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PubMedDate not supplied

Intranasal endoscopy-assisted repair of medial orbital wall fractures.

The repair of medial orbital blow-out fractures remains a challenging surgical procedure for most surgeons. Endoscopic intranasal visualization of the medial orbital wall or lamina papyracea is a technique familiar to most otolaryngologists. This endoscopic view would allow for confirmation of orbital content reduction and bimanual manipulation of an orbital implant. To determine the effectiveness of a new surgical technique, a cadaveric study was performed to evaluate the ability to (1) reduce the herniated orbital contents and (2) restore the normal anatomic orbital configuration and volume with the addition of an orbital implant. Excellent visualization of the fracture was achieved in all cadaveric specimens. In addition, endoscopic intranasal visualization of the medial orbital wall greatly facilitated the anatomic reduction of orbital contents and proper placement of the orbital implant. The surgical technique is described and a clinical case is reported in which this endoscopic technique was effectively used. Arch Facial Plast Surg. 2000;2:269-273

Adult↗

PubMed1981

Sinus involvement in inflammatory orbital pseudotumor.

Orbital pseudotumor is a difficult diagnosis to establish preoperatively. The relationship between sinus disease and orbital pseudotumor is controversial. We describe two patients with unilateral proptosis, diplopia, palpable orbital masses, ocular discomfort, and sinus problems of short duration. Echographically, both had low reflective masses in the orbit and the adjacent sinuses. Roentgenograms and echograms were interpreted as showing erosion of the bony orbital wall. A presumptive diagnosis of sinus malignant neoplasm with orbital extension was made. Sinus histopathologic examination in one case and nasal histopathologic examination in the other showed chronic inflammatory changes compatible with the diagnosis of pseudotumor. At orbitotomy, one patient had vessels communicating between the orbital and sinus lesions, and both patients had irregular pitting of the bone next to the histologically proved orbital pseudotumors. The lytic erosive changes predicted preoperatively were not present. Simultaneous orbital and sinus pseudotumors seem to be a distinct clinicopathologic entity. Those concerned with the diagnosis and management of orbital disease should be aware of this entity.

Adult↗

PubMed2006

Bioresorbable poly-L/DL-lactide (P[L/DL]LA 70/30) plates are reliable for repairing large inferior orbital wall bony defects: a pilot study.

PURPOSE: The purpose of this study was to share our clinical experience on the use of bioresorbable poly-L/DL-lactide implants (P[L/DL]LA) 70/30 (PolyMax; Synthes, Oberdorf, Switzerland) to repair, large (> or =2 cm2), inferior orbital wall defects and to evaluate whether P(L/DL)LA 70/30 implants adequately support the orbital soft tissue contents. PATIENTS AND METHODS: Thirteen patients who suffered orbital blowout fractures, with > or =2 cm2 bony defects in the inferior orbital wall, took part in the study. The inferior orbital wall was explored via subconjunctival approach. After repositioning of orbital content, each inferior orbital wall was reconstructed using a round plate of P(L/DL)LA 70/30. Computed tomography and magnetic resonance imaging coronal sections were undertaken before the operation and 2 and 36 weeks postoperatively. RESULTS: The magnetic resonance imaging studies showed no abnormal tissue foreign body reactions in the orbital region. The material showed adequate strength to stabilize bone segments during the critical period of bone healing. The bone healing seems to take place along the bone fragments. The clinical outcome was excellent in 11 of the 13 cases (85%). At the end of the study, only one patient had mild enophthalmos. CONCLUSIONS: Bioresorbable P(L/DL)LA 70/30 implants are safe and reliable for the repair of large defects (> or =2 cm2) in the inferior orbital wall. It seems that this is the first reported biodegradable material, in the literature, to promote bone healing along the bone fragments of the inferior orbital wall.

Absorbable Implants↗

PubMed2004

Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1.

