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PubMed2005

Diagnosis and anatomic mapping of an orbital varix by computed tomographic angiography.

PURPOSE: To report the use of computed tomographic angiography (CTA) to diagnose an orbital varix. DESIGN: Observational case report. METHODS: A 73-year-old female was investigated by CTA for carotid artery stenosis. An incidental orbital lesion was discovered. Reformations were obtained. RESULTS: CTA demonstrated a homogeneously enhancing orbital apex lesion. It provided exceptional anatomic detail of inflow and outflow veins, confirming the diagnosis of an orbital varix. CONCLUSIONS: CTA is cost effective, fast, non-invasive, and readily available. These aspects combined with the exceptional vascular detail obtained may make CTA the primary test for orbital varix diagnosis.

Aged↗
PubMed2006

Massive concha bullosa pyocele with orbital extention.

Concha bullosa is the most common anatomic variant of the middle turbinate. It remains usually asymptomatic. Pyocele occurs when concha bullosa becomes infected. In the formation of a pyocele, middle turbinate may become expanded and occupy the surrounding structures with local bone destruction. Direct extension of mass from the nose into the orbit may occur, because the orbital contents are separated from the ethmoidal labyrinth only by the thin lamina papyracea. We report a case of concha bullosa pyocele with orbital extension. Orbital involvement is also associated with ocular functional loss. In this case, ocular motion and vision remained normal despite of the presence of orbital extension for 2 years.

Adult↗
PubMed2006

Resolution of diplopia after repair of the deep orbit.

The degree of resolution of diplopia after repair of a blow-out fracture of the orbital floor varies and depends on many factors. We present six patients, each of whom had extensive fractures of the floor of the orbit that extended posteriorly to its anatomical limit. The mean (range) time for the resolution of diplopia after reconstruction was 4.4 (1-7) months. We think that its slow resolution in these patients may require preoperative counselling, and also the postoperative management of patients with extensive disruptions of the floor of the orbit posterior to the anterior limit of the inferior orbital fissure (within the deep orbit) must be carefully planned.

Adult↗
PubMed2005

An infant with idiopathic orbital myositis poorly responsive to steroid therapy: a case report.

A 9-month-old girl developed subacute limited adduction of the left eye, presenting with blepharoptosis. An orbital magnetic resonance imaging (MRI) 2 months after the onset revealed swelling of the left lateral rectus muscle, with increased intensity on T2-weighted images with fat saturation, which was enhanced with gadolinium. She was diagnosed with idiopathic orbital myositis based on history, physical examination, and MRI findings. Swelling of the left lateral rectus muscle was partially reduced by pulse steroid therapy. This is the first reported case of an infant orbital pseudotumor with clinical and MRI findings consistent with subacute orbital myositis. We propose that a fibrotic change of the orbital muscle may occur during a subacute course and would be incompletely responsive to steroid therapy.

Anti-Inflammatory Agents↗
PubMed2004

Prediction of tissue decompression in orbital surgery.

OBJECTIVE: A method to predict the relationships between decompressed volume of orbital soft tissues, backward displacement of globe after osteotomy, and force exerted by the surgeon, was proposed to improve surgery planning in exophthalmia reduction. DESIGN: A geometric model and a poroelastic finite element model were developed, based on computed tomography scan data. BACKGROUND: The exophthalmia is characterized by a protrusion of the eyeball. Surgery consists in an osteotomy of the orbit walls to decompress the orbital content. A few clinical observations ruling on an almost linear relationship between globe backward displacement and tissue-decompressed volume are described in the literature. METHODS: Fast prediction of decompressed volume is derived from the geometric model: a sphere in interaction with a cone. Besides, a poroelastic finite element model involving morphology, material properties of orbital components and surgical gesture was implemented. RESULTS: The geometric model provided a better decompression volume estimation than the finite element model. Besides, the finite element model permitted to quantify the backward displacement, the surgical gesture and the stiffness of the orbital content. CONCLUSIONS: The preliminary results obtained for one patient, in accordance with the clinical literature, were relatively satisfying. An efficient aid for location and size of osteotomies was derived and seemed to be able to help in the surgery planning.

Decompression, Surgical↗
PubMed2006

The galea fascia flap in orbital reconstruction: innovative harvest technique.

