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PubMed1997

Displacements of eyeball in orbital blowout fractures.

Thirty-two cases of orbital blowout fracture, excluding those of linear fracture with trap-door variety, were selected to study the changes of the eyeball position: posterior displacement or enophthalmos, medial and inferior displacement. Two-millimeter slices of computed tomographic scans were taken, and the eyeball positions were measured with the contralateral eye as a control. Intraorbital edema, if present, at least 10 days after injury had little effect on the position of the eyeball, nor was there any evidence to suggest the late onset of enophthalmos. Enophthalmos remains around 1 mm before total orbital enlargement reaches 2 ml in volume, thereafter increases proportionally with total orbital enlargement until 4 ml, then remains on a plateau. Enophthalmos increases proportionally with the increase of medial orbital wall enlargement when the inferior orbital wall enlargement is less than 2 ml. With inferior wall enlargement more than 2 ml, 3 to 4 mm of enophthalmos is seen irrespective of the increase of medial wall enlargement. The medial displacement of the eyeball increases proportionally with the increase of medial wall enlargement when inferior wall enlargement is less than 2 ml. The inferior displacement of the eyeball has little proportional relationship with medial or inferior wall enlargement when the former exceeds 2 ml. Relatively good proportional relationship is found between the enophthalmos and the medial displacement of the eyeball, but not between the enophthalmos and the inferior displacement of the eyeball.

Adolescent↗

PubMed2002

Porous polyethylene implants in orbital floor reconstruction.

The purpose of this article is to present the authors' experience with the use of porous polyethylene ultrathin sheets for orbital floor reconstruction. Thirty-two patients with orbital floor fractures were treated with porous polyethylene ultrathin sheets. Sixteen cases corresponded to orbitozygomatic fractures, 11 cases corresponded to pure orbital floor fractures, and five corresponded to panfacial fractures. The subciliary approach was used in 15 patients and the transconjunctival approach in nine; another three patients were operated on through a preexisting eyebrow wound, two were operated on with a subtarsal approach, two were operated on through an eyebrow extension of a facial wound, and one patient was operated on through the facial wound. Intraoperatively, all patients received a prophylactic dose of intravenous antibiotics. Postoperatively, 24 patients received amoxicillin clavulanate for 5 to 7 days, two patients received clindamycin, and six patients received no antibiotics. Enophthalmos was corrected in 15 of 24 patients (62.5 percent), and hypoglobus in nine of 11 (82 percent). Diplopia was resolved in 25 of 28 patients (89.3 percent) with preoperative impairment. Extrinsic eye movement impairment was resolved in 25 of 27 patients (92.6 percent). A preoperative visual acuity deficit was present in four patients (12.5 percent) and was resolved in one (from 20/100 to 20/20). Visual acuity improved in one patient (from 20/60 to 20/30). In the other two patients, visual acuity remained altered (from 20/30 to 20/30). One patient (3.1 percent) suffered blindness induced by surgery. Nine of 26 patients (34.6 percent) had residual infraorbital nerve hypesthesia and five (19.2 percent) had residual paresthesias. Postoperatively, epiphora was present in six patients (18.8 percent) and ectropion in five (15.6 percent). Although there was no statistical significance between the surgical approach and the presence of epiphora (p = 0.211) and ectropion (p = 0.422), patients who were treated using the transconjunctival approach suffered reduced ectropion (0 percent) compared with patients treated using the subciliary approach (20 percent). However, patients treated using the transconjunctival approach suffered increased epiphora (22.2 percent) compared with those treated with the subciliary approach (13.3 percent). There were four cases (12.5 percent) of postoperative facial infections. Two of these cases were resolved with systemic antibiotics, one was resolved with bone sequestrum resection, and one patient needed removal of the implant. Orbital infections were related in all cases to titanium osteosynthesis miniplates or skull bone graft. When comparing patients who were treated with and without antibiotics, no statistical differences (p = 0.958) were found relative to the presence of infections. Correction of hypoglobus is technically easier than enophthalmos, because enophthalmic correction requires a wide, deep subperiosteal dissection and implant positioning, posterior to the equator of the globe, with the inherent risk of orbital apex injury.