OBJECTIVE: To determine the incidence of specific orbital tumors based on patients referred to an ocular oncology center. DESIGN: Retrospective, observational case series. PARTICIPANTS: A total of 1264 consecutive patients referred to an ocular oncology service because of space-occupying orbital lesions. METHODS: A retrospective chart review was carried out for 1264 consecutive patients referred for a suspected orbital mass over a 30-year period. The lesions were grouped into general categories, as shown in "Results." The specific diagnosis in each case was based on clinical findings, computed tomography scan results, magnetic resonance imaging results, and histopathologic analysis results, when available. The number and percentage of benign and malignant tumors per age group also was determined. MAIN OUTCOME MEASURES: The incidence of orbital tumors and pseudotumors. RESULTS: Among 1264 consecutive patients, the number and percentage of lesions in each general category were as follows: cystic, 70 cases (6%); vasculogenic, 213 cases (17%); peripheral nerve lesions, 23 (2%); optic nerve and meningeal tumors, 105 (8%); fibrocytic lesions, 13 (1%); osseous and fibro-osseous tumors, 21 (2%); cartilaginous lesions, 1 (<1%); lipocytic and myxoid lesions, 64 (5%); myogenic tumors, 36 (3%); lacrimal gland lesions, 114 (9%); primary melanocytic lesions, 11 (<1%); metastatic tumors, 91 (7%); lymphoma and leukemia lesions, 130 (10%); secondary orbital tumors, 142 (11%); histiocytic lesions, 17 (1%); thyroid-related orbitopathy, 67 cases (5%); other inflammatory lesions, 133 cases (11%); and miscellaneous other lesions, 13 (1%). The most common diagnoses were: lymphoid tumor (139 cases;11%), idiopathic orbital inflammation (135 cases; 11%), cavernous hemangioma (77 cases; 6%), lymphangioma (54 cases; 4%), meningioma (53 cases; 4%), optic nerve glioma (48 cases; 4%), metastatic breast cancer (44 cases;4%), orbital extension of uveal melanoma (41 cases; 3%), capillary hemangioma (36 cases;3%), rhabdomyosarcoma (35 cases; 3%), dermolipoma (31 cases; 3%), herniated orbital fat (30 cases; 2%), dermoid cyst (26 cases; 2%), varix (26 cases; 2%), dacryops (19 cases; 2%), and other less common lesions. Of the 1264 lesions, 810 (64%) were benign and 454 (36%) were malignant. The percentage of malignant lesions was 20% in children (age range, 0-18 years), 27% in young adults and middle-aged patients (age range, 19-59 years), and 58% in older patents (age range, 60-92 years). Rhabdomyosarcoma was the most common malignancy in children, representing 3% of all orbital masses, and lymphoma was the most common malignancy in older patients, representing 10% of cases. CONCLUSIONS: A variety of tumors and pseudotumors can involve the orbit. In this series of 1264 lesions, 64% were benign and 36% were malignant. The percentage of malignant tumors increased with age, with malignancies being common in older patients because of the higher incidence of lymphoma and metastasis in the elderly.

Adolescent↗

PubMed2006

Compressive optic neuropathy after use of oxidized regenerated cellulose in orbital surgery: review of complications, prophylaxis, and treatment.

PURPOSE: We report 2 cases of compressive optic neuropathy after use of oxidized regenerated cellulose (ORC) in orbital surgery. To our knowledge, no complications have been reported previously after use of this material in orbital surgery. We also review the complications related to its retention at operative sites outside the orbit and recommend precautions to avoid them. DESIGN: Retrospective interventional case reports. PARTICIPANTS: Two patients with compressive optic neuropathy after use of ORC in orbital surgery. METHODS: Case reports from 2 different clinics and review of the English scientific literature. MAIN OUTCOME MEASURES: Best-corrected visual acuity, extraocular motility, proptosis, and chemosis. RESULTS: One patient underwent orbital exploration and biopsy of an orbital tumor, and the second had repair of an orbital floor fracture. Postoperatively, both presented with chemosis, ophthalmoplegia, and progressive loss of vision. Orbital imaging revealed a retrobulbar soft-tissue density compatible with hematoma. Repeat orbital exploration revealed the soft-tissue mass to be swollen ORC. CONCLUSIONS: Retained intraorbital ORC may cause a compartment syndrome and should be suspected in postoperative patients with orbital symptoms. When ORC is used around the optic nerve, it should be removed after hemostasis is achieved.

Adolescent↗

PubMed1996

Orbital infections in patients with human immunodeficiency virus infection.