AIM: To report the treatment of a recurrent adenoid-cystic carcinoma of the lacrimal gland required orbital exenteration with an en bloc resection of the lateral orbital rim and wall and an anterior portion of the temporal muscle. Reconstruction was planned with both the objectives of a shortened healing time for faster epithetic reconstruction and no visible scars. METHOD: After a cranially extended temporal approach, the dissection of the superficial galea layer was connected with the subcutaneous dissection of the upper and lower eyelid after subciliary incisions. RESULTS: Ample exposure of the temporal, frontal and orbital region was obtained, facilitating the orbital exenteration with en bloc resection of the lateral orbital rim and wall and the anterior portion of the temporal muscle. The epithelialization of the eye socket covered with the galea fascia flap was accelerated, providing faster epithetic reconstruction, without visible scars. CONCLUSIONS: Healing time is accelerated, providing faster epithetic rehabilitation without visible scars, which is important in the postoperative rehabilitation ladder after eye exenteration for both patient and surgeon. Further more ablative surgery within this region gets safer and easier due to the ample exposure of this innovative surgical technique. Further evaluation of the effectiveness and safety of this new approach is advisable.

Carcinoma, Adenoid Cystic↗
PubMed2005

An unusual case of rhabdomyosarcoma presenting as orbital apex syndrome.

PRECIS: A 12-year-old female presented with symptoms and signs of orbital apex syndrome (OAS), secondary to stage IV alveolar rhabdomyosarcoma (RMS) originating in the sphenoid and ethmoid sinuses. OBJECTIVE: To present a case of alveolar rhabdomyosarcoma, unusual in its presentation as orbital apex syndrome and also its origin from the sphenoid and ethmoid sinuses. DESIGN: : Observational case report. METHODS: Ophthalmologic findings, neuroimaging, medical and surgical intervention, histopathologic analysis, and clinical course are described. RESULTS: A 12-year-old female presented with progressive visual loss in her left eye, difficulty with eye movements, and mild headache. Her examination was consistent with orbital apex syndrome. Imaging with contrast revealed a mass originating in the left sphenoid and ethmoid sinuses invading the left optic canal. Emergent biopsy was interpreted as alveolar rhabdomyosarcoma; subsequent metastatic work-up revealed bone marrow metastases. The patient was diagnosed with stage IV alveolar rhabdomyosarcoma and immediately started on combination orbital radiation therapy (RT) and systemic chemotherapy. She experienced gradual improvement of ocular motility, though her optic neuropathy persisted. CONCLUSION: Alveolar rhabdomyosarcoma of paranasal origin, specifically from the sphenoid and ethmoid sinuses, should be included in the differential diagnosis for orbital apex syndrome in children.

Blepharoptosis↗
PubMed2006

Efficacy of computer-assited surgery in secondary orbital reconstruction.

PURPOSE: In this study the efficacy of computer-assisted surgery (CAS) used for secondary orbital reconstruction after midfacial fractures was evaluated, comparing the clinical outcome with that after conventional surgery (CS). Special consideration was given to whether CAS can reduce the number of secondary corrections. PATIENTS AND METHODS: Twenty consecutive patients (24 orbits; 12 in each group) were assessed for enophthalmos, diplopia, and aesthetics during a follow-up period of up to 3 years. RESULTS: After CAS, enophthalmos was fully corrected in 8 of 11 orbits but after CS in only 6 of 10 orbits. Improvement of diplopia was achieved in 1 of 7 (CAS) and in 3 of 4 (CS) patients. The aesthetic result after secondary reconstruction and additional surgery was better in the CAS group. Additional surgery to correct bony structures was only necessary in 3 patients of the CS group. Additional soft tissue surgery was necessary in both groups. CONCLUSION: CAS can improve the clinical outcome of reconstructive bone surgery reducing the amount of additional hard tissue procedures. It was helpful during dissection of the scarred orbital tissue and placement of a graft. However, it had no impact on soft tissue correction especially with respect to function.

Adolescent↗
PubMed2006

Orbital regional anesthesia.

Orbital regional anesthesia is a useful and safe modality for providing excellent operating conditions for the surgeon and painless, pleasant circumstances for the patient. It is especially suited for patients who are extremely sensitive and who could not tolerate topical anesthesia or a sub-Tenon's block without deep sedation. Both intraconal and extraconal techniques can be used safely and effectively if proper precautions are taken to enter the safest areas of the orbit and to avoid the vascular areas and the deep orbit where structures are tightly packed and thus more easily harmed. Thorough knowledge of orbital anatomy and understanding of the globe-orbit relationship of every patient are necessary to perform this form of regional anesthesia. In addition, knowledge of the effects and side effects of the anesthetics and adjuvants is also required.

Anesthesia, Conduction↗
PubMed2006

Orbital carcinoid metastases.

