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PubMed1994

[Orbital cellulitis in children].

BACKGROUND: Because the potential for complications is great, orbital cellulitis must be recognized promptly and treated aggressively. POPULATION AND METHODS: The files of 38 children admitted from 1988 to 1993 because of orbital or periorbital cellulitis were retrospectively analyzed. Clinical findings included fever, edema, pain, rhinorrhea, conjunctivitis, limitation of eye movement, loss of vision and ophthalmoplegia. All patients had hemogram, ionogram, blood cultures, search for soluble antigens in blood and/or urine, C-reactive protein measurement; they also had roentgenographic examination of the sinuses, orbital ultrasonography and/or CT scan in patients with retroseptal cellulitis. All patients were given systemic antibiotic therapy. RESULTS: Thirty-five patients had preseptal and three retroseptal cellulitis. Preseptal cellulitis was associated to sinusitis in 17 patients, to ocular infection in 11 (seven conjunctivitis and four dacryocystitis), to an infected wound in six. Seventy-three per cent of the patients with ocular infection were less than 2 years of age with a significant preponderance of girls (64%). The three cases of retroseptal cellulitis were associated to sinusitis. Orbital echography was performed in five cases, permitting to recognize the three cases of retroseptal cellulitis that was confirmed by CT scan. Twenty-five of the 38 children were given oral antibiotics during the days preceding admission, explaining the relative rarity of positive bacteriological findings (seven cases). Thirty-five of the 38 children were given IV cefotaxime + fosfomycin, associated to netromycin in 16 cases. Mean duration of treatment was 3 days (range: 1-7). IV antibiotherapy was followed by oral amoxicillin-clavulanic acid administration in 25 patients and pristinamycin in 11. CONCLUSIONS: Orbital cellulitis in children, more frequently preseptal, have a good prognosis under adapted antibiotherapy. A retroseptal cellulitis requires multidisciplinary management because of the risk of extension of infection from the orbit to the eye and/or into the cranial cavity.

Anti-Bacterial Agents↗

PubMed1994

[Resorbable synthetics (PDS foils) for bridging extensive orbital wall defects in an animal experiment comparison].

In a long term animal study (min 2 weeks; max 48 weeks) on 6 minipigs, clinical related defects of the medial orbital wall extending in the orbital roof (2.5 cm x 3.5 cm) were created. The defects were bridged by slowly resorbable polydioxanon implants (so called PDS-foils, Ethicon) of different thickness (0.25/0.50 mm) and compared to control defects of identical size. The histological findings reveal: 1. After 29 weeks the resorption of both PDS-implants had been completely finished. Only the morphological intact implants had osteoconductive capabilities. 2. The osseous regeneration of the orbital defects started from the osteotomized margins of the orbital wall. The regenerates were covered by unaffected mucosa. 3. The bony regeneration was supported by the activated periosteal membrane. 4. The resorbed PDS-implants were being replaced by a tight scar tissue, which did not had any adjection to the orbital content. 5. The control defects showed a prolapse of the soft tissue with resulting enophthalmos. 6. According to the material specific characteristics, PDS-foils allow a sufficient bridging of even great and anatomically demanding orbital defects. 7. Notice: The hydrolytical broken down implant material may produce an irritation of the surrounding tissue causing a foreign body granuloma.

Animals↗

PubMed1993

Enophthalmos following orbital transposition for craniofacial malformations.

This is a retrospective study of the frequency and factors that portend enophthalmos following orbital osteotomies and transposition for craniofacial malformations. Clinically obvious postoperative enophthalmos (POE) was noted in 23 (37.7 percent) of 61 patients undergoing such procedures. Postoperative enophthalmos was observed in 86 percent of Apert patients who had combined anteromedial orbital transposition and in 48 percent of patients with hypertelorbitism who had standard 360-degree osteotomies. In contrast, the incidence of postoperative enophthalmos was 21 percent following frontofacial (monobloc) or subcranial (Le Fort III) advancement. Postoperative enophthalmos also correlated with the occurrence of orbital fracture/fragmentation and with disruption of the periorbita. This study underscores the importance of establishing the correct relationship of the globe to the orbital rim (euophthalmos) while maintaining the spatial position of the eye, especially its anterior projection. Postoperative enophthalmos can be prevented by inserting bone grafts into orbital osteotomy gaps, correcting orbital volume/morphology following floor or wall outfracture/fragmentation, and preserving the periorbital supporting system.

