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PubMed2006

Intraoperative noncontact, nonionizing, optical 3D exophthalmometry during repositioning of dislocated globes: first results.

PURPOSE: This study reports on the intraoperative use of noncontact, nonionizing, optical 3-dimensional (3D) exophthalmometry during the repositioning of dislocated globes as a result of trauma. PATIENTS AND METHODS: Ten patients (4 female, 6 male, 41.4+/-15.2 years) with a relative enophthalmos of the globe as a result of zygomatic fractures were included in the study. Preoperatively, en- and exophthalmometry data were assessed from axial CT slices and optical 3D imaging. 3D data were analyzed twice for the assessment of measurement errors. Intraoperatively, optical en- and exophthalmometry was carried out to control the globe position. Surgery was considered successful when the relative en- or exophthalmos no longer exceeded 2 mm. Optical 3D en- and exophthalmometry data were reassessed 5 days and 3 months after surgery. RESULTS: Method error was 0.184 mm for optical 3D en- and exophthalmometry. The preoperatively assessed en- and exophthalmometry data determined from axial CT scans and from optical 3D images did not differ significantly statistically (P=.538). When the preoperative en- and exophthalmometry data were compared to the values assessed at the end of surgery, a significant improvement in globe position was found (P=.005). Although a relative en- or exophthalmos of 2 mm was not exceeded in any of the patients 3 months after surgery, en- and exophthalmometry data differed significantly statistically from the data assessed at the end of the operation (P=.005). CONCLUSIONS: Intraoperative optical en- and exophthalmometry is an effective means to support the surgeon in objectively optimizing the globe position with small measurement errors.

Adult↗

PubMed1978

Reliability of orbital diagnostic tests: ultrasonography, computerized tomography, and radiography.

A series of 342 patients with unilateral exophthalmos underwent orbital diagnostic studies including ultrasonography, computerized tomography, radiographic studies, and vascular contrast studies. Each test was found to have diagnostic capabilities that complemented other studies depending upon the specific disease process involved. No one test was entirely adequate without supplementary information from the other tests. Radiographic studies demonstrated bony abnormality in 50% of the tumor cases, but in only 28% of the entire series of exophthalmos cases. Computerized tomography demonstrated diagnostic soft tissue abnormality in 86% of tumors, 43% of inflammatory diseases, and an overall yield of 62% positive results. Ultrasonography proved the most versatile test for evaluation of orbital soft tissues, with 80% positive results for tumors, 87% for inflammatory disorders, and 78% overall accurate orbital diagnosis. Erroneous tumor diagnosis of 7% with computerized tomography and 3% with ultrasonography were corrected by combining these two studies, because they tend to err in opposite directions. Combination of ultrasound and CT scan resulted in a 98% correct diagnosis of all types of orbital diseases.

Bone Diseases↗

PubMed1988

Hydatid cysts of the orbit. A review of 35 cases.

The authors reviewed 35 cases of orbital hydatid cysts, which represented 5% of orbital surgical cases seen from 1944 to 1985. The average age was 16 years (range, 2-57 years). Slowly progressive unilateral exophthalmos, with or without pain, was the most frequent clinical manifestation. Computed tomography (CT) of the orbit demonstrated a well-circumscribed mass. Ultrasonography showed an anechoic cystic mass. The parasitic membrane and contents were surgically removed through an orbital approach. Hydatid cysts should be included in the differential diagnosis of unilateral exophthalmos in patients from countries where echinococcosis is endemic. Preoperative recognition is important for planning an appropriate surgical treatment in avoiding complications.

Adolescent↗

PubMed1998

Bilateral Kimura's disease with devastating visual outcome.

Kimura's disease is a chronic inflammatory disease involving connective tissues. We treated a patient with bilateral periocular Kimura's disease causing eyelid deformity and exophthalmos for over 20 years. She has been operated on 23 times and biopsies were taken and studied histologically. The disease continued despite the multiple surgical excisions. The consequent exophthalmos and lid changes caused lagophthalmos that resulted in severe visual impairment due to chronic bilateral corneal exposure. Kimura's disease may have a devastating effect on visual function.

