion in the left orbit. Operation was performed through the transcranial approach. It was noticed that the tumor was developing from the nerve that runs into the superior rectus muscle or the levator palpebrae superioris muscle, and it was diagnosed as a schwannoma on frozen section histology during surgery. The tumor was successfully removed and, postoperatively, no additional defects occurred. Careful consideration of microsurgical anatomy is essential for surgery of orbital schwannoma especially when it's necessary to cut the nerves.

Aged↗
PubMed2006

Retrobulbar alcohol injection for orbital pain relief under difficult circumstances: a case report.

INTRODUCTION: A case is presented of a patient with severe and chronic pain in the orbital region, which was relieved by retrobulbar injection of absolute alcohol. The management of chronic pain in the orbital region has received little attention and the literature is reviewed. CLINICAL PICTURE: A 52-year-old man with adenoid cystic carcinoma of the maxillary sinus was suffering from severe pain, especially in the left orbital region. There was also pain from ocular exposure and compression caused by the tumour. Magnetic resonance imaging (MRI) revealed spread of tumour to both orbits, particularly on the left. Multiple debulking surgery and various treatment modalities offered no relief from his pain. TREATMENT: A single retrobulbar injection of 2 mL of absolute alcohol, was placed into the putative orbital apex. OUTCOME: As a consequence of the injection, he had complete resolution of his pain in the 6 months prior to his death. DISCUSSION: Retrobulbar injection of alcohol offers effective pain relief in certain specific conditions characterised by chronic orbital pain when other treatments do not help. CONCLUSION: We have demonstrated that the retrobulbar technique still has a place in our armamentarium.

Analgesia↗
PubMedDate not supplied

[Orbital hernias: new views of the pathogenesis, possibilities of correction].

The paper deals with the basic pathogenetic aspects of development of orbital hernias--the factors of a tarsoorbital fascial change in the presence of the hereditary syndrome of connective tissue hyperplasticity and elevated intraorbital pressure, which affects the volume of orbital fat. The possibilities of a differential diagnosis of orbital hernias and eyelid edemas are considered. There is a biomechanical association of orbital hernias with acquired age-related enophthalmos. The examples of impairments in the tolerance of the optic nerve and in the development of optic neuropathy in enophthalmos are considered. The fact that there may be tarsoorbital fascial lesions, followed by the development of orbital hernias after parabulbar injections is indicated. The author proposes an operation dealing with the reposition of orbital hernias instead of their resection during blepharoplastic interventions.

Adolescent↗
PubMed1990

Clinical management of orbital cellulitis in children.

A prospective study was carried out by the Department of Ophthalmology and the Division of Infectious Disease at the Children's Hospital of Eastern Ontario to assess the outcome of our medical management of orbital cellulitis in children using a predetermined antibiotic regimen and to determine whether computed tomographic (CT) evidence of a subperiosteal abscess alone was an indication for surgical drainage. Between February 1985 and January 1988, 23 patients with true orbital cellulitis were admitted. CT scans were ordered routinely at the time of admission. The scans were cancelled for 13 children because they responded rapidly to medical management. CT showed edema nasal to the medial rectus, or thickening or displacement of the muscle in 8 of the 10 children who underwent the procedure. Three children required sinus and orbital drainage, but frank purulent material was found subperiosteally in only one. The results suggest that most children with orbital cellulitis can be managed with the prompt use of the appropriate intravenous antibiotics. Therapy with cloxacillin sodium and chloramphenicol or, in children under age 6 years, cefuroxime best covers the spectrum of organisms responsible for most cases of orbital cellulitis in children. CT should be used as an ancillary guide to the need for surgical exploration of the orbit in patients who do not rapidly respond to medical management.

Abscess↗
PubMedDate not supplied

Orbital "blow-in" fractures: clinical and CT features.