Adolescent↗

PubMed2003

Death associated with an indwelling orbital catheter.

We report a case of a 38-year-old woman who underwent revision of an orbital implant. A flexible indwelling orbital catheter was placed for postoperative anesthesia. Marcaine, administered to the patient through the 5.25-inch catheter while the patient was at home, led to respiratory arrest. After unsuccessful resuscitation, the patient died. At autopsy, it was noted that the catheter passed through the superior orbital fissure, with evidence of injection of marcaine in the subarachnoid space. This patient had signs and symptoms of Stickler syndrome. This leads us to believe that deficiencies in collagen II led to a weakness of the connective tissue surrounding the superior orbital fissure, leading to facilitated passage of the catheter into the subarachnoid space. This may be the first report of this type of outcome when using indwelling catheters for ophthalmic surgery. We recommend that placement of orbital indwelling catheters be performed in a controlled hospital setting.

Adult↗

PubMed2005

Incidence of infraorbital hypesthesia and sinusitis after orbital decompression for thyroid-related orbitopathy: a comparison of surgical techniques.

PURPOSE: To compare the incidence of postoperative infraorbital (V2) hypesthesia and sinusitis between transantral/Caldwell-Luc and transconjunctival orbital decompression for thyroid-related orbitopathy. METHODS: A retrospective review of all orbital decompressions from January 1994 to January 2001 performed by one surgeon was done. Seventy-eight patients (133 orbits) with thyroid-related orbitopathy underwent orbital decompression for compressive optic neuropathy, exposure keratopathy, or uncontrolled intraocular pressure. Main outcome measures were the presence of V2 hypesthesia and sinusitis determined at 3 postoperative evaluations (1 to 2 weeks, 1 to 3 months, 3 to 6 months). RESULTS: The incidence of V2 hypesthesia in the transconjunctival group declined from 29.2% (19/65) to 6.1% (4/65), whereas the incidence of V2 hypesthesia in the transantral/Caldwell-Luc group decreased from 68.2% (43/63) to 46% (29/63) over the postoperative course. The rate of sinusitis in the transconjunctival group stayed constant at 6.1% (4/65) at early and late postoperative visits, whereas the transantral group rate of sinusitis declined from 33.3% (21/63) to 9.5% (6/63). CONCLUSIONS: Transconjunctival orbital decompression results in a statistically significant decrease of early and late postoperative infraorbital hypesthesia and early postoperative sinusitis when compared with the transantral approach.

Decompression, Surgical↗

PubMed2005

Massive congenital orbital teratoma.

Orbital teratomas are rare embryonic tumors composed of a wide diversity of tissues derived from the three germinal layers. The presenting features include, a healthy newborn with extreme unilateral proptosis; marked stretching of the eyelids over a tense, fluctuating mass, with elongation of the palpebral fissure; enlargement of the bony orbit (two to three times normal size) with subsequent nasal and malar deformities; and transillumination of all or part of the orbital mass. Commonly the eye is normally developed but often vision is not preserved either due to exposure or secondary optic atrophy. The objective in the management of orbital teratoma is to save the eye to encourage orbitofacial development, maintain cosmesis and retain some vision. We report a case of massive congenital orbital teratoma successfully removed by an eyelid-sparing exenteration technique.

Female↗

PubMed2005

Orbital exenteration reconstruction with rectus abdominis microvascular free flap.

