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At least 181 records · Page 10Linked to original sources

Orbital foreign body misdiagnosed as superior orbital rim fracture.

Orbital foreign bodies may be difficult to diagnose clinically and radiologically. In cases where a foreign body is suspected, both the mechanism of injury and the composition of the offending material need to be taken into account. A case is described of an orbital foreign body misdiagnosed as a superior orbital rim fracture, resulting in persistent ptosis and diplopia, and leading to delayed recovery for the patient, a commercial airline pilot.

Adult↗

Localized inferior orbital fibrosis associated with porcine dermal collagen xenograft orbital floor implant.

We describe the clinical features, treatment, and histologic changes of a case of severe localized orbital inflammation associated with the use of porcine dermal collagen xenograft (Permacol) as an orbital floor implant in a 14-year-old boy. After uneventful blowout fracture repair with normal forced duction testing after insertion of a Permacol implant, progressive elevation and depression deficit developed in the postoperative period. There was no improvement after removal of the Permacol implant. Exploratory surgery revealed gross fibrosis of the inferior rectus muscle accounting for the abnormal ocular motility. Biopsy of the inferior rectus muscle showed chronic granulomatous inflammation suggestive of foreign body reaction. Although porcine dermal collagen xenograft has been suggested as an implant for orbital floor repair because of its reported high strength, ease of handling, and high biocompatibility, we believe that further studies are necessary before it can be recommended for this use.

Adolescent↗

Analysis of the postoperative outcome in 405 cases of orbital fracture using 2 synthetic orbital implants.

The purpose of this study was to analyze the postoperative complications according to the location (floor/medial wall/floor and medial wall) of the orbital fracture of 405 patients during the past 10 years and to investigate the possible alterative data in postoperative outcome in change with the application of 2 synthetic orbital implants: porous polyethylene (Medpor) and hydroxyapatite (Biocoral). The medical records of 405 patients were reviewed especially for enophthalmos, diplopia, sensory disturbance in the area of distribution of the infraorbital nerve, and postoperative complications originated from the implanted material itself, from March 1993 to July 2003. Of the 405 patients, 214 patients were operated with porous polyethylene and 191 patients with hydroxyapatite. The complication rate of the porous polyethylene group was 5.6%, which was not statistically different from that of the hydroxyapatite group (9.4%). Also by the location of fracture, the complication rate of both groups was similar statistically. In the comparative category, enophthalmos was more frequent statistically in patients treated with hydroxyapatite than those treated with porous polyethylene, and no other significant differences were in postoperative outcomes between the both groups. The information provided in this report should aid in using porous polyethylene or hydroxyapatite for reconstruction of the orbital fracture and in accomplishing better postoperative outcome.

Adolescent↗

An unusual orbital lesion: hepatoma metastatic to the orbit.

The authors describe a case of histologically proven orbital metastasis from a hepatic carcinoma in an 85-year-old patient with rapid onset of proptosis and visual loss. The clinical diagnosis of orbital metastatic lesion was established by standardized echography and CT scan. To the best of our knowledge, this is only the third histologically proven case of hepatoma metastatic to the orbit.

Aged↗

Cellular terrain surrounding sympathetic nerve pathways in the rat orbit: comparisons of orbital connective tissue and smooth muscle cell phenotypes.