Angiolymphoid Hyperplasia with Eosinophilia↗

PubMed2002

Unilateral exophthalmia in a European hedgehog (Erinaceus europaeus) caused by a lacrimal ductal carcinoma.

A 5-year-old European hedgehog was examined because of exophthalmos of the left eye. A retrobulbar mass in the ventromedial orbit was suspected and confirmed by a computed tomography scan. Exophthalmos progressed despite systemic broad-spectrum antibiotic therapy. The left orbit was exenterated and the mass was partially removed. The histopathologic diagnosis was lacrimal ductal carcinoma. Lacrimal ductal carcinoma is rare in humans and animals. The long-term prognosis is guarded to poor.

Animals↗

PubMed2006

[Idiopathic orbital inflammatory syndrome (orbital pseudotumors): diagnosis and therapy].

BACKGROUND: Pseudotumors of the orbit comprise a group of idiopathic inflammatory processes and are, except for endocrine orbitopathy, the most common reason for exophthalmos in adults. Orbital pseudotumors, also called idiopathic orbital inflammatory syndrome (IOIS), can be determined from orbital involvement in systemic fibrosing diseases. Finding the correct diagnosis can be challenging. Due to the topographic relations of the orbit to neighbouring structures, a multidisciplinary cooperation is highly recommended. CASE REPORT: We report a case of a 42-year-old woman with unilateral exophthalmos. Additionally we found impaired motility of the affected bulbus, ptosis and reduction of visual acuity. Orbital MR imaging demonstrated dense fibrotic masses filling the whole orbita including the extraocular muscles as well as the optic nerve. Tissue specimens were extracted while performing orbital decompression via a lateral orbitotomy. Histological examination revealed a lymphatic infiltration and fibrotically destroyed tissue containing the lacrimal gland. After surgical decompression, oral steroid therapy and immunotherapy, a recovery of the visual loss could be seen. CONCLUSIONS: Intraorbital fibrosclerosing pseudotumors often require a difficult long-term treatment. Therapeutic options are steroid therapy, immunotherapy, radiotherapy and surgery. The diagnostic steps include blood tests, ultrasound, CT and/or MRI as well as histological differentiation. Solid tumors and orbital involvement in diseases of the hematopoetic system have to be excluded. Since intraorbital fibrosis can be accompanied by manifestations in various other organs, a complete investigation of the body and thorough follow up are crucial.

Adult↗

PubMed1972

The binding of ( 3 H)thyrotropin and an 3 H-labeled exophthalmogenic factor by plasma membranes of retro-orbital tissue.

Plasma membranes of cells from retroorbital tissue have been prepared from the Harderian glands of guinea pigs and have been characterized as being reasonably free of other subcellular structures by electron microscopy and by enzyme-marker analyses. Both bovine thyrotropin and a proteolytic derivative of bovine thyrotropin with exophthalmogenic activity but without thyroid-stimulating activity specifically bind to these membranes. Gammaglobulin from the sera of patients with malignant exophthalmos increases the binding of both pituitary factors, whereas binding is not similarly increased by gammaglobulin from the sera of individuals who are not exophthalmic. The increased binding caused by the gammaglobulin from exophthalmic patients is the same whether the sera are positive or negative for the long-acting thyroid stimulator. Present binding experiments do not indicate a direct interaction between the gammaglobulin and the plasma membranes of the cells from Harderian glands. A mechanism for the pathogenesis of human exophthalmos is proposed on the basis of these data.

Animals↗

PubMed2004

Primary-gaze diplopia in patients with thyroid-related orbitopathy undergoing deep lateral orbital decompression with intraconal fat debulking: a retrospective analysis of treatment outcome.