OBJECTIVE: To describe a series of patients with metastatic orbital carcinoid tumors. DESIGN: Retrospective case series and literature review. PARTICIPANTS AND METHODS: Patients were identified from the orbital database and pathology records at Moorfields Eye Hospital. Records were evaluated for age at presentation, race, gender, laterality, visual function and clinical features, site of orbital metastasis, treatment, and outcome. The site of the primary tumor, presence of systemic symptoms, diagnosis and treatment of the primary tumor, and current survival status were also noted. MAIN OUTCOME MEASURES: Time from tumor to death. RESULTS: Thirteen patients (9 male) had an average age at biopsy-proven diagnosis of 65.3 years. The primary tumor was ileal in 7, colonic in 4, and from bronchus and breast (1 each); in 9 patients, the primary tumor was already known. Eleven of the 13 patients had noted a mass, 8 had diplopia, 3 had reduced vision, and only 2 had orbital pain. One patient presented with visual hallucinations. Imaging showed single muscle enlargement in 7 patients, a discrete mass in 5, and diffuse fat infiltration in 1 patient. Six patients underwent a meta-iodobenzyl guanidine/octreotide scan and metastatic disease was found in 4. Four patients underwent exenteration, 5 had radiotherapy after tumor debulking, 2 had radiotherapy alone, and 2 patients had local radiotherapy with receptor-targeted chemotherapy. Seven patients died from metastatic tumor. Kaplan-Meier analysis showed a 5-year survival rate of 72% and a 10-year survival rate of 38%. Comparison of the current series with other published series shows a significant difference (improvement) in survival at 5 years (P = 0.027) but not at 10 years (P = 0.08). CONCLUSIONS: The largest published series of orbital carcinoid tumors is presented, there being a recent trend towards less aggressive surgical management and probably a greater survival rate.

Adult↗
PubMed2006

Periocular and orbital amyloidosis: clinical characteristics, management, and outcome.

OBJECTIVE: To present the clinical features and management outcome in a large series of patients with periocular and orbital amyloidosis. DESIGN: Retrospective, noncomparative, interventional case series. PATIENTS: All patients diagnosed with periocular and orbital amyloidosis in 6 oculoplastic and orbital units. METHODS: Clinical records of all patients were reviewed. MAIN OUTCOME MEASURES: Clinical presentation, radiological and histological findings, treatment modalities, and outcome. RESULTS: The study included 24 patients (15 female, 9 male) with a mean age of 57+/-17 years. Nineteen cases were unilateral, and 5 were bilateral. Clinical signs and symptoms included a visible or palpable periocular mass or tissue infiltration (95.8%), ptosis (54.2%), periocular discomfort or pain (25%), proptosis or globe displacement (21%), limitations in ocular motility (16.7%), recurrent periocular subcutaneous hemorrhages (12.5%), and diplopia (8.3%). Seven cases had orbital involvement, and 17 were periocular. Immunohistochemistry in 7 patients showed B cells or plasma cells producing monoclonal immunoglobulin chains that were deposited as amyloid light chains. Only 1 patient was diagnosed with systemic amyloid light chain amyloidosis. Treatment modalities were mainly observation and surgical debulking. During a mean follow-up period of 39 months, 21% showed significant progression after treatment, whereas 79% were stable or showed no recurrence after treatment. CONCLUSION: Periocular and orbital amyloidosis may present with a wide spectrum of clinical findings and result in significant ocular morbidity. Complete surgical excision is not feasible in many cases, and the goal of treatment is to preserve function and to prevent sight-threatening complications.

Adult↗
PubMedDate not supplied

Orbital leiomyoma: report of a case and review of the literature.

A 10-year-old female presented with slowly progressive proptosis of 1 year's duration. Orbital MRI revealed an extraconal oval mass occupying the lateral half of the mid and posterior orbit. The tumor was isointense to the extraocular muscle and cerebral gray matter on T1-weighted images and hyperintense on T2-weighted images. The patient underwent superolateral orbitotomy, and it was felt that the tumor was totally excised in a piecemeal fashion. Histopathologic examination showed that the tumor was composed of spindle cells arranged in a fibrous stroma rich in dilated sinusoidal capillaries. The nuclei of tumor cells were oval with blunted ends. There were no mitotic figures. Immunohistochemically, the tumor stained positive with smooth muscle actin, desmin, and vimentin. Based on the histopathologic and immunohistochemical staining results, a diagnosis of orbital leiomyoma was made. At 34 months follow-up, the patient continues to have 20/20 vision and is free of tumor recurrence clinically. Orbital leiomyoma is an uncommon tumor. Search of the English literature showed only 15 previous cases of orbital leiomyoma that have been published since 1963.

Biomarkers, Tumor↗
PubMedDate not supplied

Primary bone tumors of the orbit.

