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PubMedDate not supplied

Changes in ocular globe-to-orbital rim position with age: implications for aesthetic blepharoplasty of the lower eyelids.

Changes in the relationship of the anterior globe to the orbital rim, orbital fat, and cheek mass are examined in the present study. Two groups of individuals (N = 28) were studied, young versus old, using three-dimensional computer tomography. A computer-derived soft tissue reformat of the data allowed the anterior-posterior changes to be evaluated at the midpupillary plane. Analysis of the data brings to light two important changes which occur with aging. First, the orbital rim moves posteriorly relative to the anterior cornea with age (p = 0.0007). This is important because overresection of orbital fat during lower blepharoplasty accentuates the proptotic appearance of the eye which occurs naturally with age due to orbital remodeling. A second finding is that there is a tendency for the cheek mass to move posteriorly with age relative to the anterior cornea (p = 0.0038). The negative vector, a warning sign for lower blepharoplasty, becomes more common with advancing age. It is suggested that the presence of a negative vector is a sign of generalized maxillary hypoplasia. Certain individuals with a negative vector can be further identified preoperatively by the clinical triad of scleral show, prominent medial fat, and a prominent nasojugal crease. These individuals likewise exhibit maxillary hypoplasia and may be more prone to complications after blepharoplasty. Lastly, a summated model of skeletal remodeling is presented. The significant points are as follows: (1) contrary to previous work, the craniofacial skeleton remodels throughout adulthood, (2) changes in the skeletal architecture impart their effects on the overlying soft tissues, and (3) facial aging is a summation of both hard and soft tissue changes which occur throughout life.

Adolescent↗
PubMed2004

Sickle beta-thalassemia presenting as orbital compression syndrome.

Orbital compression syndrome is caused by disorders of varying etiologies involving the orbit and presents with ocular and extraocular dysfunction. Ocular involvement of sickle cell disease is uncommon. A 17-year-old male presented with low backache and proptosis of both eyes of 5 days duration without past history of pain crisis or transfusion. Examination revealed pallor, icterus, bilateral proptosis, conjuctival chemosis, and symmetrical restriction of ocular movements with preserved visual acuity. He was drowsy with no other focal deficits. The fundus showed macular edema, venous engorgement, and no hemorrhage. His peripheral smear showed presence of sickle cells. Computed tomography (CT) scan of the orbit revealed orbital subperiosteal hematomas. CT head images showed epidural hematoma in the frontal lobe. High-performance liquid chromatography (HPLC) and mutation studies revealed sickle beta-thalassemia in the patient. He was managed with supportive care, transfusions to keep hemoglobin above 10 g/dl, and hydroxyurea. The patient recovered fully and remained well during follow-up of 12 months. Our case was unique for presenting as orbital compression syndrome without any history of vaso-occlusive crisis.

Adolescent↗
PubMed2000

MRI measurements of normal extraocular muscles and other orbital structures.

BACKGROUND: Studies of extraocular muscle (EOM) by magnetic resonance imaging (MRI) need to be extended to normal subjects of different ages to obtain data on the muscle thickness, cross-sectional area, and the volume of EOM and other orbital tissues. METHODS: Forty-two orbits of 21 normal subjects in three age groups with an age range of 19-70 years were examined with surface-coil MRI. The transverse and sagittal images were used to measure the thickness of the four rectus muscles during fixation in different gaze positions. The coronal images with eyes in the primary position were used to calculate the cross-sectional areas. The volumes of all six EOM, orbital fatty tissue, the optic nerve and the eyeball were measured in the coronal plane and in either the transverse or the sagittal plane. RESULTS: The horizontal muscles were thinner than vertical muscles. Muscle volume was larger in SR (superior rectus) than in IR (inferior rectus), larger in SO (superior oblique) than in IO (inferior oblique), and the same in LR (lateral rectus) as in MR (medial rectus). No significant differences were found in the values of the cross-sectional area in any image plane between the three age groups. There were no significant differences in muscle thickness and size and fatty tissue volume between age groups. The muscle thickness was linearly correlated to the angle of the eye deviation for all four rectus muscles, both in the "on" and "off" directions of the muscles. CONCLUSIONS: The study provides quantitative data, in normal subjects of different ages, on the thickness and size of EOM and the volume of other orbital tissues by MRI, to serve as a basis for further studies on the morphological changes of EOM in various orbital diseases.

