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At least 109 records · Page 6Linked to original sources
PubMed2000

[Clinical anophthalmos. Cosmetic outcome after 2 years therapy with an orbital expander for stimulating orbital growth].

BACKGROUND: Congenital anophthalmos is a rare condition in which intervention in an early age can stimulate orbital expansion. The therapeutic goal was to allow retention of a suitable prosthesis and to maximise facial symmetry. METHODS AND PATIENTS: We report on 3 anophthalmic newborn male patients, of which one presented with microphthalmos in the other eye as well as associated systemic disorders. Solid moulded shapes were adapted and manufactured out of methylmethacrylate to increase expansion of orbital soft tissue and bone. The moulding of the orbita was performed by silicone made of two components under general anaesthesia during the first two years of life. The following day the solid shapes were fitted in the outpatient department. They were increased in size when they started to rotate within the orbit or when the eyelids were relatively loose around the solid shape. The initial insertion of the orbital expander was performed in the first weeks after birth and was repeated every 3 to 6 weeks within the first year of life. The degree of orbital expansion was determined by measurements of the horizontal eyelid length, the volume of the solid shapes, by measuring the volume in cm3 of water displaced by the shape after submerging it in a cylinder of water and assessment of the cosmetic aspect. RESULTS: Within 8 months of therapy a horizontal eyelid lengthening to 10 mm and an increase of the volume of the orbital expander from 1.5 cm3 to 6 cm3 was achieved in patient 1. After 20 months of therapy patient 2 showed symmetry of the face and the horizontal eyelid length. In patient 3 therapy started 3 years late and after 2 years only a horizontal eyelid lengthening of 3 mm and a suboptimal symmetry of the face was achieved. CONCLUSION: Our own experience suggests that early prosthetic fittings are necessary for an ideal cosmetic outcome. Motivation and cooperation of the parents is an important factor to achieve optimal results.

Anophthalmos↗
PubMedDate not supplied

CT characteristics of orbital pseudotumors and other orbital inflammatory processes.

Orbital pseudotumor is a nonspecific inflammatory process of unknown etiology that may mimic a true orbital neoplasm, specifically lymphoma. It exhibits a highly variable clinical and radiographic presentation. Thirty-nine patients with a presumptive diagnosis of orbital inflammatory disease were examined with CT and evaluated with respect to 13 findings associated with inflammatory disease of the orbit. Pseudotumor was included as part of the differential diagnosis in 25 patients. Twenty-one cases received a final (clinical) diagnosis of pseudotumor. The remainder were comprised of a broad range of orbital inflammatory conditions. Key radiographic features required to entertain or exclude the diagnosis of pseudotumor included establishing the presence of an orbital mass, extraocular muscle enlargement, bony erosion, enhancement, and associated paranasal sinus disease.

Adult↗
PubMed2003

Endoscopic and transconjunctival orbital decompression for thyroid-related orbital apex compression.

OBJECTIVE: To evaluate the efficacy and safety of a combined endoscopic and transconjunctival orbital decompression in patients with thyroid-related orbitopathy with orbital apex compression. STUDY DESIGN: Retrospective review. METHODS: A sequential series of patients with thyroid-related orbitopathy presenting with orbital apex compressive myopathy with and without optic neuropathy who were undergoing combined endoscopic and transconjunctival decompression by the same surgeons from 1992 to 2001 was reviewed. Patients were regularly evaluated preoperatively and postoperatively over a 3- to 55-month period to record the effects of this approach on visual acuity, Hertel exophthalmometry, and diplopia. Complications and secondary ophthalmological procedures were reviewed. RESULTS: Between 1992 and 2001, 72 combined endoscopic and transconjunctival decompressions were performed on 41 patients with orbital apex compression. Visual acuity improved in 89.3% of the patients with compressive optic neuropathy (P <.0005) and in 34.1% of those without neuropathy. Proptosis was reduced by 3.65 mm, on average. There was one case of transient intraoperative cerebrospinal fluid extravasation at the site of the optic nerve decompression, and one patient developed epistaxis. CONCLUSIONS: The study supports the treatment of thyroid-related orbital apex compression with and without compressive optic neuropathy by a combined transconjunctival and endoscopic approach. This approach offers short hospital stays, excellent visual recovery, and minimal complications in patients with thyroid-related orbital apex compressive myopathy and related compressive optic neuropathy. The beneficial effects observed in the patients with visual loss continued to improve over time and were significant (P <.001).