Our goal was to investigate the incidence of postoperative primary gaze diplopia in patients with thyroid-related orbitopathy (TRO) undergoing deep lateral wall orbital decompression surgery with intraconal fat debulking in the Jules Stein Eye Institute over a period of 4(1/4) years. Overall 201 orbital decompression surgeries were performed in 116 patients (23 males, 93 females). All surgeries were performed by two of the authors (R.A.G. and J.D.M.) and in the noninflammatory phase of the disease. Exophthalmos decreased by an average of 3.4 +/- 2.7 mm from 23.8 +/- 3.2 mm (17-31) to 20.4 +/- 2.5 mm (14-29), p < 0.001, 95% confidence interval (CI) (3.0:3.8). 31% of patients had preoperative primary gaze diplopia and 28.4% had postoperative primary gaze diplopia. Thirty (83%) of the 36 patients with preoperative diplopia had also postoperative diplopia; 6 (16.7%) of the 36 patients had improvement in diplopia following deep lateral wall decompression. Of the 80 (69%) of patients without preoperative double vision 3 developed postoperative double vision in primary gaze (2.6% of all patients). These 3 patients were older (56 versus 46 years, p = 0.047), had more limitation in ocular movements (p = 0.017) and achieved more decrease in proptosis with surgery (6 versus 3.1 mm, p = 0.024). No complications were associated with orbital decompression. In conclusion deep lateral wall orbital decompression surgery with intraconal fat debulking is associated with a low rate (2.6%) of new-onset primary gaze diplopia. Some patients (5.2%) with preoperative diplopia actually had improvement in diplopia postoperatively. This surgery is effective in reduction of congestion and exophthalmos, and is not associated with detrimental effects on visual acuity.

Adipose Tissue↗

PubMed1987

Surgical management of volumetric changes in the bony orbit.

This article demonstrates that the periorbital fat, instead of being continuous and freely flowing, is encased within 3 compartments: 1 anterior to the extraocular muscles, 1 external to the extraocular muscles, and 1 deep to the extraocular muscles. In addition, the study establishes that fat loss anterior to the axis of the globe does not affect the anteroposterior location of the eye itself. Only fractures located posterior to the axis produce enophthalmos, and only operative procedures that create bony enlargement and fatty displacement behind this axis correct exophthalmos. Furthermore, only adding volume behind the axis of the globe can correct enophthamos. Finally, if there is sufficient space between the top of the globe and the bony roof, volume additions at the axis of the globe can correct vertical dystopia without producing exophthalmos.

Adipose Tissue↗

PubMed1992

Measurement of globe position in complex orbital fractures. II. Patient evaluation utilizing a modified exophthalmometer.

Globe position was assessed by both the Hertel exophthalmometer and the modified external auditory canal (EAC)-fixated device in 27 patients with complex orbital fractures (18 tripod and 9 Le Fort fractures). Although 94% of the patients with tripod fractures had relative exophthalmos on the fracture side or no difference between eyes by Hertel exophthalmometry, greater than 30% of the same patients showed relative enophthalmos when measured by the EAC-fixated device. In three of four patients undergoing surgical repair of the orbital floor, modified exophthalmometry showed exophthalmos of greater than or equal to 2 mm postoperatively on the fractured side. The relatively low incidence of enophthalmos in tripod fractures indicates a need for selective orbital floor repair; the uniform exploration of the orbital floor should be discouraged. Multiple comminuted facial fractures (Le Fort II and III) showed a greater variability in globe position and a high frequency (90%) of enophthalmos, suggesting a need for early orbital repair in these patients. EAC-fixated exophthalmometry can provide meaningful information regarding globe position in orbitofacial fracture patients in which orbital rim-based methods are precluded.

Adult↗

PubMed1992

Normal values of eye position in the Chinese population of Hong Kong.

Exophthalmos, interpupillary distance (IPD), interobital distance (IOD), and inner intercanthal distance (ICD) were measured in an adult Chinese population from Hong Kong (HKC). Mean values and normal range for 95% of the population were determined and the relation with head size and body height examined. Values of exophthalmos and IPD in our Chinese population were similar to those given for Caucasian groups. IOD and ICD were larger in the Chinese than in adult Caucasians. Our findings show generally larger values in the HKC than has been found for other populations in mainland China.

Adolescent↗

PubMed1989

A congenital orbital defect with periorbital-dural tissue adhesion.