Adult↗
PubMed2002

Follow-up of extended pterional orbital decompression in severe Graves' ophthalmopathy.

BACKGROUND: Compressive optic neuropathy (CON) with visual loss is, apart from corneal exposure and disfigurating proptosis, the most serious clinical sign encountered in Graves' ophthalmopathy. However, numerous different approaches and operative techniques have been proposed for orbital decompression, with varying results and side effects. The purpose of the present study was to analyze peri-operative data and long-term results in patients with severe thyroid-related orbitopathy, treated by extended pterional orbital decompression, comparing its effectiveness to other procedures. METHOD: An extended pterional orbital decompression was performed in 42 consecutive patients (59 orbits) with severe thyroid-associated ophthalmopathy after failure of medical and radiation therapy during an 11-year period. Pre- and postoperative examination included visual acuity, Hertel exophthalmometry, ocular motility, visual fields (Goldmann perimetry) and notification of complications. Long-term evaluation was carried out on average at 11 months postoperatively (range 5-26 months). FINDINGS: Visual acuity improved rapidly from a preoperative average of 0.53 +/- 0.33 (range, 0-1) to 0.77 +/- 0.31 (range, 0-1) postoperatively (p<0.001). Worsening was not seen. An average reduction of proptosis of 3.79 +/- 2.32 mm (range, 0.5-8 mm) was achieved with a mean preoperative Hertel measurement of 24.7 +/- 3.93 mm (range, 15-33 mm) (p<0.001). Double vision and restriction of eye motility was present in 76.3% of patients preoperatively and improved in 63% of patients (p<0.001). No new onsets of not already pre-existing double vision was seen. Complications included two cases of permanent palsy of the frontal branch of the facial nerve. INTERPRETATION: The extended pterional orbital decompression improved vision and decreased proptosis and restriction of extra-ocular movements in patients with severe sight-threatening and disfiguring cases of Graves' orbitopathy and is still an effective and low-risk alternative to other non-neurosurgical operative techniques. Especially new developing postdecompression strabismus can be successfully avoided.

Adult↗
PubMed2005

[Isolated fractures of the orbital floor].

BACKGROUND: The goal of this retrospective study was quantitative calculation of area and volume of isolated orbital floor fractures from computed tomography (CT) and correlation of these data with post-traumatic ophthalmologic findings. PATIENTS AND METHODS: A total of 76 patients with isolated orbital floor fractures were evaluated radiologically and clinically. CT scanning was performed in coronal sections (1.5-mm to 3.0-mm slice thickness) with contiguous table feed. Orbital floor and fracture area as well as volume of displaced tissue were measured and calculated from the CT dataset. The relation of quantitative CT data to ophthalmologic findings (motility, diplopia, and globe position) was assessed statistically. RESULTS: Calculation of the CT dataset revealed a mean orbital floor area of 6.33+/-1.05 cm(2), a mean fracture area of 2.60+/-1.14 cm(2), and a mean volume of displaced tissue of 1.16+/-0.80 cm(3). Volume of displaced tissue correlated significantly with ophthalmologic findings (p< or =0.01). Fracture area correlated significantly with globe position (p< or =0.01) and was less associated with diplopia and motility disturbances (p<0.10). CONCLUSION: Efficient evaluation of two-dimensional CT data enables quantitative assessment of orbital floor fractures. Position and function of the globe are mainly affected by the volume of displaced periorbital tissue.

Adult↗
PubMed1999

Orbital and cerebral cavernomas: comparison of clinical, neuroimaging, and neuropathological features.

Our results with 15 orbital cavernomas showed that there are important differences in comparison with cerebral cavernomas: in contrast all orbital cavernomas were embedded by a lilac hard and compact capsule. Clinical symptoms were characterized by the growth of the orbital cavernomas. There were no signs of hemorrhage, which is typical for cerebral cavernomas. The latter showed in contrast to orbital cavernomas a degenerated collagenous tissue forming the vessel walls. The capsule of the orbital cavernomas can be proved by magnetic resonance imaging (MRI). Because of its tendency to lead to irreversible loss of visual acuity, we recommend early surgery after the onset of symptoms.

