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PubMed1977

The impact of CT scanning and ultrasonography on orbital diagnosis.

New methods of soft tissue imaging have revolutionised the investigation of the orbit. The impact of CT scanning and ultrasonography is considered in relationship to established techniques including angiography. The importance of plain X-ray examination and conventional tomography is stressed for the exclusion of non-orbital causes of exophthalmos. In the orbit CT scanning is the best method of establishing the presence of a mass lesion; ultrasonography is useful principally for the investigation of optic nerve problems. Venography is still required in most patients to diagnose and establish the extent of a venous malformation in the orbit; it also has an important part to play in the diagnosis of inflammatory processes. Carotid angiography is now only required in patients with highly vascular orbital tumours, or with suspected arteriovenous anomalies. Plain X-ray examination, CT scanning and venography are regarded as the dominant investigations with conventional tomography, ultrasound, and arteriography playing a subsidiary role.

Adult↗
PubMed2003

Sclerosing lipogranuloma of the orbit after periocular steroid injection.

PURPOSE: To report the clinical and histopathologic findings of a large sclerosing lipogranuloma of the orbit arising after a sub-Tenon's corticosteroid injection. DESIGN: Interventional case report and review of the literature. METHODS: A complete ocular and systemic evaluation was performed on a 81-year-old patient, who developed a large orbital mass subsequent to a periocular corticosteroid injection producing proptosis, ptosis, and ocular motility impairment. The lesion was biopsied and submitted for histopathologic analysis. MAIN OUTCOME MEASURES: Orbital, computed tomography, and histopathologic findings. RESULTS: Histopathologic examination revealed lipogranulomatous inflammation. Specifically, this type of reaction was consistent with a diagnosis of sclerosing lipogranuloma. CONCLUSIONS: It is extremely rare to find a large granulomatous orbital lesion arising subsequent to a periocular corticosteroid injection. Only one case has been reported in the English-language literature to date. It is important to include this type of lesion in the differential diagnosis of an orbital mass seen after the injection of periocular corticosteroids.

Aged↗
PubMed1982

Orbital abscess. Presentation, diagnosis, therapy, and sequelae.

Fifteen cases of orbital abscess were reviewed. Significant morbidity occurred despite treatment with intravenous antibiotics and surgical drainage. The complications included visual loss to less than 20/200 (four patients), residual proptosis (two patients), residual diplopia (two patients), osteomyelitis (one patient), and death (one patient). Seven patients reported no pain. Fever was absent in eight patients. Four patients had normal white blood cell counts. Many of these patients had received inappropriate or inadequate doses of oral antibiotics before referral. Partially treated cases of orbital abscess may not manifest the expected clinical findings of orbital infection. Four patients presented in an insidious fashion with symptoms evolving over weeks to months. Their subacute presentations in the absence of fever, pain, or elevated white blood cell count mimicked the onset of orbital tumors. CT scan failed to detect an abscess in two cases. Conjunctival and nasal cultures were not helpful in determining the bacteriologic etiology of these infections. Surgical drainage and appropriate antibiotic therapy is the definitive treatment of orbital abscess.

Abscess↗
PubMed1987

Orbital manifestations of plasmacytic lymphoproliferations.

Orbital involvement by plasmacytic lymphoproliferative disorders is rare. Presented are four cases, with different clinical onsets and courses, demonstrating the diversity of expression of lymphoproliferative plasma cell lesions of the orbit. The first patient presented with a slowly developing palpable mass in the upper and anterior orbit. This localized lesion proved to be a reactive plasma cell proliferation. The second case had a 3-month history of proptosis, diplopia, and droopy eyelid and a pulsatile temporal mass with bone destruction. Results of biopsy and systemic investigations showed a solitary plasmacytoma of bone. In the third case, a patient with a known multiple myeloma for 2 years presented with a progressive osteolytic mass which proved on biopsy to be a plasmacytoma. At the time, she also had other active bone lesions. The fourth case presented as a possible orbital cellulitis in a man with known multiple myeloma for 2 years. He proved to have disseminated myeloma, the orbital infiltrate being secondary to sinus involvement. The differential diagnosis for each case can be quite involved. Each case required a biopsy for an accurate diagnosis in addition to a complete clinical, radiographic, and laboratory workup. The pathologic features of each tumor can be misleading. These will be discussed as well as the use of ancillary diagnostic methods such as electron microscopy and immunohistochemistry to further characterize each lesion. The clinical course and treatment modalities will be discussed.