Adult↗
PubMed1999

Prospective anthropometric analysis of sagittal orbital-globe relationship following fronto-orbital advancement in childhood.

Fronto-orbital advancement is a common procedure for correction of supraorbital retrusion in patients with coronal craniosynostosis. The aim of this study was two-fold: to quantitate change in the sagittal orbital-globe relationship following fronto-orbital advancement in childhood and to determine the ratio of skeletal-to-soft tissue movement. Soft-tissue points on the orbital rim, orbitale superius (os), orbitale laterale (ol), orbitale inferius (oi), and nasion (n), referenced to apex corneae (ac), were measured preoperatively and postoperatively by a custom-made anthropometer. Intraoperative bony advancement was measured with a caliper. Patients were selected with uniform advancement at the fronto-nasal suture and laterally at the mortise and tenon. Fifteen patients with syndromic craniosynostosis were included in the study (six male, nine female): Apert (n = 2), Crouzon (n = 5), Pfeiffer (n = 4), Saethre-Chotzen (n = 3), and Boston type (n = 1). Average age at operation was 8.7 years (range, 4.5 to 10.5 years). Age, sex, method of fixation, postoperative interval, diagnosis, and skeletal movement were analyzed for possible effect on the magnitude of soft-tissue advancement. Average intraoperative skeletal advancement was 12.1 mm, and average postoperative soft-tissue movement was 10.3 mm (p < 0.001), measured at the midpoint of the supraorbital rims (os). The soft tissue: skeletal movement ratio was 0.9:1. Os was the only point at which soft-tissue advancement could be predicted (Spearman's rank correlation coefficient = 0.67); soft-tissue changes at ol, oi, and n were unpredictable. Skeletal movement was the only determinant of soft-tissue advancement of all variables tested, i.e., diagnosis, age, sex, previous fronto-orbital advancement, and wire versus plate fixation. We make recommendations for calculating the magnitude of fronto-orbital advancement, based on preoperative anthropometry and a soft-to-hard tissue advancement factor.

Anthropometry↗
PubMed1992

Histological changes in the orbital region of rats after orbital puncture.

To contribute to the assessment of the degree of discomfort in rats after orbital puncture, we have examined the histological changes in the intraorbital tissues caused by this technique of blood sampling. Orbits were studied from rats euthanized either within 1 min, 4 days, 28 days or 56 days after puncture while under diethyl-ether anaesthesia. The techniques of 2 animal technicians were compared, one using a broken haematocrit capillary and the other using an intact Pasteur's pipette. Non-punctured orbits served as controls. Microscopic slides containing the eye in situ at 2 horizontal levels in the orbital region were examined for 37 parameters; the slides were scored blind and in random order. Orbital puncture caused haemorrhages in the puncture track and, depending on the technique used, also in the periosteum. Four days after puncture, inflammatory reactions were present in the puncture track. Depending on the technique of puncture, these reactions were also seen in the eye muscles and periosteum or in the Harderian gland. Within 4 weeks after puncture, the lesions had healed without detectable scars. The different histological effects of the 2 techniques of orbital puncture are discussed in the light of the characteristics of these techniques.

Animals↗
PubMed2000

[Orbital filling using a vascularized parietal bone graft: a case report of rehabilitation with an orbital graft of axial implants].