This case demonstrates a previously unreported congenital orbital deformity. The patient was born with a unilateral exophthalmos. The etiology of the defect was demonstrated by CT scan as a convex bowing of the right superomedial orbital wall behind the axis of the eye. At surgery, this convexity was revealed to be a small bony defect through which the periorbital tissue and dura mater adhered. This sort of orbital deformity, although subtle, must be considered in the differential diagnosis of congenital unilateral exophthalmos.

Exophthalmos↗

PubMed2001

Rationale of treatment in Graves ophthalmopathy.

Graves ophthalmopathy is a chronic and multisystem disorder caused by an autoimmune process, characterized by the presence of antibodies that stimulate a general fibroblastic reaction (thyroid gland and lower extremities), and involves orbital fat tissue and muscles. The clinical findings and therapy for the treatment of the exophthalmos, such as changes in extrinsic eye motility, diplopia, optic nerve involvement, and lid retraction, were analyzed, and the various types of surgical treatment currently available for Graves ophthalmopathy were evaluated. The aim was to choose the best option to treat each case. The surgical techniques were transpalpebral decompression by removal of intraorbital fat, three-wall osseous expansion, and zygomatic osteotomy. Adjunctive procedures were lengthening of the levator muscle of the upper eyelid, lengthening of the retractor of the lower eyelid (if necessary), and surgery of the extrinsic muscles to correct diplopia. All these techniques were useful in treating the disease, which is characterized by chronic evolution and, at times, a "malignant" outcome. A total of 39 orbits were treated using different techniques of decompression and secondary adjunctive procedures. Results were analyzed after a minimum 6-month follow-up. It was evident that surgery greatly reduced the degree of exophthalmos and improved eye motility, diplopia, and visual acuity. Close cooperation among a team of specialists, including an endocrinologist, ophthalmologist, neuroradiologist, surgeon, anesthesiologist, and radiotherapist, is essential to manage and to quantify the postoperative results of this complex disorder. The authors' experience and application of different surgical strategies, as based on clinical data and histopathological classification, are presented.

Adult↗

PubMed2003

Transcaruncular orbital decompression for management of compressive optic neuropathy in thyroid-related orbitopathy.

This study was conducted to assess the outcome of transcaruncular orbital decompression to treat compressive optic neuropathy in thyroid-related orbitopathy. It involved a retrospective, noncomparative case series of 18 eyes of 10 consecutive patients with documented vision loss secondary to thyroid-related orbitopathy. Bony decompression of the orbital apex was performed via a transcaruncular approach. Main outcome measures were visual acuity, color vision, presence of diplopia, and reduction of exophthalmos. Of 18 eyes, 16 (89 percent) had improved visual acuity after the operation. One eye had no improvement and one had worsening of vision in the setting of diabetic retinopathy. Color vision was improved in 12 eyes (67 percent). Five of the patients did not have diplopia before the operation; none of these patients developed double vision after intervention. Exophthalmos was decreased by an average of 2.6 mm. The authors conclude that transcaruncular orbital decompression for compressive optic neuropathy in thyroid-related orbitopathy is successful in restoring visual function. Compared with other approaches used for decompression surgery, the transcaruncular approach offers direct access to the medial wall and orbital apex without a cutaneous incision or disruption of the medial canthus. In addition, this approach allows a controlled, graded removal of the ethmoidal air cells and reduced recovery time.

Adult↗

PubMed1981

Dysthyroid orbital disease in Macaca fascicularis.

Fluctuating left exophthalmos in a mature male Macaca fascicularis was studied clinically utilizing the diagnostic modalities of A- and B-scan ultrasonography and computerized tomography in addition to routine ophthalmic examination and radiography. Laboratory results were suggestive of thyroid hypofunction. Clinical and histopathologic observations were consistent with a diagnosis of dysthyroid orbitopathy, a condition previously unreported in nonhuman primates and the most common cause of unilateral exophthalmos in humans.

Animals↗

PubMed1987

Elevated anti-alpha-galactosyl antibody titres. A marker of progression in autoimmune thyroid disorders and in endocrine ophthalmopathy?