OBJECTIVES: To determine the course of reconstructive treatment and outcomes with use of the rectus abdominis free flap after orbital exenteration with or without total maxillectomy. STUDY DESIGN: Retrospective chart review of treatment and outcomes of patients who had rectus abdominis free-tissue transfer for orbital exenteration with or without total maxillectomy at the Mayo Clinic between 1994 and 2004. METHODS: Charts of patients who had rectus abdominis free flap reconstruction after orbital exenteration were retrospectively reviewed and the surgical technique evaluated. An explanation of the surgical technique for rectus abdominis free-tissue transfer to the orbital cavity is provided, along with a discussion of the advantages and disadvantages of this reconstructive method. RESULTS: Twelve of 13 patients who underwent reconstruction with rectus abdominis free-tissue transfer had a successful outcome (flap viability 92%). Cosmetic results were acceptable both to patients and to surgeons. CONCLUSIONS: Rectus abdominis microvascular free-tissue transfer for repair of orbital exenteration defects is a safe and reliable alternative to the use of the temporalis or the pectoralis major muscle as a pedicle flap; it provides a larger volume of well-vascularized tissue and greater placement flexibility without associated orientation problems; and the long vascular pedicle facilitates the use of multiple donor vessels within the head and neck, which is an advantage in previously irradiated patients. Postoperative care and the donor site defect are well tolerated. The flap allows reliable obturation of the oral maxillectomy defect, and it negates the need for cavity care in these patients.

Adult↗

PubMed2005

Orbital floor restoration.

Orbital blow-out fractures reconstruction aims to restore the continuity of the orbital floor, to provide support of orbital contents and prevent soft tissues' fibrosis. Different materials have been tested over the years to reach this purpose. Traditionally, autogenous grafts have been used as the material of choice; in recent years alloplastic materials have gained popularity because of their availability and ease of use. The purpose of this study was to review materials used in orbital floor reconstructive surgery at the Department of Maxillo-Facial Surgery of University of Rome "La Sapienza", with emphasis on their biocompatibility, their shaping features, and mechanical properties. This report presents the results obtained by the application of these products on 379 patients who underwent surgical treatment for blow-out fractures from 1995 to 2003: the diagnosis of fracture of the orbital floor was based on clinical symptoms and CT axial scanning through coronal reconstruction. Follow-up period spanned from 1 to 8 years.

Biocompatible Materials↗

PubMed2000

Objective quantification of the motion of soft tissues in the orbit.

Orbital soft-tissue motion analysis aids in the localization and diagnosis of orbital disorders. A technique has been developed to objectively quantify and visualize motion in the orbit during gaze. T1-weighted MR volume sequences are acquired during gaze and soft-tissue motion is quantified using optical flow techniques. The flow field is visualized using color-coding: orientation of the flow vector is coded by hue and magnitude by saturation of the pixel. Current clinical circumstances limit MR image acquisition to short sequences and short acquisition times. The effect of these limitations on the performance of optical flow computation has been studied for four representative optical flow algorithms: on short (nine frames) and long (21 frames) simulated sequences of rotation of a magnetic resonance (MR) imaged object, on short measured MR sequences of controlled rotation of the same object and on short MR sequences of motion in the orbit. On the short simulated and motion-controlled sequences, the Lucas and Kanade algorithm showed the best performance with respect to both accuracy and robustness. These motion estimates were accurate to within 20%. Motion in the orbit ranged between 0.05 and 0.25 mm/degree gaze. Color-coding was found to be attractive as a visualization technique, because it shows both magnitude and orientation of all flow vectors without cluttering.

Algorithms↗

PubMedDate not supplied

Modified lateral orbitotomy for removal of orbital neoplasms in two dogs.

A simplified lateral orbitotomy is described that decreases surgical time and lessens tissue dissection, yet maintains the exposure to the orbit provided by other orbitotomy techniques. The approach involves cutting the orbital ligament, incising the temporalis aponeurosis from the dorsal zygomatic arch, making parallel zygomatic arch osteotomies, and reflecting the zygomatic arch ventrally. Closure of the wound involves wiring the zygomatic arch back into place. This orbitotomy procedure provides excellent exposure for removal or biopsy of orbital masses. The use of this technique for surgical excision of orbital masses in two dogs, one with an adenoma of the third eyelid gland and one with an orbital fibrosarcoma, and their subsequent management is described.

Adenoma↗

PubMed1977

Computerized tomography of the orbits. A report of 196 patients.