Orbital and intracranial complications of dental cellulitis are exceptional. The authors report such a case with orbital cellulitis and frontal abscess that dictated orbital exenteration with resection of the eyelids. Before realization of an implant supported epithesis, the orbit was filled with a prefabricated vascularized fascio-osseous parietal bone flap. This allowed placement of two extra-oral fixtures (Nobel biocare) in an antero-posterior axis. In some cases, preimplant orbital bone graft appears to be the only solution when implant placement in the orbital rim is impossible or contra-indicated. Indications, advantages and disadvantages of this technique will be discussed.

Adult↗
PubMedDate not supplied

[Orbital phlebography craniobasal meningiomas spreading into the orbit].

Analysis of the results of orbital phlebography performed in 39 patients with cranio-orbital meningiomas testifies to the important diagnostic value of this methods of examination in determining the spread of craniobasal meningiomas to the orbit. By means of orbital phlebography it is possible not only to precisely define the topography of the new growth in the orbital cavity, but to reveal disorders of venous drainage from the orbit and collateral tracts which provide the draining function of the superior ophthalmic vein.

Humans↗
PubMed2002

[Orbital exenteration in therapy-resistant painful scleritis-associated inflammation of orbital soft tissues].

PATIENT: Presentation of a 67-year-old female with persisting left hemifacial pain - very intense in the periorbital area, and an ipsilateral red eye. The patient had received analgesics and corticosteroids systemically, but no significant improvement was achieved. She had a history of anterior nodular scleritis in her left eye three years ago. Immunologic screening, especially for Wegener's granulomatosis, was negative. The ophthalmic evaluation revealed a left blind eye with diffuse anterior scleritis, an intercalar staphyloma nasally and superiorly, absolute angle closure glaucoma with rubeotic iris and mature cataract. With a 3 mm proptosis with a totally immurable globe, the MRI demonstrated a diffuse orbital tumour with involvement of intraconal space and extraconal muscles. A lid-sparing exenteration of the left orbit was performed. Postoperatively, the patient recovered rapidly and had no more pain. Macroscopically, the orbital fat was replaced by dense scar tissue. Microscopically, a focal necrotising granulomatous vasculitis of small vessels and scleritis with zonal granulomatous reaction on scleral collagen was observed. CONCLUSIONS: Unilateral proptosis with anterior and posterior scleritis combined with granulomatous inflammation of orbital soft tissues may be the first symptom of Wegener's granulomatosis. In addition to systemic immunosuppression, the lidsparing orbital exenteration may be one option of therapy.

Aged↗
PubMed1997

Predictability of magnetic resonance imaging in differentiation of orbital lymphoma from orbital inflammatory syndrome.

Twenty-two patients with clinical presentations of either orbital lymphoma or orbital inflammatory syndrome (OIS) involving 25 orbits were examined by magnetic resonance imaging (MRI) before biopsy. To determine whether MRI adds specificity to radiographic diagnosis, the MRI signal characteristics of all tumors were examined. Attention was focused on the signal intensity of each tumor on T1- and T2-weighted images. In nine of 12 (75%) orbital lymphomas, the tumors appeared hyperintense to fat on T2-weighted images and became brighter relative to their appearance on T1-weighted images. In 11 of 13 (85%) orbital infiltrates with OIS, the tumors appeared isointense to fat on T2-weighted images and became slightly darker or unchanged relative to their appearance on T1-weighted images. Tumor density and homogeneity were fairly similar in all 25 lesions and were therefore not useful for further differentiation. Similarly, the presence of moderate enhancement with gadopentetate dimeglumine was seen in all but one tumor, and it was therefore not useful for further differentiation.

Adult↗
PubMed1986

Orbital neurilemoma with extension through the superior orbital fissure.