Acrocephalosyndactylia↗

PubMed1996

The role of orbital fat preservation in facial aesthetic surgery. A new concept.

Preservation of lower orbital fat in facial rejuvenation is a new concept for preventing the "operated" appearance that may follow fat removal in conventional blepharoplasty. By creating a narrower, more shallow orbit, the surgeon can create a truly youthful eyelid-cheek complex. Orbital fat advanced over the complete inferior orbital rim hides the bony framework that becomes apparent with normal aging. This technique is used routinely in isolated blepharoplasty and with composite rhytidectomy. It accompanies repositioning of the orbicularis oculi muscle, cheek fat, and facial platysma muscle. It is a procedure that can correct postoperative problems caused by excess orbital fat removal, lower eyelid retraction, and contour problems resulting from malar augmentation. The orbital fat is one of the many deep "pieces" of the human face that must be preserved and repositioned for optimal facial rejuvenation.

Adipose Tissue↗

PubMed1996

Orbital floor fracture following nose blowing.

A 70-year-old woman with an upper respiratory infection sustained an orbital floor fracture after vigorous nose blowing. The injury was complicated by orbital emphysema and cellulitis. CT scanning confirmed orbital floor fracture and associated orbital soft tissue herniation into the maxillary antrum. A follow-up sinus endoscopy three months later showed a healed periosteum and mucosa, but continued orbital herniation. As the patient's symptoms had largely resolved, repair was averted. Follow-up after nine months showed no recurrence of orbital swelling. The case presented illustrates a rare complication of vigorous nose blowing, coupled with thinning of the sinus walls seen in aging.

Aged↗

PubMed1996

Acute dacryocystitis: an unusual cause of life-threatening orbital intraconal abscess with frozen globe.

An 84-year-old woman developed a markedly proptotic right eye with external ophthalmoplegia and displacement of the globe into the superotemporal orbit. She had minimal pain and no history of the usual predisposing causes of orbital cellulitis. Vision was unaffected. Orbital computed tomography (CT) showed an extraconal inferomedial abscess with an adjacent intraconal component. A purulent abscess in the anterior inferomedial aspect of the orbit, which extended into the medial aspect of the intraconal space, was incised and drained. After surgery, the orbital inflammation and proptosis resolved, but an irreducible, nonpurulent lacrimal sac mucocele persisted. A dacryocystectomy was performed. Pathologic examination of the lacrimal sac biopsy specimen showed only chronic nongranulomatous inflammation. This case demonstrates that acute dacryocystitis may cause an intraconal orbital abscess with proptosis and complete external ophthalmoplegia, and represent a sight- and life-threatening condition.

Abscess↗

PubMed1995

[Histopathologic classification of 1921 orbital tumors].

PURPOSE: The retrospective study is undertaken to determine the histopathologic types of space-occupying lesions of the orbit in 1921 cases examined between 1953-1992 at the Eye Pathology Laboratory of Shanghai Medical University. METHODS: The authors reviewed old diagnostic pathologic slides on file including HE stain as well as special stains, if available, for all the indeterminate cases. Newly prepared immunohistochemical stains are made for the controversial cases to help diagnosis. Some slides are discussed and diagnosed by Pathology Slide Meeting of the Shanghai Surgical Pathology Society. Cases with diagnosis not agreed upon by the pathology meeting are excluded from this study. RESULTS: The 5 leading malignant orbital tumors are malignant lacrimal gland tumors (138 cases, 32%), malignant lacrimal sac tumors (112 cases, 26%), rhabdomyosarcomas (65 cases, 15%), lymphosarcomas (56 cases, 13%), and malignant hemangiopericytomas (31 cases, 7%). The 5 leading benign orbital tumors are cavernous hemangionas (411 cases, 36%), dermoid cysts (152 cases, 13%), benign mixed tumors (150 cases, 13%), inflammatory pseudotumosr (129 cases, 11%), and schwannomas (92 cases, 8%). Rare tumors of the orbit include alveolar soft tissue sarcoma, chondrosarcoma, mesenchymal chondrosarcoma, synovial sarcoma, giant cell tumor, granular myoblastoma, yolk sac tumor, and retinal anlage tumor. CONCLUSION: This study, in agreement with other reports of the statics study of the orbital tumors demonstrates the prevalence of hemangiomas, lacrimal gland tumors and lymphoid pseudo-tumors to be the common space-occupying lesions in the orbit. Some rare tumors are discussed.