The value of orbital CCT scans was studied by grouping the CCT scans of 196 patients into clinical diagnostic categories. In 83% of patients with suspected Graves' ophthalmopathy, CCT confirmed the diagnosis. The CCT scan differentiated patients with Graves' disease from those with orbital pseudotumour or malignancies. The CCT scan was positive in 92% or patients with proven orbital malignancies. In 73% of patients with proptosis of unknown aetiology, and in 56% of patients with ocular motility problems, the CCT scan led to the diagnosis. The CCT scan ruled out orbital mass lesions in cases of optic neuritis, optic atrophy or vascular malformations. The greatest value of the CCT scan was in the localization and determination of the size and shape of various orbital lesions and in the accurate follow-up of those lesions utilizing serial scans.

Adult↗

PubMed2005

Mortality following exenteration for malignant tumours of the orbit.

BACKGROUND: Orbital exenteration is a rare, but disfiguring procedure reserved for the treatment of locally invasive malignancy or potentially life threatening orbital neoplasms, when less destructive techniques are inadequate. The authors report their experience and analyses of 64 cases of orbital exenteration performed over a 13 year period, looking specifically at key factors affecting mortality associated with such a destructive surgical procedure. METHODS: Records were reviewed retrospectively of all patients who had undergone exenteration of the orbit from 1 January 1991 to 1 April 2004 inclusive, at the Manchester Royal Eye Hospital. In all cases of deceased individuals, the cause of death was determined by liaison with the general practitioner and local health authority. Duplicate death certificates were requested for all deceased patients from the Registrar for Births, Deaths, and Marriages, Southport, UK. Kaplan-Meier analysis was used to estimate survival following exenteration. RESULTS: Overall, 1 year survival post-exenteration was high at 93%. After 3 years this had fallen to 67%, followed by 57% after 5 years, and 37% at 10 years. 13 patients died as a direct result of the orbital tumour. A further nine died of unrelated medical conditions, and two patients succumbed to malignant processes originating elsewhere in the body. There was no difference in survival rate at 3 years (p=0.99) and 5 years (p=0.454) between those with clear resection margins and those without. CONCLUSION: In this study it was found that there was an overall mortality rate of 38% over 12 years. The presence of clear surgical margins, although reassuring for the surgeon, should not be regarded as an indication of cure. However, an overall 1 year survival of 93% and a 10 year survival of 37% are reassuring in that a proportion of individuals achieve surgical cure following exenteration. 38% of patients died as a result of other medical causes over the 12 year follow up.

Adolescent↗

PubMed1995

Color Doppler US of the orbit.

Color Doppler imaging of the orbit shows promise in evaluation of several types of orbital abnormalities. The most promising use is for evaluation of vascular disorders. Screening for orbital varices and cavernous-carotid fistulas is easily accomplished. Color Doppler imaging can also be useful in diagnosis of ocular ischemia, central retinal vessel occlusion, and anterior ischemic optic neuropathy. In cases of inflammatory disease, it may be helpful in searching for complications of infection and in monitoring the size of fluid collections. In cases of tumors, color Doppler imaging can be used to monitor lesion size and in surgical planning. More work needs to be done to determine the role of color Doppler imaging in evaluation of trauma and congenital abnormalities. An understanding of the basic anatomy of the orbit, examination techniques, and common disease processes in the orbit will allow the radiologist to offer this potentially valuable modality to referring clinicians.

Adult↗

PubMedDate not supplied

Artifacts and pitfalls in MR imaging of the orbit: a clinical review.

High-resolution magnetic resonance (MR) imaging of the orbit has become widely accepted as a valuable diagnostic technique. However, there are a number of artifacts and pitfalls associated with orbital MR imaging. Chemical shift artifacts may be induced by orbital fat or silicone oil used to treat retinal detachment. Motion artifacts are caused primarily by unavoidable globe motion during imaging. Artifacts due to a nonuniform magnetic field are particularly noticeable at air-tissue interfaces but may also be caused by incomplete fat saturation or highly magnetic materials near the orbit. Protocol errors may cause artifacts such as saturation, phase wraparound, truncation, shading, and partial-volume artifacts. This information can be used to improve orbital image quality and avoid misinterpretation of image artifacts. Use of fat saturation, silicone saturation, and careful patient screening for metal near the eyes and instruction to reduce motion can help reduce the occurrence of artifacts. In addition, optimal imaging technique is essential and should include use of proper surface coils, plane of section, and pulse sequences.

