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At least 127 records · Page 7Linked to original sources

Orbital volume measurement in the management of pure blowout fractures of the orbital floor.

With the recent advent of accurate orbital volume assessment by computed tomography, a retrospective analysis was made of 31 patients with 'pure' blowout fracture of the orbital floor, managed either surgically or conservatively, to determine whether orbital volume measurement could provide an additional parameter of use in the management of such fractures. There was a significant difference in orbital volume discrepancy between patients managed surgically or conservatively suggesting that this investigation may be of use in decision making on surgical intervention in patients with orbital blowout fractures.

Anthropometry↗

Combined cranio-orbital surgery for extensive malignant neoplasms of the orbit.

Extensive, invasive neoplasms of the cranio-orbital region are generally considered to be inoperable and are treated with local radiation therapy and occasionally with chemotherapy. Upon local recurrence of these neoplasms, further treatment efforts are usually deemed futile. Over the past 4 years, 10 patients with extensive neoplasms of the cranio-orbital region that were previously thought to be inoperable were referred to us for further evaluation. Five of these patients had failed an intensive course of radiation therapy. Radical regional cranio-orbital resection was performed. The resection included the skin, globe, sphenoid wings, and orbitofrontal bone. The maxillary sinus and nasal septum were left exposed. The exposed dura mater and the frontal and temporal bones were resurfaced with split-thickness skin grafts. All patients in this series have survived free of local disease to date. Combined cranio-orbital resection offers both palliation and a possible cure for patients with extensive, invasive neoplasms of the cranio-orbital region. Reconstructive surgery can be performed using full-thickness flaps after 2 years of observation for local recurrence.

Adolescent↗

Orbital cellulitis and orbital fractures.

Orbital cellulitis as a complication of orbital fracture is discussed. Three cases of orbital cellulitis that followed trauma to the orbit are presented. A description of the proposed mechanism by which an orbital fracture predisposes to cellulitis follows. Suggestions are made for prophylactic management.

Adult↗

Orbitotonography, the dynamic assessment of orbital tension: 1. Results in subjects without known orbital disease.

This paper describes a new orbitotonometer and method of dynamically assessing the orbital tissue resistance ("orbital tension"). In 20 healthy volunteers without known orbital disease the inexpensive instrument proved to be safe and accurate, providing useful, reproducible clinical information. The full diagnostic work-up of patients with orbital disease should include the accurate measurement of orbital tension, as this may provide the ophthalmologist with earlier objective evidence of the disease process as well as a method of following its course.

Adult↗

Invasive orbital pseudotumor--CT demonstration of extension beyond orbit.

Two cases of orbital pseudotumor are described with computed tomographic (CT) studies showing extension of the pseudotumor beyond the confines of the bony orbit. In one patient with orbital pseudotumor involving the medial rectus muscle, the pseudotumor extended through the medial wall of the orbit into the ethmoid sinus. A second patient had extension of orbital pseudotumor into the infraorbital fissure causing enlargement of the infraorbital fissure and foramen. Both lesions were confirmed by biopsy.

Adult↗

Orbital compression syndrome after orbital extravasation of X-ray contrast material.

PURPOSE: To report the orbital compression syndrome after orbital extravasation of x-ray contrast material during catheterization of the left middle meningeal artery. METHODS: Case report. RESULTS: A 61-year-old woman had profound loss of vision, pain, and proptosis of her left eye immediately after catheterization of the left middle meningeal artery. Computed tomography (CT) revealed that contrast material had extravasated into the orbit. Her symptoms improved with lateral canthotomy and cantholysis and resolved totally within 24 hours without the need for an orbital surgical procedure to remove the contrast material. CONCLUSION: This report describes an unusual cause of the orbital compression syndrome.

Compartment Syndromes↗

Fundus manifestations of orbital disease and treatment of orbital disease.

Disorders of the orbit can secondarily involve the eye. Although nonspecific, changes which can be noted on funduscopic examination including abnormalities of the retina, choroid, and optic nerve, can be secondary to an underlying orbital process. Awareness of these findings and their association with orbital disease is of great importance to the practicing ophthalmologist, since many orbital disorders are treatable and indeed, some are life-threatening. In addition, treatment of these disorders can potentially result in a variety of ocular complications. An understanding of the potential risks is of the utmost importance in planning treatment of an orbital disease.

Choroid Diseases↗

Two unusual osteogenic orbital tumors: presumed parosteal osteosarcomas of the orbit.