BACKGROUND: Opportunistic infections frequently involve the anterior and posterior segments of the eye but rarely occur in the orbit in patients with human immunodeficiency virus (HIV) infection. The authors managed eight patients with HIV and unilateral orbital infections who presented between July 1988 and March 1995. METHODS: Records of the patients were reviewed. A literature review of orbital infections in patients infected with HIV also was conducted. RESULTS: There were five men and three women, with a mean age of 33.8 years. The mean CD-4 cell count from five of the eight patients was 18.4 cells/mm3. Invasive aspergillosis was the most common orbital infection occurring in four patients, all of whom had contiguous sinus involvement and intracranial extension. Orbital cellulitis with subperiosteal abscesses secondary to ethmoiditis caused by Propionibacterium acnes and Pseudomonas aeruginosa developed in two patients. Orbital cellulitis and panophthalmitis secondary to Staphylococcus aureus endogenous endophthalmitis developed in one patient, and one patient had presumed syphilitic optic neuritis, orbital periostitis, and necrotizing vasculitis. Five patients had permanent visual loss, including four who had loss of light perception. Four patients died of orbital diseases within 1 year of presentation, and three deaths were attributed to intracranial spread of Aspergillus fumigatus. Other organisms reported in the literature that caused orbital infections in patients with HIV include Rhizopus arrhizus, Toxoplasma gondii, and Pneumocystis carinii. CONCLUSION: Opportunistic infections of the orbit from bacterial, fungal, and parasitic organisms should be recognized as a serious complication of systemic HIV infection and are associated with a high ocular morbidity and mortality rate.

AIDS-Related Opportunistic Infections↗

PubMed2003

Orbital apex injury: trauma at the junction between the face and the cranium.

Orbital apex injury is usually seen in multiply and severely injured patients who are subject to high-energy trauma. Orbital apex injury rarely occurs in isolation. By proximity, the face, the skull base, or their combination are the most likely regions to be injured in association with orbital apex trauma. The vast majority of these injuries occur as an extension of orbital, LeFort, naso-orbito-ethmoid, panfacial, sphenoid, or temporal bone fractures of the skull. Complex osseous anatomic structures with intimately related multiple neurovascular organs make injuries to the orbital apex diagnostically and therapeutically challenging. Often other facial fractures extend into the orbital apex, or the orbital apex is damaged in conjunction with fractures of the skull base. Therefore abnormal imaging findings within the orbital apex may be indicators of traumatic injury to the entire junctional zone of face and cranium. In this article, we will give an overview of normal CT anatomy, review clinical syndromes, which may indicate traumatic injury of the orbital apex and present an imaging strategy for evaluation of the orbital apex.

Humans↗

PubMed2003

Assessment of internal orbital reconstructions for pure blowout fractures: cranial bone grafts versus titanium mesh.

PURPOSE: To assess the adequacy of internal orbital reconstruction in pure blowout fractures using either cranial bone grafts or titanium mesh implants. PATIENTS AND METHODS: The preoperative and postoperative true coronal computed tomography (CT) scans of 58 patients with unilateral pure orbital blowout fractures were included in the study. Demographic data and measurements of the pretreatment size of the defects were tabulated. The accuracy of reconstruction was assessed subjectively by 1 surgeon by scoring the position of the implant/graft, repositioning of orbital soft tissues, and assessment of orbital volume using the uninjured side for comparison. The cross-sectional area of the anterior, middle, and posterior regions of the reconstructed defect was statistically compared with the same locations on the uninjured orbits by scanning the CT scans and calculating the number of pixels within the selected CT slices. A comparison of the accuracy of reconstructions for those reconstructed with cranial bone graft and those with titanium mesh was statistically performed using parametric (for subjective analyses) and nonparametric tests (for cross-sectional area data). RESULTS: Thirty-eight cases were classified as fractures of the orbital floor, 4 as isolated medial wall fractures, and 16 as combined floor/medial wall fractures. There was a statistically significant difference in the surgeon's subjective ratings of adequacy of reconstructions between titanium mesh and bone-grafted groups. Orbits reconstructed with titanium mesh were more accurate than those reconstructed with bone (P <.001). Overall, there was no significant difference in cross-sectional areas between the reconstructed and uninjured orbits in the middle and posterior regions of the defects, but the anterior region showed significantly smaller cross-sectional areas in the reconstructed orbits (P <.001). CONCLUSIONS: Although there was great individual variability and both materials could be successfully used, the orbits reconstructed with titanium mesh showed better overall reconstructions than those reconstructed with bone grafts.

Adolescent↗

PubMed1989

[Conventional x-ray study and computed tomography in the diagnosis of orbital fractures].