An otherwise healthy 33-year-old man developed slowly progressive unilateral proptosis. Computed tomography demonstrated a large orbital mass extending posteriorly through the superior orbital fissure. The encapsulated tumor, including the portion within the superior orbital fissure, was completely removed by a lateral orbitotomy. Histopathologic examination revealed a neurilemoma (schwannoma). In spite of extension of the tumor through the superior orbital fissure, the patient had excellent vision and no motility disturbance before or after surgery. The clinical, computed tomographic, histopathologic, and ultrastructural features of this orbital tumor are discussed.

Adult↗
PubMed1990

Primary orbital melanoma associated with orbital melanocytosis.

We report a case of primary orbital melanoma in a 17-year-old girl. The patient presented with painless proptosis during the first trimester of pregnancy. Computed tomography demonstrated a well-circumscribed mass located infra-temporally in the right orbit. The tumor was bluish-black, grossly encapsulated, and associated with orbital blue nevi. Histologic examination of the mass revealed a pigmented spindle-cell neoplasm. On electron microscopy, the presence of premelanosomes and the absence of basal lamina supported the diagnosis of melanoma. Malignant transformation of a preexisting nevus is postulated since perineural foci of benign dendritic melanocytes were seen within the melanoma. There has been no recurrence or metastasis in a 2-year follow-up. Of 30 primary orbital melanomas reviewed, 12 (40%) were associated with periorbital pigmentary disorders, such as oculodermal melanocytosis, blue nevus, and ocular melanocytosis. Our case is unique since the pigmentary lesions were limited to the orbital tissues.

Adolescent↗
PubMed1997

Tumors of the orbit. Pitfalls of the surgical approach in 37 children with orbital tumor.

The authors review their experience with 37 children with orbital tumors, summarizing their surgical techniques, the indications applied, and the pitfalls of each surgical approach. Tumors located in the retro-ocular or intraorbital space were surgically excised through a transcranial approach (28 cases), while for tumors in other sites lateral orbitotomy (5 cases), medial orbitotomy (1 case) and biopsy (3 cases) were performed. A transcranial approach was used for tumors with intracranial extension and for those located in the orbital apex and deep medial orbital compartment. Lateral orbitotomy was used for tumors located in the superior, temporal or inferior compartment of the orbit and those in the lateral apex. A medial orbitotomy was used for tumors located medial to the optic nerve. Outcomes of the surgical intervention varied, depending on the pathology, location and extent of the individual tumors. To obtain optimal exposure and minimize functional deficits, the pitfalls of surgical approaches to orbital tumors are discussed.

Adolescent↗
PubMed2004

Inflammatory orbital pseudotumor with extension beyond the orbit.

PURPOSE: To summarize the clinical profile and response to treatment of 4 biopsy-proven cases of inflammatory orbital pseudotumor extending beyond the orbit. DESIGN: Retrospective observational case series. METHODS: Four patients' charts were retrospectively reviewed. There were three men with extraorbital extension (two intracranial; one maxillary antrum) and one woman with intracranial disease that extended into the orbit. The men were 40, 41, and 60 years old; the woman was 73 years old. RESULTS: Two men with orbital myositis and mild discomfort, initially treated with corticosteroids, had asymptomatic intracranial disease 9 and 12 months after initial presentation. A third man had extension into the maxillary antrum after initial symptoms of painless diplopia. The woman had intraorbital disease with minimal discomfort (dacryoadenitis and myositis) 5 years after presenting with intracranial disease in the Meckel cave that subsequently became bilateral. Histopathologic examination in all cases showed nonspecific inflammation without evidence of vasculitis or granulomas. CONCLUSIONS: Unlike typical cases of nonspecific orbital inflammation, two of these four cases did not have pain as a prominent feature. Neuroimaging was essential in diagnosing asymptomatic extraorbital disease. Surgery has a prominent role in confirming this diagnosis, primarily by helping to rule out other diseases, such as those with granulomatous inflammation or vasculitis. Additional therapy was usually not required postoperatively.

Adult↗
PubMed1994

Enterogenous cyst of the orbital apex and superior orbital fissure.