Artifacts↗

PubMed1985

Otolaryngologists' role in diagnosis and treatment of orbital pseudotumor.

Patients with pseudotumor of the orbit often present with proptosis, inflammatory changes of the orbital structures, loss of vision, and abnormalities of extraocular motility. Because these signs and symptoms mimic more common disorders of the paranasal sinuses, the otolaryngologist often plays an important role in the diagnosis of this clinical entity. Also, since orbital pseudotumor can be secondary to an inflammatory disease of the paranasal sinuses, appropriate medical and surgical treatment must be rendered by the otolaryngologist. The experience of orbital pseudotumor at Indiana University Medical Center in the Department of Otolaryngology-Head and Neck Surgery is presented. Appropriate diagnostic workup is discussed, including the importance of the CT scan. The differential diagnosis of space-occupying orbital processes is examined. It is important that the otolaryngologist become more familiar with this clinical entity and its appropriate treatment.

Adult↗

PubMedDate not supplied

Orbital dirofilariasis.

PURPOSE: To warn the ophthalmologist to consider orbital dirofilariasis in the differential diagnosis of inflammatory masses of the orbit. PATIENTS: Two cases with non-specific swelling and pain of the orbit who had a initial diagnosis of "inflammatory pseudotumor of the orbit". RESULTS: These are two new cases of orbital dirofilariasis. CONCLUSION: In the ophthalmic literature, the highest incidence of ocular dirofilariasis is reported in Italy. Since both these patients had no history of travel in endemic areas of Dirofilaria, this parasitic infection is presumably not rare in Italy and is probably underdiagnosed.

Animals↗

PubMed1994

Primary intraosseous orbital hemangioma: a case report and review of the literature.

Primary intraosseous orbital hemangiomas are rare tumors. Only 25 cases have been reported in the literature. Very few of them have multiple orbital bone involvement. We report a case with extensive involvement of the orbital roof, the medial and lateral walls of the orbit, and the lesser and greater wings of the sphenoid, and describe a unilateral extradural frontotemporal approach to excise the tumor and decompress the right superior orbital fissure and both optic nerves. A brief clinical and radiological review of the literature is presented.

Angiography, Digital Subtraction↗

PubMed2005

[Orbital fat evaluation after enucleation and evisceration in rabbits].

PURPOSE: To evaluate rabbit adipocytes of the orbital fat tissue after enucleation and evisceration. METHODS: Twenty-tree specimens from 23 rabbits aged 42 days which had undergone socket surgery (evisceration and enucleation) were evaluated. The animals were sacrificed on the 30th, 90th and 180th postoperative day. The orbital fat tissue was prepared for light microscope evaluation (magnification: 200x) and analyzed by IpWin 32 software program. The number of cells in each field and the area of each adipocyte were used to calculate the cell median area. The data were compared between the groups (enucleation and evisceration) and submitted to statistical analysis by a non-parametrical test. RESULTS: There were no statistical differences when considering the mean area of adipocytes between enucleation or evisceration or time of sacrifice. CONCLUSION: The volume decrease in the anophthalmic cavity is not related to orbital fat atrophy. The genesis of orbital volume reduction might result from the spacial distribution and interrelationships of the orbital soft tissue rather than changes in volume of adipocytes.

Adipocytes↗

PubMed2005

[Cranial idiopathic hypertrophic pachymeningitis associated with orbital pseudotumor: case report].

Hypertrophic pachymeningitis is a rare disorder characterized by meningeal thickness, that can be caused by infection, tumoral infiltration, inflammatory disorders or idiopathic. We report the case of a 40 year-old man that presented with longstanding headache and progressive bilateral visual loss and proptosis. Cranial and orbital magnetic resonance imaging revealed diffuse dural thickness and bilateral extraconal orbital lesion. Extensive investigation did not reveal any systemic condition. Histopathological study after meningeal and orbital biopsy disclosed a chronic inflammatory process compatible respectively with idiopathic hypertrophic pachymeningitis (IHP) and orbital pseudotumor. This case emphasizes that orbital involvement can occur in IHP and that its early identification is of great importance in order to improve the visual prognosis of this condition.

Adult↗