Hemangioma, Cavernous↗

PubMedDate not supplied

Localized orbital lymphoma.

BACKGROUND AND OBJECTIVE: Localized orbital non Hodgkin's lymphoma is a rare event which has not been reported much in the literature. The aim of this study was to evaluate the clinical features, histology, treatment and clinical outcome of patients with localized orbital lymphoma. METHODS AND RESULTS: Fifteen patients with stage I-E orbital lymphoma diagnosed between 1975 and 1992 were reviewed. Diagnosis was formulated from 3-84 (median 23) months after the appearance of symptoms. Eight patients were males and 7 were females; median age was 55 years. The lacrimal gland was involved in 8 cases, the orbit in 7. Bilateral orbital localization was observed in only one patient. All cases were diagnosed as low-grade MALT lymphoma. Chemotherapy was administered in 7 patients, radiotherapy was employed in 7 and surgical excision was performed in the remaining case. Almost all the patients (14/15; 93%) achieved a complete remission (CR). Local relapse (LR) was observed in 3 cases but disease spread was never recorded. INTERPRETATION AND CONCLUSIONS: Correct histological diagnosis and careful staging are very important for the treatment and outcome of localized low-grade orbital lymphoma. These patients show a very good prognosis and radiation therapy alone is very effective in the treatment of this malignancy.

Adult↗

PubMed1997

[Orbital cellulitis. A case report].

This study describes the case of a 6 years old child, male, with orbital cellulitis and underlines the importance of an early diagnosis and therapy to avoid severe complications often present in this disease. Swelling and redness of the eyelid, pain and ophthalmoplegia are the first sign of an orbital cellulitis and they require rapid diagnostic procedure such as ultrasound and TC scan of the orbital region to evaluate the integrity of the profound orbital tissues. The child was admitted at the Department of Pediatrics, University "La Sapienza" of Rome and underwent an ultrasound, TC scan and serum exams which demonstrated the elevation of the sedimentation rate, reactive C protein and WBC plus the interesting of the profound orbital tissues. The child was treated with antibiotic and antiinflammatory therapy showing a complete recovery within 7 days. An ultrasound performed 7 days later demonstrated a complete resolution of the inflammatory process. In summary, this study would like to stress the necessity of an early diagnosis and an appropriate therapy in order to avoid the severe complications often present in children with orbital cellulitis.

Anti-Bacterial Agents↗

PubMed1997

Combined endoscopic and subciliary orbital decompression for thyroid-related compressive optic neuropathy.

Compressive optic neuropathy is a feared, although unusual, complication of thyroid-related orbitopathy. A variety of surgical approaches have been described to achieve orbital decompression and alleviate the hallmark apical orbital crowding of this condition. We describe a subciliary anterior orbitotomy approach to the floor combined with an endoscopic medial wall resection. The anterior orbitotomy allows removal of the bones of the orbital floor both medial and lateral to the canal of the infraorbital nerve. The anterior orbital floor is retained for globe support. This combined approach retains the low morbidity of the endoscopic operation while achieving increased apical medial orbital wall and orbital floor decompression. We describe two illustrative cases where this approach produced a dramatic improvement in visual function. The surgical refinements associated with this combined approach offer technical advantages over other operations in the treatment of thyroid-related compressive optic neuropathy.

Aged↗

PubMed1997

[ORBIT-NET. Discussion forum on orbitology on the internet].

INTRODUCTION: A basic service in the public network "Internet" is electronic mail (e-mail). E-mail makes the participation in discussion groups possible by mailing contributions to the discussion to all members electronically. To complement the existing list of ophthalmologic discussion groups ORBIT-NET was introduced. It offers experts in research, clinic, diagnostic and therapy of orbital diseases the opportunity to make queries or present interesting casuistries and to ask for comments, differential diagnosis or advice on therapy. Other participants can be made aware of new scientific results, actual publications or meetings. MATERIAL AND METHODS: For participation a computer, a modem, an Internet-Provider and special software are required. Registration is made either by e-mail or regular mail. A verification is necessary to limit the list of participants to experts. RESULTS: Since the introduction of ORBIT-NET on November 9th, 1996, there have been no technical problems. ORBIT-NET has been effective as a platform. CONCLUSIONS: The international, interdisciplinary platform ORBIT-NET is an addition to the existing ophthalmologic discussion groups. ORBIT-NET offers orbitologists an international discussion of results and diagnosis, supports further training and can give encouragement to further research.