Sympathetic axons are abundant within some orbital tissues but are absent from others. This study investigated cellular phenotypes of tissues containing sympathetic nerves en passage and compared these with phenotypes in regions devoid of sympathetic nerves and with smooth muscle targets. Two primary orbital smooth muscle targets, the tarsal muscle and orbital muscle, contained many synaptophysin-immunoreactive nerves. Target cells had ultrastructural features typical of smooth muscle and were immunoreactive for alpha-smooth muscle actin, smooth muscle myosin heavy chain, desmin, vinculin, and laminin, but not non-muscle myosin, vimentin, fibronectin, or type IV collagen; nerve growth factor (NGF) mRNA was detected by reverse transcription-polymerase chain reaction. Periorbital sheath devoid of sympathetic nerves contained elongated fibroblasts that were immunoreactive for vimentin, non-muscle myosin, and fibronectin, but not for alpha-smooth muscle actin, smooth muscle myosin heavy chain, vinculin, desmin, laminin, or type IV collagen, and did not express NGF mRNA. Regions of periorbital sheath containing sympathetic nerves had few synaptophysin-immunoreactive varicosities. Cells in this region contained myofilaments, ribosomes, and rough endoplasmic reticulum and were larger than tarsal muscle cells. They expressed NGF mRNA and showed a unique immunophenotype, reacting for vimentin, alpha-smooth muscle actin and myosin heavy chain, desmin, vinculin, laminin, and type IV collagen. This phenotype reflects both fibroblast and smooth muscle features similar to myofibroblasts or transdifferentiated smooth muscle described in other tissues. The spatial association between these cells and sympathetic nerves suggests that they may be involved in axon guidance or maintenance.

Animals↗

Parameningeal rhabdomyosarcoma (including the orbit): results of orbital irradiation.

Twenty-three patients with parameningeal (including orbital rhabdomyosarcoma (RMS)) were treated at Memorial Sloan-Kettering Cancer Center (MSKCC) between July 1971 and January 1983. Twenty were children with a mean age of 6 and 3 were adults. In 6 patients, the primary tumor was from the orbit, whereas the remaining 17 had other parameningeal primary sites. The tumors were in a very progressive local stage, with extensive destruction of the facial bones in 19 patients. Eight patients were treated with T2 chemotherapy protocol and 15 received T6. Seven patients received 5,000 to 7,200 rad delivered to the primary tumor in 11-16 weeks, 15 patients received between 4,500 to 5,000 rad in 4-7 weeks, and 1 patient received 3,000 rad in 3 weeks for residual microscopic disease following surgery. Two patients were treated with radiation to the whole brain; no patients received radiation of the whole central nervous axis (CNA). Fifteen of the 23 patients (65%) are alive and well with a medical follow-up time of 5 years. Two patients died of therapeutic complications and six died of tumor spread. In five patients, involvement of the central nervous system (CNS) was the cause of death. The prognosis of orbital RMS with parameningeal involvement is no better than in other tumors of parameningeal sites. In those patients who had impaired vision because of optic nerve damage prior to treatment, the vision did not improve following treatment. There was no impaired vision seen due to radiation damage of eye structures except in the lens.

Adolescent↗

Transconjunctival approach for retrobulbar intraconal orbital cavernous hemangiomas. Orbital surgeon's perspective.

BACKGROUND: Cavernous hemangioma is the most common benign intraorbital tumor found in adults. Most cavernous hemangiomas are located within the intraconal space. When indicated, complete surgical removal is the only treatment option. Several surgical techniques have been refined over the past decades. We describe our experience over transconjunctival approach in 24 patients with retrobulbar intraconal orbital cavernous hemangiomas. METHOD: This retrospective study includes 24 nonrandomly selected patients who had retrobulbar intraconal tumors. The presumptive preoperative diagnosis was based on magnetic resonance imaging findings. Compression on the optic nerve and/or the globe and proptosis constituted indications for surgery. The tumor was exposed via a transconjunctival route after temporarily disinserting an extraocular muscle depending on the location of the lesion. RESULTS: In all patients, the tumor was in touch with the globe and in most cases extended to the orbital apex. All tumors were removed intact. In 14 patients, tumors were extirpated with the aid of a cryoprobe. Visual acuity increased in 8 patients and remained stable in the rest. No serious or permanent complications were observed during or after the operation. CONCLUSIONS: Retrobulbar intraconal cavernous hemangiomas can be removed successfully through a transconjunctival approach with minimal damage to surrounding tissues. This method is best for tumors whose anterior borders are in contact or very close to the eye even if the posterior border abuts the orbital apex.

Adult↗

Orbital emphysema: a potentially blinding complication following orbital fractures.