Aged↗
PubMed1994

Orbital reconstruction using porous polyethylene sheets.

BACKGROUND: There has been growing interest in using porous alloplastic implants for reconstructive orbital surgery because of their perceived increased biocompatibility. One commercially available porous implant is high-density porous polyethylene (Medpor). It is made of pure particles of polyethylene that form interconnecting pores and have excellent handling characteristics. METHODS: The authors performed 37 orbital reconstructions using 0.85-, 1.5-, or 3-mm porous polyethylene sheets to reconstruct internal orbital defects. Mean postoperative follow-up was 18.5 months. Four patients were treated for anophthalmic enophthalmos; there was one patient with spontaneous enophthalmos. In selected patients, other implants also were used, including miniplates or microplates, silastic sheets, autologous bone, or nasal septal cartilage. In patients with enophthalmos, the implants were stacked to reverse the malposition evident at surgery. RESULTS: Preoperatively, 27 patients had symptomatic diplopia. Postoperatively, the diplopia resolved in 15 patients and decreased in 7. No patients had induced diplopia or exacerbation of preoperative diplopia. Enophthalmos resolved in 9 of 18 patients. Hypoglobus was normalized in nine of nine patients. There was one major complication of orbital infection requiring explantation 1 week postoperatively. Minor complications included undercorrection, a symptomatically palpable implant, and transient postoperative chemosis. CONCLUSION: Porous polyethylene sheets offer several distinct advantages when used for orbital reconstruction. They are easy to handle, shape, contour, position, fixate, and use with other autogenous and alloplastic implants. In this series, these sheets permitted predictable, stable results with few complications.

Adolescent↗
PubMed1996

Abscessed hydroxyapatite orbital implants. A report of two cases.

PURPOSE: The authors describe the rare condition of an abscess within a hydroxyapatite orbital implant in two patients who had undergone seemingly uncomplicated enucleation and orbital implant surgery. METHODS: In the first patient, 14 weeks postoperatively, a chronic discharge developed and the socket became uncomfortable. A pyogenic granuloma was present, occurring over an area of dehiscence. The hydroxyapatite orbital implant was removed 10 months postoperatively. In the second patient, moderate orbital discomfort was noted during the first week postoperatively along with a temporal shift of the implant. The discomfort persisted, and 1 week later a discharge began. The implant was removed 9 weeks after implantation. At the time of surgery, an unsuspected pyogenic granuloma was found in the medial conjunctival formix overlying a small area of implant dehiscence. RESULTS: Conjunctival and implant cultures grew Staphylococcus aureus in our first patient, whereas coagulase-negative staphylococci were cultured from the conjunctiva and implant in our second patient. Results of histopathologic examination of both implants disclosed an abscess cavity containing clusters of gram-positive cocci. CONCLUSION: Persistent orbital discomfort, discharge, and the development of a pyogenic granuloma after hydroxyapatite implant should warn the ophthalmic surgeon of potential implant infection.

Abscess↗
PubMed1999

Two faces of orbital hematoma in intranasal (endoscopic) sinus surgery.

Orbital hematoma and blindness can occur during or after sinus surgery. All orbital hematomas in 3500 endoscopic sinus ethmoidectomies were identified and evaluated for type, treatment, and sequelae. Fifteen orbital hematomas were identified, with 1 case of temporary blindness and no cases of permanent blindness. Two types of orbital hematoma were identified-slow (venous) and fast (arterial)-which differ in management. The venous type results from penetration of the lamina papyracea and disruption of veins. The arterial hematoma is caused by anterior or posterior ethmoid artery injury. The treatment approach to each is different, with blindness more likely occurring from a fast (arterial) hematoma. Of the 2 types of orbital hematoma that can occur during sinus surgery, surgical decompression and hemorrhage control are more likely with the fast arterial hematoma, which has not been the subject of any prior presentation. Cause and management of each will be discussed.

Adolescent↗
PubMed2006

[Vascular tumours and malformation of the orbit].

Vascular diseases are an important part of orbital pathology. We describe vascular tumours of the orbit and vascular diseases with repercussion on the orbit, from intra or extra orbital origin. The classification of these abnormalities is difficult and several terms are used to describe the same histological entity. The objective of this work is, using the current classification, to illustrate the different imaging aspects of the most frequent vascular diseases of the orbit.

Aneurysm↗
PubMed2003

Post-traumatic orbital cellulitis.