Computer Communication Networks↗

PubMed1996

Radiological evaluation of orbital tumours in Ibadan, Nigeria.

Tissue diagnosis of orbital tumours is especially difficult because of the wide range of tissues normally occurring in the orbit [2]. Unfortunately, such tumours are relatively surgically inaccessible for biopsy due to the presence of the bony walls of the orbit and its peculiar shape. This gives rise to a need for effective methods of indirect assessment of the orbit and its contents prior to definitive therapy. Such indirect assessment may be achieved using certain modalities of radiological imaging. These include conventional plain X-ray films, ultrasound scan (USS) and computerized axial tomography (CAT scan), orbital venography and magnetic resonance imaging. This paper is a pilot study of current practices in the use of radiological imaging techniques in the diagnosis of orbital tumours at a University Hospital.

Adolescent↗

PubMed1996

[Orbital rim reconstruction with coral porous hydroxyapatite].

OBJECTIVE: To search for the effect and safety of coral porous hydroxyapatite (CHA) implanted material in orbital rim reconstruction. METHODS: 7 cases of orbital rim reconstruction were treated with CHA which is a plate form mass with an interconnected system of canals of approximately 200 microns in size. It has three types: 1.0 cm x 1.5 cm x 5.0 cm, 0.6 cm x 1.5 cm x 5.0 cm and 0.4 cm x 1.5 cm x 5.0 cm. According to the shape of a contralateral healthy orbit, a rubber putty model was made before the operation. An incision was designed at the upper 1/3 of the face for the elimination of wrinkles or a prolonged incision of lower lid bag plastic surgery was made. After the exposure of the defective part of the orbit, a correctly molded CHA tamponade was inserted. RESULTS: The orbital rim reconstruction in 7 cases with orbital defect was successfully treated with CHA. During a follow-up of 3-12 months (average 6.6 months), there was no extrusion or migration of implant. CONCLUSION CHA is a good material for substitution of bone graft and is much better than autogenous tissue of other artificial materials.

Adult↗

PubMedDate not supplied

Bilateral proptosis caused by orbital myositis. A case report.

Proptosis, unilateral or bilateral, is a frequent indication for medical evaluation and orbital computed tomography. The most common cause of proptosis in adults and children is inflammatory disorders. Orbital myositis is a subgroup of the orbital pseudotumor syndrome in which one or more of the extraocular muscles are primarily infiltrated by an inflammatory process. Computed tomography and ultrasonography showed enlargement of one or more extraocular muscles in orbital myositis. In our case, we observed clinically and by orbital computed tomography, evidence of isolated bilateral extraocular muscle swelling after upper respiratory tract infection. Proptosis and other findings were spontaneously and completely resolved after twenty days. Because proptosis caused by orbital myositis is extremely rate in children and there is limited information in the literature, this case was reported.

Acute Disease↗

PubMedDate not supplied

Unilateral exophthalmos due to orbital metastasis from a contralateral intraocular melanoma.