During a 16 month period, seven patients were admitted to our trauma center with "blow-in" fractures of the orbital roof. This injury results from a significant direct blunt force applied to the supraorbital region of the frontal bone with transmission of energy to the thin orbital plate of this bone and displacement of bone fragments downward into the superior orbit. High resolution CT with multiplanar reformation and three-dimensional display proved very useful in identifying and characterizing the bone and soft tissue abnormalities found in our patients. Our experience suggests that CT demonstration of supraorbital frontal bone fractures and/or frontal lobe cerebral contusions is an indication for thin section CT of the entire orbit, even when there is no evidence of a superior orbital rim fracture. Demonstration of an orbital blow-in fracture should prompt careful clinical assessment of the globe, optic nerve, and extraocular muscles to identify and appropriately manage underlying injuries to these structures.

Adolescent↗
PubMedDate not supplied

Cranial and orbital growth in Chinese fetuses.

We assess Chinese fetal orbital growth by biparietal diameter (BPD) in normal pregnancies. One hundred and ninety-six normal fetuses, whose gestational periods ranged from 14 weeks to term, were measured by prenatal ultrasonography. Orbital parameters measured included orbital diameter (OD), biorbital distance (BOD), and interorbital distance (IOD). At the same time, fetal BPD was measured. The results show that orbital growth correlates well with BPD; OD versus BPD (r = 0.94, p less than 0.001), BOD versus BPD (r = 0.96, p less than 0.001), and IOD versus BPD (r = 0.83, p less than 0.001). Polynomial regression analysis demonstrates that the best-fit model for orbital parameters versus BPD was the first-order linear regression. From the above analysis, the 5th, 50th and 95th confidence limits of OD, BOD, and IOD were computed for specific growth values of BPD, and these can serve as a reference for prenatal diagnosis of fetal orbital malformations when menstrual age is not defined.

Asian People↗
PubMed1987

Ocular and orbital metastasis from systemic malignancies.

One hundred and seventy adult patients and one hundred and forty-eight children with systemic malignancies were examined for ocular and/or orbital metastases. Thirty-six patients (11.3%) had intraocular and/or orbital metastasis. Twenty-nine of the 36 patients (80.5%) had orbital metastasis, five patients (13.9%) had intraocular and two patients (5.5%) had intraocular and orbital metastasis. The commonest malignancy producing ocular metastasis was carcinoma breast in females and carcinoma bronchus in males. Eight of the 17 children had orbital deposits from leukaemia (47%) and six from neuroblastoma (35%). One child had uveal infiltration from acute lymphatic leukaemia. Ophthalmic metastasis were treated by external irradiation and/or combination chemotherapy whenever possible. The mean survival was five months for intraocular metastasis and 15.6 months for the orbital metastasis in adults. Prognosis was very poor in children.

Adult↗
PubMed1985

Antithyroglobulin monoclonal and autoantibodies cross-react with an orbital connective tissue membrane antigen: a possible mechanism for the association of ophthalmopathy with autoimmune thyroid disorders.

The possibility that Graves' ophthalmopathy and autoimmune thyroid disorders may be associated because of autoimmune reactions against antigens shared between human orbital and thyroid tissues was investigated using anti-thyroglobulin (Tg) monoclonal and autoantibodies. Eleven of 16 mouse monoclonal antibodies (MCAB) tested reacted, in an enzyme-linked immunosorbent assay (ELISA), with an antigen in human orbital connective tissue membranes (OCTmem), but not with the OCT soluble fraction, or with membrane or soluble fractions of human eye muscle, lacrimal gland or skin connective tissue. The anti-OCTmem activity was absorbed by OCTmem and Tg, but not by liver membranes or bovine serum albumin (BSA). In preliminary studies four out of 113 human MCAB against thyroid or orbital tissue antigens showed reactivity restricted to Tg and OCTmem. Sera from approximately 50% of patients with autoimmune thyroid disorders, with or without ophthalmopathy, also reacted with OCTmem. The autoantibody activity correlated closely with serum titres of antithyroglobulin but not with the presence, duration, or severity of the eye disease. The OCTmem reactivity was absorbed by Tg, thyroid membranes, and OCTmem but not liver membranes, membranes prepared from other orbital tissues, or BSA. The OCTmem-Tg shared antigen site appeared not to be native thyroglobulin since, (i) MCAB and serum autoantibodies did not react with the cytosol fraction of OCT, and (ii) because the membrane antigen was not solubilizable. Because not all patients with ophthalmopathy have detectable anti-Tg antibodies and, conversely, because not all patients with detectable anti-Tg antibodies develop ophthalmopathy it is unlikely that autoimmunity against a OCTmem-Tg shared antigen is the primary mechanism of Graves' ophthalmopathy, although this possibility has not been excluded. On the other hand the reaction of anti-Tg autoantibodies with OCT membranes may be a model for other autoimmune reactions against other thyroid-orbital tissue-shared antigens. While the pathogenesis of Graves' ophthalmopathy is likely to be multifactorial, humoral and cellular reactions against primary orbital antigens, thyroid-orbitol tissue shared antigens, or both, are likely to play important roles.