A case of visual loss due to orbital emphysema secondary to a blow-out fracture of the orbit is presented. Because vision returned to 20/20 following an optic nerve decompression procedure, we hypothesize that our patient developed a compressive optic neuropathy with ischemia due to the emphysema. Essential instructions concerning the injury that the emergency physician should give the patient suffering an orbital blow-out are also presented.

Adolescent↗

Combined use of an orbital osteotomy and living bone graft in the treatment of huge ossifying tumors involving the orbit.

Huge ossifying tumors involving the orbit were treated with a combination of craniofacial surgery and microsurgical techniques in two patients. The orbital osteotomy facilitated wide exposure of the tumors and their excision even though the tumors were extremely large. Stable results were obtained in one stage without visual disturbance by simultaneous reconstruction of the resulting bony defects using a free vascularized bone graft even in unfavorable tissue beds such as when one side of the bone graft is exposed to the affected nasal cavity or maxillary sinus. The combination of craniofacial surgery and microsurgical techniques has proven in our experience to be an effective approach to the treatment of a huge orbital ossifying tumor in one stage.

Adult↗

The orbital pulley system: a revolution in concepts of orbital anatomy.

Magnetic resonance imaging (MRI) now enables precise visualization of the mechanical state of the living human orbit. Resulting insights have motivated histological re-examination of human and simian orbits, providing abundant consistent evidence for the active pulley hypothesis, a re-formulation of ocular motor physiology. Each extraocular muscle (EOM) consists of a global layer (GL) contiguous with the tendon and inserting on the eyeball, and a similar-sized orbital layer (OL) inserting on a connective tissue ring forming the EOM pulley. The pulley controls the EOM path and serves as the EOM's functional origin. Activity of the OL positions the pulley along each rectus EOM to assure that its pulling direction shifts by half the change in ocular orientation, the half-angle behavior characteristic of a linear ocular motor plant. Half-angle behavior is equivalent to Listing's law of ocular torsion, and makes 3-D ocular rotations effectively commutative. Pulleys are configured to maintain oblique EOM paths orthogonal to half-angle behavior, and violate Listing's law during the vestibulo-ocular reflex. Rectus pulley positions shift during convergence, facilitating stereopsis. Innervations, fiber types, and metabolism of the OL and GL differ, consistent with the elastic loading of the former, and viscous loading of the latter. Disorders of the location and stability of rectus pulleys are associated with predictable patterns of incomitant strabismus that may mimic cranial nerve palsies. Surgical interventions improve defective pulley function. Understanding of ocular motor control requires characterization of the behavior of the EOM pulleys as well as knowledge of angular eye orientation.

Adult↗

Chronic orbital inflammatory disease: parasitisation of orbital leucocytes by mollicute-like organisms.

Chronic orbital inflammatory disease (COID) is usually considered non-infectious and idiopathic. Treatment is empirical, palliative, and may not prevent disease progression. COID occurs in isolation or in association with various systemic diseases. Exophthalmos may be an important presenting sign. Vasculitis, lymphoid infiltrates, and granulomas are common. Mollicute-like organisms (MLO) parasitising and destroying vitreous leucocytes are often found to cause human chronic uveitis when an appropriate search is made. Inoculation of these MLO into mouse eyelids produced chronic uveitis and exophthalmic orbital inflammatory disease. Mollicutes are cell wall deficient bacteria. Extracellular mollicutes cause human and animal diseases characterised by lymphoid infiltrates, immunosuppression, and autoantibody production. Intracellular morphologically similar bacteria are non-cultivable pathogens termed MLO. Identification is based on direct detection in diseased cells by transmission electron microscopy. MLO are cytopathogenic and detection is aided by the alterations they produce. MLO replace the cytoplasm, destroy the organelles, and alter the nucleus. This results in cell proliferation, destruction, and dysfunction. MLO parasitise lymphocytes, monocytes, and polymorphonuclear leucocytes. This report describes orbital leucocytes parasitised by MLO in three patients with isolated COID. Rifampicin treatment of MLO disease is discussed.