OBJECTIVE: To report two cases of suspected parosteal osteosarcoma of the orbit, with dedifferentiation into a high-grade liposarcoma occurring in one patient. DESIGN: Two retrospective case reports. METHODS: The clinical, radiologic, and pathologic records of two patients with suspected orbital parosteal osteosarcoma were retrospectively reviewed. MAIN OUTCOME MEASURES: Histologic evaluation and clinical follow-up were measured. RESULTS: The first patient was a 47-year-old male presenting with a 5-month history of painless right lower lid swelling; excision biopsy suggested a well-differentiated parosteal osteosarcoma of the orbital floor, which recurred 3 years later. Six months after excision of the recurrence, the mass demonstrated accelerated growth, and a lid-sparing exenteration was performed; histologic examination showed a high-grade liposarcoma. The patient remains disease-free at 4 years. The second patient, a 40-year-old male, presented with an 8-year history of proptosis and a right superotemporal orbital mass. The mass was excised completely at lateral orbitotomy; histologic examination suggested a well-differentiated parosteal osteosarcoma. The patient remains well 9 months postoperatively. CONCLUSIONS: Parosteal osteosarcoma is an uncommon tumor, usually affecting long bones, that is extremely rare in the orbit. It is a low-grade sarcoma that tends to recur locally after excision but has a favorable prognosis. Dedifferentiation into a high-grade sarcoma occasionally occurs in parosteal osteosarcoma, but transformation into liposarcoma does not seem to have been previously reported. It is important to recognize dedifferentiated parosteal osteosarcoma, because the prognosis is poor, and radical treatment may be required.

Adult↗

A combined orbital and antral approach to surgical decompression of the orbit.

A combined orbital decompression procedure has been found effective in treating proptosis. The procedure includes a lower eyelid incision by an ophthalmologist to expose the floor of the orbit, while a Caldwell-Luc antrotomy is performed simultaneously by an otolaryngologist. The ophthalmologist has a better view of the contents of the orbit and the anterior orbital floor. The otolaryngologist has better access to the posterior orbital floor and ethmoid sinus. Together, isolation and preservation of the second division of the fifth cranial nerve are facilitated. The headlight worn by each surgeon helps illuminate the other's field of dissection. This combined approach offers advantages over separate operations.

Adult↗

Orbital wall approach with preoperative orbital imaging for identification and retrieval of lost or transected extraocular muscles.

PURPOSE: To report the results of an anterior approach along the orbital wall to recover a lost or transected extraocular muscle. METHODS: This is a retrospective review of lost or transected muscles retrieved by an anterior orbitotomy approach to the adjacent orbital wall because they were unable to be recovered by a standard conjunctival approach. Magnetic resonance imaging or computed tomography was performed on all subjects before surgery. RESULTS: Six patients underwent anterior orbitotomy via an orbital wall approach; all had undergone an attempted retrieval from a standard transconjunctival approach that failed. Five muscles had been lost from surgical or traumatic transection, and 1 muscle had been lost during strabismus surgery. The muscle location at retrieval ranged from 20 to 25 mm (mean, 23 mm) posterior to the limbus. The duration that these muscles were disinserted ranged from 7 days to 7.5 years (mean, 24 months). Preoperative deviation in primary gaze ranged from 15 to 50 PD, whereas first day postretrieval deviations all measured less than 8 PD. After a mean follow-up of 162 weeks, the mean deviation in primary gaze was 2 PD (range, orthotropia to 7 PD of esotropia). CONCLUSIONS: Anterior orbitotomy along the orbital wall with preoperative orbital imaging of extraocular muscle anatomy and function combine to create a valuable approach for retrieval of a lost or transected muscle. This technique may successfully retrieve lost or transected muscles that previously were irretrievable when using a standard transconjunctival approach.

Humans↗

Retained foreign body in the orbit and cavernous sinus with delayed presentation of superior orbital fissure syndrome: case report.

Reports of delayed onset of neurological symptoms after penetrating intracranial trauma are rare. We present the case of a patient who presented with superior orbital fissure syndrome 72 hours after reported trauma to the right eye. Subsequent workup revealed a foreign body located within the orbit, passing through the superior orbital fissure and into cavernous sinus, impinging on the right cavernous carotid artery. Evidence of an intraorbital abscess was also present. Surgical management consisted of a combination of frontopterional and orbital approaches to fully expose both the cavernous sinus and the orbital contents. The foreign body was removed and the abscess was drained. The carotid artery was found to be intact. At 10-month follow-up examination, a slight ptosis and medial gaze of the right eye persist. All other symptoms have resolved.

Abscess↗

Orbital decompression for gross proptosis associated with orbital lymphangioma.

A 14-year-old boy with 11 mm of proptosis and exposure keratopathy secondary to an orbital lymphangioma underwent surgical debulking with a carbon dioxide laser through a lateral orbitotomy combined with a 3-wall orbital decompression. The proptosis was reduced by approximately 2 mm as a result of the debulking procedure, but a further 5 mm reduction was achieved with the orbital decompression. No serious adverse effects were encountered. Bony orbital decompression may be a useful alternative treatment in patients with severe proptosis secondary to orbital lymphangioma.

Adolescent↗

Orbital reconstruction after eyelid- and conjunctiva-sparing orbital exenteration.