37 cases of skull fractures with involvement of the orbit were reviewed retrospectively. The value of plain films, tomography and computed tomography was analysed. Combined use of 28 degrees Caldwell and water views revealed 96% of all orbital floor fractures. Orbital emphysema in facial bone fractures nearly almost (in 14 of 15 cases) indicated involvement of the medial orbital wall. CT--performed on a biplane basis--showed best diagnostic accuracy in evaluating orbital fractures. Axial CT scans revealed only 70% of all orbital floor fractures. Because of that coronal scans are especially necessary for evaluating the orbital floor and the orbital roof. CT is necessary for evaluating the medial orbital wall since conventional radiology only shows 15% of all medial orbital wall fractures.

Adolescent↗

PubMed2005

Video-endoscope assisted teaching during sub-periosteal orbital surgery.

PURPOSE: The authors report the novel use of the video-endoscope as an adjunct in teaching orbital surgery, in particular within the sub-periosteal orbital space. This is of most use during situations where visualisation is of critical importance and direct supervision is not possible. MATERIALS AND METHODS: This technique was used for 16 cases of orbital surgery during a 12-month period. There were 5 orbital fracture repairs, 8 orbital decompressions (4 via a swinging eyelid and 4 via a transcaruncular approach), an infraorbital nerve biopsy, an eosinophilic granuloma and an orbitofrontal cholesterol granuloma. All procedures were performed by the trainee under consultant supervision with the endoscope being used when direct visualisation was not possible for the consultant. A rigid Storz 3-chip video-endoscope with 0, 30 and 70-degree tips was used to enable visual supervision. RESULTS: The endoscope was of particular use in procedures involving the posterior orbital floor, orbital roof and medial orbital wall. It also enabled safe supervision of curettage of an orbital roof lesion which abutted the dura. The technique was easy to use; it provided good local illumination and a magnified view for supervision. CONCLUSION: This technique is a valuable adjunct in allowing the trainee to safely perform selected complex orbital surgery under video-endoscopic supervision.

Endoscopy↗

PubMed2002

Clinical applications of color Doppler imaging in the management of orbital lesions.

PURPOSE: To present the clinical applications of color Doppler imaging (CDI) as an adjunctive study in the diagnosis and treatment of orbital lesions. METHODS: Retrospective noncomparative case series. Medical records of 17 patients with orbital lesions who underwent orbital CDI were reviewed, and their orbital CDI results, diagnosis, and treatment were studied. The main outcome measures were detection of abnormal orbital vascular flow and presence or absence of blood flow within orbital lesions by CDI. RESULTS: Absence of intralesional flow was associated with an orbital lesion considered benign. Tumors in which flow was present were more frequently malignant or had malignant potential. Reversal of flow in the superior ophthalmic vein was observed in patients with carotid-cavernous fistula and orbital varix. CONCLUSIONS: CDI is a useful adjunctive imaging study for evaluating the vascularity of orbital tumors. The absence or presence of intratumoral blood flow as demonstrated by CDI can help determine the nature of the orbital mass and can assist with surgical planning.

Adult↗

PubMed2001

Direct local approach through a W-shaped incision in moderate or severe blowout fractures of the medial orbital wall.

For moderate or severe blowout fractures of the medial orbital wall, the goals of treatment are complete reduction of the herniated soft tissue and anatomic reconstruction of the wall without surgical complications. Various surgical approaches have been used, depending on the anatomic location and the extent of medial wall fracture. However, there is no consistent method to achieve the treatment goals with minimal morbidity because of one or more problems of limitation of entire medial wall exposure, limitation of large implant or bone graft insertion, surgical damage of important periorbital or intraorbital structures, or postoperative scar deformities. In this study, a direct local approach through a 3-cm, W-shaped incision on the superior medial orbital area was used as a consistent method to reconstruct medial orbital blowout fractures. The angle of the W-limbs is 110 to 120 degrees. Four limbs of the W were placed parallel or oblique to the relaxed skin tension lines. This technique was applied to 39 orbits of 37 patients with moderate or severe blowout fractures of the medial orbital wall. This approach provided exposure of the entire medial orbital wall, adequate placement of a large implant, short operation time within 2 hours, and no damage of important internal structures. Postoperative computed tomographic scans showed complete reduction of the herniated orbital tissues and anatomic reconstruction of the medial orbital wall without complication related to the surgical approach in all cases. During the follow-up period of 6 to 14 months, excellent functional and cosmetic results were observed with an inconspicuous scar without secondary scar deformities. Therefore, a direct local approach through a W-shaped incision on the superior medial orbit may be a consistent method to gain the surgical goal in treatment of moderate or severe blowout fractures of the medial orbital wall.

Adolescent↗

PubMed2001

Surgical management of the anophthalmic orbit, part 2: post-tumoral.