Progressive, left exophthalmos developed due to a left, retrobulbar mass in a 76-year-old Japanese woman. An open tumor biopsy was carried out, and both macro- and microscopic findings of the mass confirmed that it was a malignant melanoma. Orbital melanomas usually result from distant metastasis of cutaneous melanomas or from secondary extension of ipsilateral intraocular melanomas. Thorough physical, laboratory, and radiological examination, however, did not disclose any primary cutaneous or visceral melanoma, nor had the patient any previous history of excision or spontaneous regression of a pigmented lesion. Histopathologically, the left retrobulbar melanoma was rich in sinusoidal vessels which were surrounded by melanoma cells, oriented in a perpendicular array, a histological feature more characteristic of uveal melanomas than of cutaneous ones. The ophthalmological examination excluded development of a primary intraocular melanoma on the left side. Fundoscopic examination of the right eye was not feasible because of the complete opacity of the right vitreous body which had resulted from previous episode of idiopathic vitreous hemorrhage. Unexpectedly, CT and MR studies depicted retrobulbar masses of non-homogeneous densities in the bilateral orbits. These radiologic studies indicated the metastatic nature of the left retrobulbar melanoma, while suggesting the development of a primary, intraocular melanoma on the right side, extension into the right orbit, and involvement of the right optic nerve. All these clinical, radiological, and histological data suggested the development of a primary melanoma in the right eye and subsequent metastasis to the left orbit producing exophthalmos. The mechanism of such a peculiar mode of metastasis remains entirely unknown. This is a rare case of metastatic orbital melanoma, without visceral involvement, which originated in the contralateral eye. Development of the right ocular melanoma remained unrecognized due to atrophic degeneration of the right eyeball and complete opacity of the right vitreous body, until the contralateral orbital metastasis grew massive enough to cause exophthalmos.

Aged↗

PubMed1998

[Orbital edema induced by psychotropic drugs?].

INTRODUCTION: Drugs known to be responsible for orbital edema are calcium channel blockers, rifampicin, atracurarium, methylprednisolone and mannitol. We describe three patients with orbital edema induced by psychotropic drugs administrated for a long period of time. OBSERVATIONS: These patients were aged 51 to 73 years, and had orbital edema predominant in the morning, but persisting during the day. All the other causes of orbital edema--including steatoblepharon--were ruled out by medical history and investigations. In one case the edema decreased after the interruption of nearly all psychotropic drugs. DISCUSSION: The exclusive orbital localization of the edema suggests a local or regional mechanism that could be an exacerbation of the physiological morning orbital edema induced by decreased lymphatic flow. This flow is usually enhanced by gravity and automatic palpebral blinking.

Aged↗

PubMed1997

[Orbital decompression in exophthalmos due to thyroid disease. Report of 69 cases].

Dysthyroid exophthalmos is due to mismatching of the orbit and its contents, essentially due to muscle enlargement, and, to a lesser degree, fat volumetric changes. Surgical treatment is designed to expand the orbital volume by bone removal or to reduce orbital contents by fat removal, or a combination of the two techniques. Our series consisted of 69 patients who underwent orbital decompression for proptosis, with osteotomy (12 cases) or associated with fat removal (57 cases). We obtained good results for all cases, and did not encounter any complications. Several factors now appear to play a role in the choice of surgical technique, particularly the preoperative radiologic (CT) examination which determines the muscular and fat involvement, wall orbital changes and appearance of the sinuses. Orbital fat removal seems to be useful in proptosis reduction in those cases in which fat is more involved and easy to remove. Anthral ethmoidal decompression is the best technique in the case of dysthyroid optic neuropathy.

Adult↗

PubMed1998

Orbital lymphoma masquerading as thyroid ophthalmopathy.

BACKGROUND: Lymphoid tumors are known to originate within the lacrimal gland and orbital fat. Ocular findings commonly seen are a palpable mass with proptosis and downward displacement of the globe. Graves' ophthalmopathy is the most common orbital pathology occurring in the general population. Signs and symptoms of Graves' ophthalmopathy, such as unilateral or bilateral proptosis, double vision, limitation of movement of the extraocular muscles, are not specific for this condition. CASE REPORT: A 57-year-old man came to us with a chief symptom of "eye swelling" for the last 3 years. He had been diagnosed with hyperthyroidism and had received three surgical procedures for orbital decompression. Clinical findings included limitation of upward and downward gaze, exophthalmometry readings of 30 1/2 mm O.D. and 31 mm O.S. (with a base of 112), and profound proptosis with fatty tissue prolapse. Subsequent thyroid testing revealed euthyroid status and computed tomography scan revealed orbital lymphoma. Orbital involvement from a malignant nodular histiocytic lymphoma resulted in a proptosis similar to that observed in Graves' ophthalmopathy. CONCLUSIONS: This very unusual presentation of orbital lymphoma mimicked Graves' disease so closely that the true cause was overlooked. This case emphasizes the need to include space-occupying lesions in the differential diagnosis of proptosis and gaze restrictions. The disease process and controversial management strategies are discussed.

Combined Modality Therapy↗