The titres of anti-alpha-galactosyl antibodies were measured by passive haemagglutination in 50 control subjects and in 128 patients presenting with various thyroid disorders. Titres of control subjects ranged from 1/10 to 1/80, regardless of age and blood group. Elevated titres (greater than 1/80) were constantly noted in 6/6 patients with progressive exophthalmos, in 5/5 patients with untreated Graves' disease, and in 11/12 patients with progressive nontoxic goitre. By contrast, the titres were within the normal range in primary myxoedema (17 patients) and in residual exophthalmos (11 patients), whereas they were only erratically increased in 1/31 patients with treated or cured Graves' disease and in 5/36 patients with nonprogressive nontoxic goitre. Finally, elevated titres were also found in 3/7 patients presenting with autoimmune thyroiditis. No correlations could be established between elevated titres and the thyrotropin binding inhibiting immunoglobulin activity, the antithyroglobulin antibody titres or the antimicrosomal antibody titres. As in the control subjects, the anti-alpha-galactosyl antibodies mainly belonged to the IgG class. Affinity purified anti-alpha-galactosyl antibodies were capable of binding to trypsinized human and porcine thyroid cells in culture, as shown by indirect immunofluorescence. On the other hand, they were not able to react with untreated thyroid cells. The data show that the measurement of anti-alpha-galactosyl antibody titres could represent an easy and useful tool to determine whether an autoimmune thyroid disorder is in progression. Besides, they suggest that some of the antigenic determinants implicated in the enhanced production of anti-alpha-galactosyl antibodies are present, but normally hidden, within the cell surface of thyroid cells.

Adult↗

PubMed1995

Ten-year follow-up study of thyroid function in euthyroid patients with simple goiter or Hashimoto's thyroiditis.

In an attempt to study the natural course of Hashimoto's thyroiditis and simple goiter, 74 euthryroid patients with Hashimoto's thyroiditis and 212 patients with simple goiter were followed for 10 years. In 204 patients with simple goiter (96.2%) it remained as a simple goiter throughout the observation period, whereas 8 patients (3.8%) later had Hashimoto's thyroiditis as evidenced by the appearance of circulating thyroid autoantibodies. These 8 patients had HLA typing significantly different from that of control subjects. None of the patients with simple goiter had hyperthyroid Graves' disease despite the fact that 17.5% of those patients had mild to moderate exophthalmos with either Moebius' sign or von Graefe's sign. In contrast, 12 patients with Hashimoto's thyroiditis (16.2%) had exophthalmos with Moebius' sign and/or von Graefe's sign, and 4 of 12 such patients later had hyperthyroid Graves' disease. TSH binding inhibitory immunoglobulin was detected in 3 of 4 such patients with hyperthyroid Graves' disease. Forty-nine patients with Hashimoto's thyroiditis (66.2%) still remained euthyroid but 20 of those (27.0%) turned into hypothyroidism during the 10-year follow-up.

Adolescent↗

PubMed2005

A case of complete ophthalmoplegia in herpes zoster ophthalmicus.

PURPOSE: To report a case with complete ophthalmoplegia after herpes zoster ophthalmicus. METHODS: A 70-year-old male patient visited a clinic because of vesicular eruptions over the left side of his face with severe pain. Drooping and severe swelling of the left eyelid were present, along with keratitis and uveitis. While the lid swelling and uveitis were improving, external ophthalmoplegia and exophthalmos were discovered. Intramuscular injections of dexamethasone 5 mg were given for 10 days, followed by oral administration of prednisolone at a dosage of 15 mg for two weeks and 10 mg for two weeks. RESULTS: The patient was fully recovered from the complete ophthalmoplegia and exophthalmos six months after the onset of the cutaneous lesion. CONCLUSIONS: Complete ophthalmoplegia is a rare ophthalmic complication of herpes zoster infection. Therefore, an evaluation of extraocular muscle and lid function should be performed during the examination of herpes zoster patients in order to screen for ophthalmoplegia.

Aged↗