Adult↗
PubMed1985

Neurosurgical involvement in tumors of the orbit.

The neurosurgeon has a great deal to offer in the therapy of orbital tumors. Dr. Dandy's supposition that all orbital tumors could be approached by the intracranial route is certainly correct, but technical advances have made the medial and lateral approaches to the orbit more useful for most tumors which are confined to the orbit (22, 25). For those which involve the posterior orbit and canal and have intracranial extensions, the intracranial approach is excellent. Since Dandy's first description of the procedure in 1922, there have been 29 patient reports concerning the results of transcranial canalicular decompression for non-traumatic causes. The most common diagnosis was meningioma (15), and other tumor diagnoses were fibrous dysplasia (7) and hemangioma (2). One-third of the patients were improved; one-third had vision stabilized; and one-third were made worse by surgery. Modern techniques with the microscope and high speed drill have greatly improved these results. Our own experience in the decompression of 15 canals in 11 patients is as follows. There were six patients with meningioma, and two were bilateral. Three patients were found to have a vascular dolichoectasis and one patient had an hemangioma, and in two patients no compression was identified. Immediately postoperatively, two-thirds of the patients were improved, and only one eye (representing 6.7% of the nerves decompressed) was worsened. This resulted from an attempt to totally remove an adherent sheath meningioma. Long-term follow-up median 34 months has demonstrated maintenance of these gains. Eighty percent of the patients have improved or remained stable. These data indicate that the procedure described can be done safely without major risk of visual loss. The neurosurgeon should play an increasingly important role in the evaluation and therapy of posteriorly placed orbital tumors and unexplained compressive optic neuropathy.

Brain Neoplasms↗
PubMed1984

Internal ophthalmoplegia resulting from acute orbital phycomycosis.

Phycomycosis is an opportunistic infection occurring in immunocompromised hosts. It is the most acutely fatal fungal disease known. Therefore, early recognition and treatment are essential. Ocular and orbital involvement is part of a rhino-orbital-cerebral form of the disease. The orbital apex syndrome is the hallmark orbital involvement. A case of phycomycosis with internal ophthalmoplegia alone is reported. The internal ophthalmoplegia is probably secondary to involvement at the apex of the orbit, although not sufficiently diffuse to result in the complete orbital apex syndrome.

Adult↗
PubMedDate not supplied

NMR of the normal and pathologic eye and orbit.

Nuclear magnetic resonance (NMR) images of the eye and orbit were reviewed in a series of 100 normals and in four patients with orbital or ocular pathology. A rich retrobulbar fat content rendered the orbit well suited for NMR imaging. The lens, vitreous, optic nerve, and extraocular muscles were well visualized with spin-echo technique. However, NMR spatial resolution was inferior to that of high-resolution computed tomography (CT). NMR was comparable to CT in demonstrating choroidal melanoma and orbital pseudotumor. NMR exhibited a particular sensitivity in displaying tissue contrast for infiltrative orbital fat lesions with a relatively long T1. This initial experience suggests a promising role for NMR in orbital imaging.

Adolescent↗
PubMed1982

Aspects of orbital floor fracture repair.