Adult↗
PubMed2002

The one-piece orbitozygomatic approach: the MacCarty burr hole and the inferior orbital fissure as keys to technique and application.

OBJECTIVE: Use of the MacCarty keyhole burr hole and the inferior orbital fissure provides simplicity and safety to perform the one-piece frontotemporal orbitozygomatic (FTOZ1) approach. METHODS: We performed the FTOZ1 approach with its three subtypes (i.e., total, temporal, and frontal) in cadaveric head specimens in the Goodyear Laboratory and subsequently in surgical cases. RESULTS: The orbitozygomatic osteotomy, when added to a frontotemporal craniotomy, comprises the frontotemporal orbitozygomatic (FTOZ) approach, provides an expanded exposure to the anterior and middle cranial fossae, and enables the surgeon to create a window to the posterior cranial fossa. The MacCarty burr hole is used to facilitate orbital cuts, and the anterolateral portion of the inferior orbital fissure connects the orbital cuts to the zygomatic cuts. This allows the FTOZ1 craniotomy flap to be "out-fractured" with ease. The three types of FTOZ1 approach, i.e., the total, the temporal, and the frontal, are described step by step. CONCLUSIONS: Understanding the MacCarty keyhole burr hole and the microsurgical anatomy of the inferior orbital fissure is essential to performing the FTOZ1 approach. The three types of FTOZ1 approach enable the surgeon to tailor the approach according to the surgical exposure needed for each lesion.

Frontal Lobe↗
PubMed1982

Orbital diameters: a new parameter for prenatal diagnosis and dating.

Fetal inner orbital diameter and outer orbital diameter were measured in the occipital transverse and occipital posterior positions in 180 normal pregnancies. The outer orbital diameter was found to be closely related to the biparietal diameter. After a nomogram had been constructed, 463 patients whose fetuses were at risk for various anomalies were studied in two cases, hypotelorism was suspected because the orbital measurements fell below the 95% confidence limits, and this diagnosis was confirmed at the time of delivery. The conclusion is that, in situations in which fetal head position precludes accurate biparietal diameter determinations, the outer orbital diameter can often be obtained and used to estimate that variable and, therefore, gestational age. Furthermore, the nomogram constructed has proved to be a useful tool in diagnosing hypotension in utero. Theoretically, this should also be true of fetal hypertelorism.

Cephalometry↗
PubMed1982

Combined clinical and computed tomographic diagnosis of orbital lymphoid tumors.

Computed tomography has made it possible to make a strongly presumptive preoperative diagnosis of orbital lymphoid tumors, particularly when the radiographic findings are analyzed in conjunction with the clinical features. Twenty-six patients (with 27 orbital lymphoid tumors) had an average age of 57 years and had painless swelling or low-grade proptosis averaging 7.5 months in duration. The computed tomographic findings were highly characteristic. Almost all of the tumors had a retrobulbar or superior orbital component. In both the coronal and axial planes, distinctive growth patterns and contourings were discovered. The lesions molded themselves to preexisting orbital structures without eroding bone or enlarging the orbit. Against the bone, globe, and muscle edges, the lesions featured smooth, sharply demarcated contours with abruptly acute or perpendicular angulations, whereas a streaky profile became apparent as they irregularly infiltrated the retrobulbar fat, reflecting involvement of microfascial structural elements. No distinguishing differences were discovered in the growth patterns of the benign and the malignant tumors.

Adult↗
PubMed1985

Solitary eosinophilic granuloma of the lateral orbital wall.

Two children (aged 18 and 23 months at the initial examinations) were each ultimately found at surgery to have a solitary eosinophilic granuloma of the lateral orbital wall. Both patients had a symptomatic period of six weeks during which time other diagnoses were considered: bacterial preseptal cellulitis and mumps dacryoadenitis in the first case and traumatic recurrent orbital hematoma in the second. Diagnostic difficulties stemmed from confusing features in their histories, as well as the location of the lesion and the deceptively minimal swelling relative to the actual size of the lesion. Follow-up ten and 18 months after curettage of the two lesions showed no recurrence or evidence of systemic involvement. Although most reported cases describe the orbital frontal bone as the site of origin in the orbit, our cases demonstrated that unifocal eosinophilic granuloma may occur in the lateral wall of the orbit.