Ablative surgery for tumors of the globe and its adnexal structures is frequently the cause of major orbitofacial deformity. Radiotherapy compounds the problem because it suppresses skeletal growth in the growing patient and induces a contraction of the remaining soft tissues in the orbit. Goals for reconstruction in these patients include the restoration of orbital structures to allow the fitting of an ocular prosthesis and the correction of distorted orbitofacial relationships. The authors present a series of 53 patients (mean age, 29 years; 28 male) who were treated over the past 18 years by composite reconstruction of the post-tumoral anophthalmic orbit. The follow-up ranged from 5 months to 18 years (mean, 7.75 years). Four patients were treated primarily (immediate reconstruction after tumor ablation), and 49 were treated secondarily (mean oncological follow-up since ablative surgery, 14.8 years). Twenty-eight patients underwent orbital enucleation (including three bilateral cases), 23 underwent orbital exenteration, and two underwent evisceration. Forty-two patients received radiotherapy, including 20 enucleation patients, 15 exenteration patients, and seven others in whom details of primary therapy were incomplete. A staged reconstruction was undertaken in each case; it considered, in turn, the bony orbital volume (orbital remodeling and cranial bone grafts), orbital contents (implant, temporalis muscle transposition, cranial bone grafts, and dermafat grafts), conjunctival sac (mucosal and skin grafts), ocular prosthesis, eyelids (local flaps and skin grafts), and additional procedures to restore orbitofacial symmetry. The authors conclude that the long-term results of post-tumoral orbital reconstruction are favorable, and they particularly recommend the use of autogenous tissues in irradiated orbits.

Adolescent↗

PubMed2004

Congenital microphthalmos with orbital cysts: distinct diagnostic features and management.

PURPOSE: To review the clinical features and treatment strategies for microphthalmic globes with orbital cyst. METHODS: : The clinical records of 23 patients treated for microphthalmos associated with orbital cysts were reviewed retrospectively. RESULTS: Most cases of congenital microphthalmos with orbital cysts were first noted at birth, and all were confirmed by means of computed tomography and/or ultrasonography. Six of the 23 cases were bilateral. Sixty-seven percent of bilateral and 29% of unilateral cases also had other congenital malformations. Mild microphthalmos was noted in 3 orbits, moderate in 16 orbits, and severe in 10 orbits. On the basis of clinical findings, 8 orbits were treated with enucleation and cyst excision and 15 were treated with cyst excision only. Cyst aspiration was performed on 5 orbits; 2 required aspiration and subsequent cyst excision. Twenty-six orbits had good cosmesis and 2 had acceptable cosmesis. The mean follow-up interval was 5.15 years. CONCLUSIONS: Management of microphthalmos with orbital cyst is a cosmetic issue. Cyst size, degree of microphthalmos, and general condition of the patient determine the best treatment approach.

Child, Preschool↗

PubMed2003

[Secondary reconstruction of post-fracture deformities in the nasal-orbital ethmoid region].

OBJECTIVE: To study the surgical reconstruction of secondary fracture deformities of the nasal-orbital ethmoid area. METHODS: Typical bicoronal and subciliary incisions or the adjacent scar incision were employed to expose the fractured area. The flattened nasal bone was narrowed by curved osteotomy along the medial orbital rims and trimed with a bur. 2-3 pieces of cranial outer table were used to reconstruct the nasal framework, which were fixed to the frontal bone with mini-plates. After the medial orbital wall and orbital floor were exposed, the herniated orbital contents were released and reduced to the orbital cavity. The fractured orbital walls were repaired precisely with autogenous cranial outer table or Medpor. The medial canthal tendons were anchored superior-posteriorly to the lacrimal fossa with transnasal wires. RESULTS: From December 1996 to December 2001, 34 cases of severe nasal-orbital ethmoid fracture deformities were repaired with this technique. Of them, 12 cases had combined orbital-zygomatic fracture, 4 cases had fontal sinus fracture, 1 case had Le Fort II and 1 case had Le Fort III fracture. All the patients recovered well and their facial appearance improved greatly. CONCLUSIONS: The key points for surgical reconstruction of the periorbital post-fracture deformities are narrowing the flattened nasal root by curved osteotomy, the nasal framework reconstruction with autogenous bone graft, the orbital wall repair to correct enophthalmos, and most importantly, the medial canthal tendon reduction and canthal plasty.