PURPOSE: To describe the technique and results of eyelid- and conjunctiva-sparing orbital exenteration with temporalis transfer and dermis-fat graft. METHODS: Five patients who underwent this procedure were studied, based on retrospective chart review. Schematic drawings were produced to illustrate the surgical technique. RESULTS: The study included three female and two male patients with an age range of 7 to 76 years. Two patients required surgery for invasive optic nerve sheath meningioma, one for hemangiopericytoma, and the fourth for mesenchymal chondrosarcoma. The last patient had eyelid-sparing exenteration performed more than 20 years earlier for retinoblastoma and underwent a similar reconstruction. One case was complicated by infection and graft atrophy. The remaining four cases retained orbital volume and eyelid structures with a reasonable cosmetic outcome. Average follow-up period was 21 months, during which one patient had development of intracranial meningioma at the proximal end of the optic canal. CONCLUSIONS: Eyelid- and conjunctiva-sparing orbital exenteration with temporalis transfer and dermis-fat graft is a useful technique that minimizes the usual deformity and achieves good results. Case selection is emphasized, as this technique is mainly reserved for histopathologically benign orbital lesions that exhibit local aggressive behavior and for malignant lesions only if there is no eyelid, lacrimal gland, or orbital fissure involvement nor significant conjunctival or deep extension of an intraocular tumor.

Adult↗

Carcinoid tumour metastatic to the orbit with infiltration to the extraocular orbital muscle.

Ninety-three percent of symptomatic patients with small intestinal carcinoid tumours have metastases. The most common sites of metastases are lymph nodes and liver. Orbital metastases have rarely been described and the majority of them involve the choroid rather than extraocular orbital structures. We report a patient who developed proptosis, impairment of vision and reduced ocular motility on the left side, eighteen months after operation for primary intestinal carcinoid tumour with hepatic metastases. CT and MR studies revealed the tumour mass infiltrating the inferior rectus muscle. Biopsy examined by imprint and frozen section showed tumour consistent with metastatic carcinoid. The tumour was removed. HE and staining for cytokeratin, chromogranin, NSE, serotonin, somatostatin and gastrin showed that the tumour tissue corresponded to that of the primary intestinal carcinoid tumour. Intramuscular orbital metastasis from a carcinoid tumour is a rare occurrence. Diagnosis may be difficult, especially where no evidence of primary carcinoid tumour is present. Metastatic orbital carcinoid should be suspected in patients with a clinical history of carcinoid tumour and who develop ocular complaints and mass lesion in the orbit. Complete surgical removal of the tumour is important for optimal restitution of vision and eye movements.

Carcinoid Tumor↗

Orbital actinomycosis associated with painful ophthalmoplegia. Actinomycosis of the orbit.

PURPOSE: To evaluate a case of orbital actinomycosis presenting as Tolosa-Hunt syndrome in a patient with a history of carcinomas of the kidney and breast. METHODS: A woman with ingravescent painful ophthalmoplegia was brought to our observation. Brain and orbital and total body CT scans showed the presence of two orbital neoformations and a miliary pattern of dissemination in the lung. The initial diagnosis, which pointed to secondary localisations of the previous kidney and breast tumours, was changed to orbital and pulmonary actinomycosis following microbiological analysis of lung biopsy samples. RESULTS: Prolonged antibiotic therapy with synthetic penicillin completely resolved the case. CONCLUSIONS: Actinomycosis is a very rare infection that may also affect the orbit and its association with a pulmonary dissemination is highly unusual. It is important to consider this type of infection among the causes of painful ophthalmoplegia.

Actinomyces↗

Orbital hydatid cyst manifested as expanding exophthalmos following blunt orbital trauma.

A 14-year-old boy suffered right blunt orbital trauma. X-ray revealed a compressed fracture of the right ethmoidal sinuses. Three months after the trauma, progressive, painless right proptosis developed. Ocular examination revealed a severe proptosis and pronounced down displacement of the right globe without signs of orbital inflammation. A well-demarcated, extraconal right orbital cystic mass was seen on computerized tomography scan. The cyst contents were aspirated and found to contain echinococcal scolices and "hydatid sand." Hypertonic saline was injected and the cyst was excised. Progressive proptosis after blunt orbital trauma in patients from endemic areas should be suspected of being an orbital hydatid cyst.

Adolescent↗

[Metastatic orbital tumors:a case of orbital metastasis in malignant melanoma of the skin (author's transl)].

The authors feel that orbital tumor metastases are more common than generally presumed. The occurence of orbital metastases of malignant melanomas of the skin is discussed in this paper. Until now 20 cases have been published. Therapy of metastases is an unsolved problem, immunologic factors might be of some importance. The authoress describes a case of histologically verified orbital metastasis of a primary malignant melanoma of the skin, which was surgical removed three years ago. In contrast to similar cases other haematogen tumor manifestations were absent first, and the orbital metastasis seemed to be totally removed by orbital exenteration. One year later however, probably as a second metastasis, rapidly progressive tumor tissue appeared. General melanomatosis having appeared at the same time finally lead to death.

Adult↗