Diagnosis, Differential↗
PubMed1986

Involvement of orbital tissues by sarcoid.

Of 15 biopsy specimens identified as showing sarcoid involving the extraocular orbital tissues, three were from patients known to have systemic sarcoidosis before biopsy. Of the other 12 patients who were not known to have systemic disease at the time of biopsy, 11 were found to have evidence of systemic sarcoidosis after the biopsy. One patient, however, had no evidence of sarcoidosis at the time of the biopsy nor did she develop sarcoidosis during a seven-year follow-up period. Our results suggest that most patients with sarcoid involving the orbit will be found to have evidence of systemic sarcoidosis, but that rare patients exist in whom the orbital lesion appears to represent an isolated process. There was no histologic difference between orbital specimens from patients with systemic sarcoidosis and the specimens from the patient with isolated sarcoid of the orbit.

Adult↗
PubMed1993

Diplopia caused by orbital floor blowout fracture.

Diplopia caused by orbital floor blowout fractures is one of the major complications of orbital injuries. The records of 48 patients who had incurred orbital injuries were reviewed; 23 had a history of a pure orbital blowout fracture. Surgery was indicated when the vertical movement of the eye was impaired, and it was performed after complete resolution of orbital hemorrhage and edema. The maximal time before the first surgical procedure was 14 days. Two patients required a second procedure because of persistent diplopia and enophthalmos.

Adolescent↗
PubMedDate not supplied

Orbital lymphoma associated with acquired immune deficiency syndrome (AIDS).

A new case of AIDS-associated, small noncleaved cell (Burkitt's) lymphoma that presented as an orbital mass is described. Extraocular muscle involvement was documented by computed tomography and confirmed by orbital biopsy. Extensive abdominal involvement was subsequently diagnosed and this caused the patient's death only 15 days after the initial consultation and orbital biopsy. A literature review discloses only eight previous case reports of AIDS-associated non-Hodgkin's lymphoma (NHL) involving the orbit: two cases of Burkitt's type and six cases of large cell immunoblastic type. Three additional cases of orbital NHL can be found among larger series of AIDS cases. Affected patients are uniformly young adult males with a history of homosexuality and/or IV drug abuse. Variations in clinical presentation are discussed. Although the morphology of the histopathologic specimen in our case was consistent with a high-grade, small noncleaved cell NHL, flow cytometry revealed an atypical immunophenotype for Burkitt's lymphoma in that CD20 and immunoglobulin light chain antigens were not expressed. Morphologic classification and immunophenotypic characteristics of AIDS-associated NHLs are discussed.

Adult↗
PubMed1981

Differential diagnosis of lateral orbital masses.

Computed tomography is ideal for demonstrating orbital masses. It provides information regarding lesion location and involvement of intraorbital structures. It therefore can be used in both staging and follow-up of orbital lesions. Mass location, attenuation characteristics, form, and presence or absence of contrast enhancement all may aid the radiologist in the differential diagnosis of orbital lesions by CT. However, this review of lateral orbital masses illustrates that the differential diagnosis can be quite varied. Careful correlation with history and clinical findings may lead one to the proper diagnosis; however, often the exact nature of a lateral orbital mass must await histologic confirmation.

Diagnosis, Differential↗
PubMed1986

Anterior eye protection with orbital neoplasia.

The administration of adequate doses of radiation to tumors involving the orbit and surrounding facial structures and sinuses is often complicated by the need to protect the sensitive ocular components, the lens and cornea. A technique has been devised that uses four photon beam fields and an optional electron field to treat the contents of both orbits and adjacent sinuses with effective, reproducible protection of cornea and lens. Essential features include: alignment of the corneal surfaces with the central plane of rotation of the treatment machine, use of a narrow eye block across the entire beam to shield a strip equal to the width of the cornea, positioned symmetrically across the central plane of rotation, fine alignment of the eye block with both corneal surfaces by altering pedestal angle, treatment with paired, wedged, anterior oblique fields to encompass desired orbital and sinus volumes with additional blocking placed as needed, and complementary, lateral strip fields using collimators set to eye block thickness to equalize dose in the posterior orbit shielded by the strip eye block. A similar anterior electron beam strip field may be added to boost the medial orbit and ethmoid regions covered by the eye block. Bite block head immobilization and easy, direct daily visualization of block position assures eye protection for each treatment and provides substantial reduction in dose to the cornea, lens and iris. Additional blocking may be incorporated to provide partial lacrimal and parotid sparing.