Trauma to the face may result in fracture of the maxillary floor and the passage of some of the ocular contents into the maxillary antrum. In some cases, the impaction of the extrinsic ocular musculature results in an annoying diplopia. In others, the maxillary fracture may involve not only the orbital floor, but also extend into the anterior maxilla with additional facial deformities. Surgical corrections of some of these fractures have utilized bone grafts from the anterior iliac crest to the orbital floor. In others, flat Teflon plates have been inserted along the line of the orbital floor fracture after any impacted orbital contents have been freed from the fracture. Both of these remedies suffer from disadvantages. The authors have utilized specially prepared and shaped plastic plates which have been inserted along both the bony orbital floor and the anterior maxilla. These reduce the possibility of displacement and extrusion of the implanted plastic prosthesis. Particularly in major osseous deformities, the functional and cosmetic results have been most gratifying. This technique may also be modified in patients who have coincidentally suffered the additional loss of the eyeball as a result of the injury and include an orbital implant.

Bone Transplantation↗
PubMed1981

Investigation and management of orbital trauma.

Clinical examination and conventional radiography of the orbit following recent orbital trauma often gives an incomplete picture of the damage present. In many infra-orbital blowout injuries, damage to the medial orbital wall occurs with prolapse and sometimes incarceration of orbital contents into both the maxillary and ethmoidal air sinuses. Late enophthalmos is thought to be caused by both atrophy of orbital fat and its loss into the paranasal sinuses. Hypocycloidal tomography in an antero-posterior plane is helpful in the recognition of those defects, but it does not distinguish between the presence of blood clot and soft tissue. Computerised axial tomography (C.A.T.) and ultrasonography are currently available investigative techniques which do distinguish between the presence of air, blood clot, soft tissue and bone and, in addition, there is a significant reduction in radiation dosage when compared with tomography. A comparison of these techniques and the clinical findings is described. These investigations should indicate the necessity for surgical intervention and prevent some of the late complications, such as enophthalmos.

Humans↗
PubMed1982

Microvessels in the human orbit in relation to the connective tissue system.

In the connective tissue system of the human orbit, the microvascular bed mainly arises from and drains into relatively large-calibre arteries and veins. The microvascular system shows a density increase from the apical region of the orbit towards the hind part of the eye-ball. Some of the microvessels are long, often arranged in loops. The smallest-sized vessels, branches of these long microvessels, show a dichotomous branching pattern and are in general confined to one adipose tissue compartment. Besides a "metabolic" function, the microvascular system, due to its compartmentalized structure, makes theoretically possible selective blood-filling of one or more adipose tissue compartments. If this does in fact occur, the microvascular bed, in co-operation with the orbital connective tissue "organ", could serve an important biomechanical function in controlling and regulating eye-ball movements. At microvascular level, the orbital vascular system is intensively interconnected with the extra-orbital vascular system. In the next article some histological aspects of the orbital connective tissue system will be described.

Aged↗
PubMed1993

Idiopathic sclerosing inflammation of the orbit: immunohistologic analysis and comparison with retroperitoneal fibrosis.

Idiopathic sclerosing inflammation of the orbit is clinically characterized by an insidious, chronic and progressive fibrosing process damaging orbital structures through entrapment and mass effect. Histologically, desmoplasia and a sparse infiltrate of lymphocytes, histiocytes, plasma cells, and occasional neutrophils and eosinophils are seen. An immune pathogenesis is suspected but presently poorly understood. To characterize the inflammatory infiltrate and to compare orbital and other inflammatory fibrosing lesions, immunoperoxidase studies using the streptavidin method were performed on 16 formalin or Bouins' fixed, paraffin-embedded orbital biopsy specimens and six specimens of retroperitoneal fibrosis. Positive staining of orbital tissue occurred as follows: T-cells (UCHL-1) 94% of cases, B-cells (L26) 40%, tissue macrophages (KP-1) 56%, HLA Dr positive antigen presenting cells and activated T-cells (LN3) 44%, and immunoglobulins (kappa, 80%; lambda, 63%, IgG, 73%, IgA, 44% and IgM, 31%). Results were strikingly similar for retroperitoneal fibrosis. These findings imply a cell mediated pathogenesis in idiopathic sclerosing inflammation of the orbit that is similar to retroperitoneal fibrosis and suggest therapeutic potential for agents modifying this facet of the immune system.