Adolescent↗

PubMed2005

[Correction of enophthalmos deformity caused by orbital blow-out fractures using medpor implantation].

OBJECTIVE: To study the surgical reconstruction for correction of enophthalmos deformity caused by orbital blow-out fractures. METHODS: From December 1996 to March 2004, 56 cases of enophthalmos deformity caused by orbital blow-out fracture were repaired. There were 37 cases diplopia, 35 cases with worsened visual acuity than pre-trauma. Typical sub-ciliary incision was employed to expose the fractured area. The dissection was done beneath the medial and inferior orbital periosteum. The fracture areas were exposed and the tissues protrusion to maxillary sinus were released through the space between fractured bones. After the medial and inferior orbital walls and orbital floors were exposed,the herniated orbital contents were released and reduced to the orbital cavity. The fractured orbital walls were repaired precisely with Medpor which were fixed to the area beneath the periosteum with 2 plates at least. RESULTS: All 56 cases of enophthalmos deformity caused by orbital blow-out fracture repaired with this technique recovered well and their facial appearance improved greatly. With a follow-up ranged from 2 months to 5 years, the degree of enophthalmos stabilized at within 2 mm, no relapse and other complications occurred. Of 34 patients with diplopia, 27 were improved. Of the 35 cases with worsened visual acuity, 9 were improved with different degree. No diplopia or visual acuity worsening occurred. CONCLUSION: It is safe and effective to correct the orbital blow-out fractures. The earlier it is repaired, the better the effect will be. Medpor with its advantages like better histocompatibility, easier sculpturing, moderate hardness, lower absorptivity, fewer complications and permanence effect is the preferable implantation material for correcting enophthalmos deformity.

Adult↗

PubMed2006

[Management in squamous cell carcinoma of maxillary sinus with orbital invasion].

OBJECTIVE: To explore the orbital management in advanced squamous cell carcinoma of maxillary sinus with orbital invasion. METHOD: Forty-six postoperative cases of advanced squamous cell carcinoma of maxillary sinus with orbital invasion were followed up. Two,three,five-year survival rates and 2-year recurrence rates were analysed in,orbital bone invaded group, periorbit invaded group and orbital content invaded group. RESULT: Two, three,five-year survival rates and 2-year recurrence rates were 65.2%, 55.6%, 46.7% and 38.1% in orbital bone invaded group; 57.1%, 50.0%, 45.5% and 53.8% in periorbit invaded group; 44. 4%, 37. 5%, 37. 5% and 62. 5% in orbital content invaded group, respectively. Survival rates of three groups descended and recurrence rates of three groups ascended but without statistical significance( P >0. 05). CONCLUSION: During the surgery for advanced squamous cell carcinoma of maxillary sinus with orbital invasion without the evidence of optical nerve and eye ball involvement, preservation of orbital contents is considerable even though the orbital bone and periorbit are involved by the tumor.

Adult↗

PubMed1978

[Diagnostic ultrasonography and X-ray computer tomography in space-occupying orbital lesions--a joint effort (author's transl)].

Diagnostic ultrasonography (A-and B-scans) and X-ray computer tomography are completely different in their physical bases. The yield, therefore, different informations in the examination of space-space-occupying lesions in the orbit. The informations which can be recorded from normal and pathologic tissues in the orbit are described in this paper. The value, but also the limitations, of the various diagnostic methods are demonstrated in clinical cases. The reliable diagnosis of unilateral, progressive pseudoprotrusion in high myopia by ultrasound exophthalmometry is described. Facilities and diagnostic value of ultrasonography and X-ray computer tomography in the localisation of orbital tumours and in the determination of their relationship to the orbital walls are discussed. The diagnostic management in intermittent exophthalmos, in orbital abscess and in Grave's disease is reported. The complete ophthalmic examination is followed by ultrasound exophthalmometry and--if indicated--A- and B-scan ultrasonography of orbital tissues. Computed X-ray tomography is indicated in all tumour-suspicious lesions within the orbit. The results of diagnostic ultrasonography and computed X-ray tomography may complete each other in a very helpful manner. The combined evaluation yields better results than the use of only one of these methods. In orbital varices we recommend, to supplement ultrasonography by venography and eventually arteriography. In diagnoses of orbital abscesses resulting from paranasal sinusitis it may usually suffice to combine ultrasound diagnosis with native X-ray examinations. Good interdisciplinary cooperation in diagnosis and therapy is mandatory in all patients with space-occupying orbital lesions.

Abscess↗