Cornea↗
PubMed2005

Bilateral orbital tumor as initial presenting sign in human T-cell leukemia virus-1 associated adult T-cell leukemia/lymphoma.

PURPOSE: To report a case of human T-cell leukemia virus type1 (HTLV-1)-associated adult T-cell leukemia/lymphoma (ATLL) whose initial sign was exophthalmos. DESIGN: Case report. METHODS: A 64-year-old Japanese man presented with exophthalmos and choroidal folds of the right eye without general symptoms and received ophthalmologic and laboratory examination, magnetic resonance imaging (MRI), and orbital biopsy. RESULTS: Antibodies against HTLV-1 were extremely high but atypical lymphocytes were not present in the peripheral blood. MRI showed multiple tumorous lesions in both orbits. Orbital biopsy revealed an orbital mass that consisted of atypical lymphocytes originally from T cells and established the diagnosis of lymphoadenopathy type of ATLL. CONCLUSION: Although ocular involvement by ATLL is extremely rare, ATLL can first present in the orbit, and only the results of a biopsy can provide definitive information for its diagnosis.

Antibodies, Viral↗
PubMed2005

Long-term follow-up and prognosis of orbital apex syndrome resulting from nasopharyngeal rhabdomyosarcoma.

PURPOSE: Nasopharyngeal rhabdomyosarcoma may present with a variety of ophthalmic symptoms. Direct extension of the tumor into the orbital apex can lead to ophthalmoplegia and loss of vision. The prognosis for recovery of vision and ocular motility in patients with an orbital apex syndrome due to nasopharyngeal rhabdomyosarcoma is examined. DESIGN: Retrospective case series. METHODS: Six eyes from four patients with nasopharyngeal rhabdomyosarcoma who presented to the Children';s Hospital of Philadelphia with a clinical orbital apex syndrome were identified. Complete ophthalmic examination, including visual acuity and extraocular motility at the time of presentation, was reviewed. Tumor extension into the orbital apex was confirmed radiographically. Follow-up ophthalmic evaluations were reviewed for all patients with an average follow-up of 5.5 +/- 3.1 years (range 1 to 8 years). RESULTS: Six eyes of four patients had limited ocular ductions along with marked loss of vision at presentation. All patients were treated with chemotherapy and radiation, with reduction of tumor mass. Ocular motility recovered in all patients, occurring by an average of 2.2 +/- 1.8 months after initiation of therapy. Four of six eyes had little or no recovery of visual acuity detected at long-term follow-up. CONCLUSIONS: Patients with ocular motor deficits in orbital apex syndromes caused by extension of nasopharyngeal rhabdomyosarcoma have an excellent prognosis for recovery after treatment of the tumor. The long-term prognosis for visual recovery, however, is poor.

Child, Preschool↗
PubMed2005

Polycystic echinococcosis of the orbit.

PURPOSE: To report a case of polycystic echinococcosis of the orbit caused by Echinococcus oligarthrus. DESIGN: Interventional case report. METHODS: A 14-year-old girl presented with a massive proptosis of the right eye of 9 years duration and loss of vision. The eye was phthisic, and a cystic mass was palpable. Computed tomography scan showed closely packed multiple orbital cysts with destruction of the medial orbital wall. Surgical exploration was performed. RESULTS: The phthisic eye was enucleated. Dissection of the outer fibrous capsule yielded approximately 30 intact translucent white cysts of various sizes that were suggestive of polycystic echinococcosis. The diagnosis of echinococcosis was confirmed on histopathologic evaluation. The specific diagnosis of E oligarthrus was made on the basis of the presence of straight-backed hooks and central guards. CONCLUSION: Polycystic echinococcosis of the orbit caused by E oligarthrus is rare. It may be an entirely new entity or hitherto unrecognized form of orbital echinococcosis.

Adolescent↗