Orbital cellulitis is uncommon. It may arise as a sequel to eyelid infection, or from direct spread of infection from the paranasal sinuses; it may be of odontogenic origin and has been reported after meningitis and after nasoorbital fractures with pre-existing sinusitis. Clinically, orbital cellulitis is of great importance, as it is a severe disease with potentially disastrous consequences. It may lead to optic neuritis, optic atrophy, blindness, cavernous sinus thrombosis, superior orbital fissure syndrome, meningitis, subdural empyema, and even death. We report two cases of severe post-traumatic orbital cellulitis with subperiosteal abscesses. These were managed surgically and vision was preserved. We describe the anatomy, a classification of orbital infection, and the importance of multidisciplinary management of these cases.

Adult↗
PubMed1997

Orbital floor reconstruction with autogenous mandibular symphyseal bone grafts.

PURPOSE: This article shows the usefulness of the mandibular symphysis as a source of bone graft for the reconstruction of the orbital floor. PATIENTS AND METHODS: A retrospective study was conducted on 16 patients who had isolated blowout fractures (n = 10) or orbital floor defects (n = 6) reconstructed with mandibular symphyseal bone grafts. Symphyseal bone grafts were used when the defects were less than 2 cm in diameter. Patients were examined at recall visits for any evidence of unsuccessful reconstruction by checking extraocular movements, and evidence of diplopia or enophthalmous. RESULTS: During a mean follow-up of 12 months (range, 9 to 36 months), patients had no postoperative complaints. There were no instances of infection at the surgical sites, and none of the grafts were extruded or lost. There was good restoration of the orbital floor, with no clinical evidence of enophthalmous or diplopia. Extraocular movements were intact in all patients. CONCLUSION: The mandibular symphysis is a readily available source of autogenous bone that can be harvested with minimal morbidity. Its contour is suitable for use in orbital floor reconstruction. It merits consideration when autogenous bone grafts are considered for orbital floor defects less than 2 cm in diameter.

Adult↗
PubMed1977

The importance of retrograde phlebography in the diagnosis of orbital lesions.

The authors describe a technique for retrograde phlebography of the orbit. A selection of the typical findings in 51 cases of orbital phlebography is presented. The diagnostic importance of the examination in cases of similar clinical symptoms has been stressed. This method is best suited to the investigation of cases of venous malformation, especially of the intra-orbital, peri-orbital and retro-orbital area. Side-effects and complications have been described. A comparative assessment against other competetive methods of investigation, like the computer tomography has been attempted.

Cavernous Sinus↗
PubMed1984

Fractures of the orbital floor: indications for exploration and for the use of a floor implant.

Fractures of the orbital floor are frequently treated by exploratory surgery and by the insertion of a floor implant, because of the possibility of late diplopia and enophthalmos. The findings of this study would suggest that this fear is not justified and that there is no indication for an early diagnostic exploration of the fractured orbital floor, if there are no clinical or radiological signs of orbital floor fracture within 14 days of the accident. The significance of the status of the periorbita in the method of treatment of the fractured orbital floor is stressed. The suggestion is made, contrary to what is generally found in the literature, that a linear or a comminuted floor fracture and an orbital floor with a defect do not require a floor implant, if the periorbita is intact.

Eye Movements↗
PubMed2003

Surgical treatment of subperiosteal abscess of the orbit: Sendai's ten-year experience.

OBJECTIVE: One of the common complications of acute infection of the paranasal sinus is cellulitis of the orbit. This is secondary to the spread of infection through the very thin bony wall between the ethmoid sinuses and the orbit, the roof of the orbit in frontal sinusitis, and the floor of the orbit in maxillary sinusitis. When the infection does not penetrate the periorbita, it dissects under the periosteum and forms subperiosteal abscess. METHODS: We experienced 10 patients with subperiosteal abscess for 10 years from 1992 to 2002 that required surgical drainage. The age of the patients ranged from 4 to 76 years including five males and five females. RESULTS: Successful and safe drainage of the abscess with endoscopic sinus surgery was obtained in four patients while six patients required external surgery. The selection of the surgical approach depended upon the localization of abscess in the orbit. Five of the seven patients with visual disturbance resulted in a complete recovery of vision after surgery. However, there was no improvement of visual acuity in the other two patients who had already shown severe damage of vision prior to treatment. CONCLUSION: Ocular symptoms such as exophthalmos, double vision, and ptosis subsided completely in all patients. It is suggested that prompt diagnosis and surgical drainage before severe loss of visual acuity rescue or recover the vision.