Adolescent↗

Computed tomography in orbital pseudothumor (idiopathic orbital inflammation).

CT scans of 9 patients with orbital pseudotumor (bilateral in 6 and unilateral in 3) showed findings distinct from those observed in Graves' ophthalmopathy. In bilateral involvement, they ranged from localized mass lesions to complete obiliteration of normal orbital CT anatomical landmarks; diffuse or multifocal lesions involving the posterior globe and muscle insertions were most typical of the diagnosis. However, findings in unilateral psedotumor may be indistinguishable from orbital mass lesions other than Graves' ophthalmopathy. Serial CT scans were used to show progression of disease and response to treatment.

Adolescent↗

[Comparison between the blood from orbital sinus and heart in analizing plasma biochemical values--increase of plasma enzyme values in the blood from orbital sinus].

Plasma biochemical values, blood urea nitrogen (BUN), glucose, aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine phosphokinase (CPK), were compared between the samples collected from orbital sinus, heart and tail vein in mice, rats and hamsters. The significant higher values of AST, LDH and CPK were shown in samples from orbital sinus as compared with that from other sites. The blood from orbital sinus was bleeding by two methods and compared in the plasma enzyme values. It is suggested that the leakages of these enzymes from destroyed ocular tissues result in the increase of the plasma enzyme values.

Animals↗

[Hydatid orbital cyst: a unique intra-orbital locality. A case report].

Orbital hydatidosis is uncommon, accounting for 1 to 2% of all localizations. It is caused by Echinococcus granulosis, a dog parasite tapeworm. We report an intra-orbital hydatid cyst observed in a five-year-old boy, presenting the main features of this unusual localization. Hydatid cyst should be evoked in case of tumorous exophthalmia in young patients, especially in children having lived in endemic zones. The preoperative diagnosis is based on clinical findings and ultrasonographic, computed tomographic and magnetic resonance imaging findings. The fronto-orbital approach is most commonly used for treatment. Infectious and functional prognosis depends on early surgery.

Animals↗

[Chronic hematic cyst of the orbit (orbital subperiosteal hematoma)].

A case of chronic hematic cyst of the orbit which caused unilateral globe displacement with painful diplopia is described in a 72-year-old man. CT scans showed an extraconal soft tissue mass located between the orbital roof and the superior rectus muscle with a bone lysis. Characteristic appearance on MRI (benign signs, subperiosteal localization of the hematoma) has been confirmed by removal surgery. Chronic hematic cyst of the orbit is uncommon and MRI is helpful to establish this diagnostic.

Aged↗

Calcified schwannoma of the orbit and differential diagnosis of orbital calcification.

Calcified schwannoma of the orbit is rarely reported in the world literature. A 38-year-old Chinese male presented with a 5-year history of slow progressive left-sided axial proptosis. A smooth, retrobulbar and intracornal mass with central calcification and high internal reflectivity was found on computed tomography and sonographic study. From the clinical and radiologic features, the presumptive diagnosis of orbital cavernous hemangioma or meningioma was made and orbitotomy with tumor exicision was performed. Tumor excision revealed the rare diagnosis of calcified schwannoma. The differential diagnoses of a calcified orbital mass and the radiologic and clinical findings of the calcified schwannoma are described and discussed.

Adult↗

[A case of orbital osteoma--summary of the case reports in Japan, and the usefulness of the microsurgical drilling procedure in surgical treatment of orbital osteoma].

A 57-year-old woman was admitted with a 3-month history of diplopia and exophthalmos in the right eye. Plain skull X-P and axial CT demonstrated two bony tumors. One involved her right orbit, frontal sinus and ethmoidal sinus, and the other was located in the left occipital bone. The right intraorbital tumor was removed almost totally via the superomedial orbital approach by means of microsurgical drilling. Histopathological examination revealed mature osteoma. The microsurgical drilling procedure was helpful in obtaining an optimal result from surgical treatment of the orbital osteoma.

Female↗