Primary tumors of orbital bone constitute 0.6% to 2% of all orbital tumors. Our experience over a 24-year period in the Orbital Clinic at the University of British Columbia yielded 62 (1.9%) cases from a total of 3,340 orbital tumors. Although a heterogeneous group, primary orbital bone tumors may be classified on a clinicopathologic basis into benign fibro-osseous or cartilaginous, reactive, neoplastic and vascular disorders. Presentation is usually a gradual mass effect, with infiltration and acute hemorrhage being features of malignant and reactive lesions respectively. The two most commonly encountered entities were fibrous dysplasia and osteoma, accounting for 22 cases. Although both these conditions rarely present a diagnostic challenge, nonspecific histologic and radiologic appearances can result in poor characterization of several of the rarer lesions. Hence, close cooperation between clinician, radiologist and pathologist is essential for accurate diagnosis.

Bone Neoplasms↗
PubMed2006

Subperiosteal abscess of the orbit: an unusual complication of the third molar surgery.

Few procedures in oral surgery show severe complications with the potential to result in life-threatening problems. Subperiosteal orbital abscess is an extremely rare but transcendent complication arising spontaneously or after dental surgery. This report describes a case of subperiosteal abscess of the orbit in a 57-year-old man that occurred following the uneventful extraction of the left maxillary third molar. In the emergency department, proptosis and extraocular muscle dysfunction were marked but no decrease in visual acuity was observed. Echography, computed tomography scan, and magnetic resonance imaging allowed distinction from other types of orbital inflammation. Surgical drainage confirmed the diagnosis. In this patient, orbital abscess was probably caused by extension of the infection to the pterygopalatine and infratemporal regions progressing next to the inferior orbital fissure. This report highlights the difficulty in the clinical diagnosis of this complication.

Abscess↗
PubMed2006

A finite-element analysis model of orbital biomechanics.

To reach a better understanding of the suspension of the eye in the orbit, an orbital mechanics model based upon finite-element analysis (FEA) has been developed. The FEA model developed contains few prior assumptions or constraints (e.g., the position of the eye in the orbit), allowing modeling of complex three-dimensional tissue interactions; unlike most current models of eye motility. Active eye movements and forced ductions were simulated and showed that the supporting action of the orbital fat plays an important role in the suspension of the eye in the orbit and in stabilization of rectus muscle paths.

Adipose Tissue↗
PubMed2000

Recurrent orbital solitary fibrous tumor in a 14-year-old girl.

PURPOSE: To report a case of orbital solitary fibrous tumor in a pediatric patient. METHODS: Case report and review of the literature. RESULTS: A 14-year-old girl presented with a 5-month history of painless proptosis of the left eye. Magnetic resonance imaging revealed a well-circumscribed mass in the anterior superomedial left orbit. The lesion was excised, and histopathologic examination revealed a solitary fibrous tumor. The lesion recurred in the orbit 4 months postoperatively, and histologic examination of the new lesion was consistent with solitary fibrous tumor. CONCLUSION: Based on this case report of orbital solitary fibrous tumor in a pediatric patient, solitary fibrous tumor should be included in the differential diagnosis of pediatric orbital tumors.

Adolescent↗
PubMed2000

Orbital compartment syndrome caused by intraorbital bacitracin ointment after endoscopic sinus surgery.

PURPOSE: To present an unusual case of orbital compartment syndrome after endoscopic sinus surgery. METHODS: Case report. RESULTS: Acute proptosis, chemosis, decreased vision, and ophthalmoplegia were found immediately after endoscopic sinus surgery. Ophthalmologic evaluation showed a tense orbit, and intraocular pressure increased to 54 mm Hg. Treatment was initiated and the intraocular pressure dropped. Computed tomography (CT) revealed the presence of bacitracin ointment in the orbit. CONCLUSION: Ophthalmic complications after sinus surgery are well identified. Postoperative orbital compartment syndrome may be caused by retrobulbar hemorrhage, edema, air (emphysema), or foreign material. In this case, the findings were caused by inadvertent injection of bacitracin ointment into the orbit.

Aged↗
PubMed2000

Orbital T-cell lymphoma in a multiple myeloma patient.

PURPOSE: To report an 82-year-old woman with multiple myeloma who developed an orbital T-cell lymphoma concomitantly. METHODS: The patient presented with left upper eyelid swelling. Magnetic resonance imaging demonstrated an orbital mass compressing the eyeball. The mass was excised for diagnostic purposes and orbital decompression. RESULTS: Histopathologic and immunohistochemical evaluation identified the mass as a T-cell lymphoma. The disease progressed rapidly despite chemotherapy. CONCLUSIONS: Orbital T-cell lymphoma is rare and we are unaware of previous reports of orbital T-cell lymphoma in patients with multiple myeloma.

Aged↗