BACKGROUND: Enterogenous cysts of the central nervous system are rare congenital tumors with a single layer of mucin-secreting epithelial cells resembling gastrointestinal epithelium. The tumor is located most commonly at lower cervical and cervicothoracic spinal levels; only 22 intracranial cases have been reported. To the authors knowledge, this entity has not been described in the orbit. METHODS: A 23-year-old woman with painful loss of vision and ophthalmoplegia in the left eye was treated with oral and intravenous corticosteroids for presumed orbital inflammation. After a cystic lesion in the left orbital apex was demonstrated on computed tomographic scan and magnetic resonance imaging, various diagnoses, including optic nerve tumor, granulomatous inflammation, lymphoma, vascular anomaly, and pseudotumor, were considered until transcranial biopsy established the correct diagnosis. The tumor subsequently recurred twice. RESULTS: More than 3 years after the last recurrence, the patient has no pain but had unilateral optic atrophy, significant visual field loss, limited motility, and an anesthetic cornea in the left eye. CONCLUSION: The diagnosis of enterogenous cyst is difficult without adequate biopsy because the radiologic and clinical presentation of this rare tumor may be confused with other lesions. Previous attempts to explain intracranially placed enterogenous cysts offer no explanation for an orbital occurrence nor do they adequately describe a mechanism for an intracranial location in general. An embryologically based explanation that takes into account the occurrence of this entity from the caudal to rostral extent of the neuraxis is described. This theory suggests that the orbit is the most rostral possible location for an enterogenous cyst.

Adult↗
PubMed2000

Orbital rhabdomyosarcoma presenting as an apparent orbital subperiosteal abscess.

We present a patient with acute sinusitis whose CT scan showed a ring-enhancing lesion within the orbit typical of an orbital subperiosteal abscess. On exploration of the orbit, there was no pus present but a tumour was found, which on histological examination was found to be a rhabdomyosarcoma. The clinical signs and CT characteristics of orbital subperiosteal abscesses and rhabdomyosarcomas are discussed. A ring-enhancing lesion within the orbit on CT scan should not be regarded as being pathognomonic for a subperiosteal abscess and the possibility of other diagnoses should be considered.

Abscess↗
PubMed2002

Late orbital haemorrhage around alloplastic orbital floor implants: a case series and review.

BACKGROUND: Alloplastic implants have been used to repair orbital wall fractures and correct anophthalmic enophthalmos (or volume deficiency in an anophthalmic socket). Orbital haemorrhage is a rare complication of these implants. METHOD: A retrospective review of patient files of two consultant oculoplastic surgeons. RESULTS: Four cases of orbital haemorrhage following alloplastic implants were identified. The haemorrhages occurred 5-18 years after surgery, and occurred within the pseudocapsule of the implant. In one case, recurrent haemorrhages were noted. CONCLUSION: Although rare, orbital haemorrhage is a potential complication of alloplastic orbital floor implants, which may present many years after surgery.

Aged↗
PubMed1998

The value of orbital echography in orbital practice.

Twenty-three consecutive patients with orbital masses who were referred to a major medical center and later had biopsies underwent ophthalmic echographic evaluation. The efficacy of orbital echography was compared with both the clinical evaluation and other orbital imaging methods (computed tomography and magnetic resonance imaging). Echography was successful in all patients (100%) in detecting the orbital mass. The diagnosis was accurate in 18 of 22 patients (82%) echographically, 12 of 14 patients (86%) clinically, and 11 of 13 patients (85%) radiologically when a short differential was attempted. If all the patients examined were considered, echographic evaluation arrived at an accurate diagnosis in 18 of 23 patients (78%), clinical impression was accurate in 12 of 23 patients (52%), and radiologic evaluation was accurate in 11 of 20 patients (55%). In three patients, echography was the only imaging method used. The role of ophthalmic echography in the diagnosis of orbital masses is discussed.

Adult↗