Humans↗
PubMed1995

Using a titanium mesh plate to reconstruct the orbital floor after an incompletely reduced zygomaticomaxillary complex fracture.

A 30 year-old male came to us for correcting his severe left enophthalmos five months after a facial trauma in a traffic accident. CT scan of his left orbit showed a greatly increased orbital volume, which was resulted from the incomplete reduction of left zygomaticomaxillary complex (ZMC) fracture, unrepaired medial and lateral walls, and improper restoration of the orbital floor with a silicone sheet. Also, the decreased ocular volume, due to the evisceration of the ruptured eyeball with intraocular silicone ball implantation, contributed to the patient's enophthalmos. Because the patient refused any kind of osteotomy for his incompletely reduced and malunion ZMC fracture in the procedures of orbital reconstruction, correction of his severe enophthalmos became very difficult if not impossible. Therefore, we used a piece of titanium mesh plate about 2.5 x 4 cm in size, and folded it into an L shape. The shorter part of the L-shaped plate was used to fix the whole plate by screwing it into the anterior surface of the inferior orbital rim. The longer part of the plate was used as a new orbital floor. To hold and push the intraocular implant upward and anteriorly, the longer part of the plate was adjusted to a level higher than the original floor level, and was bent upward gently in the posterior part. Postoperatively, the severe enophthalmos was markedly improved, and the patient was satisfied although an evident supratarsal sulcus was still present. After a follow-up of 18 months, no complication of migration, infection, or extrusion of the titanium mesh plate occurred.

Adult↗
PubMed1995

[Basedow exophthalmos: lipectomy or orbital expansion?].

Graves' disease is due to mismatching of the orbit and its contents. Primary muscular hypertrophy is often accompanied increased intraorbital pressure due to obstruction of the venolymphatic drainage at the orbital apex. In moist cases, the fat undergoes minimal volumetric and structural changes. Among the numerous techniques proposed for orbital decompression the solution which allows the greatest orbitoperiosteal expansion while preserving the integrity of the orbital fat is valgus displacement of the malar bone combined with resection of the lateral wall and recession of the inferior and medial orbital walls. This technique, which can be adapted to the severity of each case, is performed via a infraciliary transpalpebral facial incision. It is easier to perform than via a coronal incision. It should be preferred to trans-sinus techniques which have a limited and dangerous action (considerable incidence of postoperative diplopia) and decompression lipectomy, which is difficult to perform, with a light risk and, furthermore, does not take into account the fundamental physiological role of the orbital fat nor the essentially muscular pathogenesis of exophthalmos.

Adult↗
PubMed1994

[Usefulness of 99mTc-PMT SPECT and 18F-FDG PET in diagnosing orbital metastasis of hepatocellular carcinoma].

We reported a case in which 99mTc-PMT scintigraphy was useful in diagnosing orbital metastasis of HCC. The case involved a 70 y.o. male, who had undergone nine transcatheter arterial embolizations over two years because of HCC and who had a past history of gastric cancer. The patient had complained of headache and visual disturbance for two months. Cranial CT and MRI studies showed a large homogeneous mass with remarkable bone destruction in the right lateral orbital wall. Because AFP was elevated, orbital metastasis of HCC was suspected, and 99mTc-PMT scanning was performed. On the planar and SPECT images, very high uptake was found in the right orbital tumor. The FDG-PET study showed remarkable hypermetabolism in the medial portion of tumor and follow-up MRI revealed that the tumor had expanded and invaded to the medial side of the orbit. 99mTc-PMT scanning was critical in diagnosing this case of orbital metastasis, and FDG-PET imaging was useful in determining the most active portion of the tumor.

Aged↗