Abscess↗
PubMed2002

Orbital trauma.

The orbit is designed to protect and nurture the eyeball. The seven bones of the orbit enclose a pear-shaped cavity. The bones of the superior and lateral orbit are extremely strong, as opposed to the bones of the inferior and medial orbit, which are extremely weak. The strengths and weaknesses inherent to the orbital bones produce a unique pressure safety valve, designed to protect the eyeball.

Eye Injuries↗
PubMed1995

Correction of post-traumatic orbital deformities: operative techniques and review of 26 patients.

The skeletal reconstruction of post-traumatic orbital deformities includes the zygomatic complex, the nasoethmoid area and the internal orbit. Repositioning of the malpositioned zygoma is the key element and the first step. Due to remodelling processes, most of the landmarks for proper positioning are lost, leaving the lateral orbital wall as the only reliable landmark in secondary revisions. The details of the skeletal reconstruction are discussed. Between January 1988 and December 1992, 31 patients with major post-traumatic orbital deformities have been operated on, of which 26 could be followed for a minimum of 6 months. A total of 61 operative procedures using craniofacial techniques have been performed. Complications occurred in 5 (15%) of the 26 patients, the most severe being visual loss caused by a displaced bone graft. The most frequent deformity was enophthalmos. Most patients presented with more than one deformity. The aesthetic results were rated as 'good' in 12, 'satisfactory' in 8 and 'unsatisfactory' in 6 patients. Of the patients suffering from double vision, 55% were improved after orbital reconstruction. Craniofacial techniques allow radical correction of post-traumatic skeletal deformities. The functional and aesthetic results, however, are limited by the soft tissues.

Adult↗
PubMed1988

Medial orbital wall fracture with enophthalmos.

An isolated blow-out fracture of the medial orbital wall is uncommon, whereas the incidence in conjunction with an orbital floor fracture is high. The most striking features of an isolated medial wall fracture are diplopia on medial and lateral gaze and/or enophthalmos. The cases of two patients with a fracture of the medial orbital wall with enophthalmos are presented. One patient had an isolated medial wall fracture, whereas the other had a combined medial and inferior orbital wall fracture. Treatment of the enophthalmos consisted of exposure of the medial wall fracture site using a bicoronal flap, freeing of the herniated soft tissues and reconstruction of the defect with an autogenous medial iliac bone graft. The incidence, aetiology, pathogenesis, signs and symptoms and surgical treatment of the isolated orbital medial blow-out fracture are discussed.

Adolescent↗
PubMed1993

Orbital colour Doppler imaging.

Colour Doppler imaging (CDI) is an ultrasonic method for qualitatively and quantitatively assessing blood flow. Recently this technique has been adapted for investigation of the orbital, optic nerve and ocular vasculature. We discuss the history, principles and methodology of this examination technique for ophthalmology. Also described are normal haemodynamic characteristics as well as the findings in common pathological states involving derangements of orbital blood flow. Although CDI is relatively new to ophthalmology it has already proved to be of benefit in conditions with altered orbital, ocular and optic nerve blood flow. In the future it is expected that the indications for the applications of CDI will become more clearly defined and that orbital CDI will be more widely available and utilised, especially in the investigation of vascular diseases of the orbit, optic nerve and retina.

Arterial Occlusive Diseases↗
PubMed2001

Upside-down orbitopathy: unilateral orbital dependent-tissue oedema causing total visual loss.

The case is reported of a 24-year-old man who was involved in a road traffic accident and became trapped upside down with the right side of his face being the most dependent part of his body. Marked hemifacial tissue oedema was associated with right acute compressive orbitopathy and vascular compromise. Acute dysfunction of al orbital nerves was found on examination. Such neuropathy is usually related to the consequences of direct trauma, fractures or haemorrhage; however, computed tomography scanning demonstrated no evidence of orbital fracture or haemorrhage. Immediate anterior surgical orbital decompression was performed in the emergency room in addition to high dose intravenous steroids. Dependent orbtal tissue oedema is proposed as a mechanism of compressive orbitopathy with consequent ischaemic damage to all orbital nerves, total visual loss and complete ophthalmoparesis. Good recovery of other orbital nerves has occurred and the globe has reperfused. Despite intervention, no visual function has returned.

Accidents, Traffic↗