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At least 145 records · Page 8Linked to original sources

PubMed2003

[Orbital vasculonervous network and orbital surgical compartments by high field magnetic resonance].

PURPOSE: To elucidate the possibilities and indications of high-resolution magnetic resonance imaging (MRI) in the study of the orbit and its contents. METHODS: Orbital anatomy was studied in sliced specimens of fifteen fresh frozen cadavers and the results were compared with those obtained in thirty asymptomatic subjects who underwent a magnetic resonance with 1.5 Tesla equipment. The information obtained was used to interpret the findings in twenty-two patients with various orbital diseases. RESULTS: High-resolution MRI allows visualization of structures difficult to assess previously, like the cerebrospinal fluid (CSF) surrounding the optic nerve, the complete intraorbital route and the exit of the third cranial nerve, the ophthalmic artery and the intraorbital relationships of the sixth cranial nerve, which can be clearly differentiated from the lateral rectus muscle. CONCLUSIONS: High-resolution MRI is a very useful tool for the study of the orbit and its content. It provides accurate diagnoses through non-invasive procedures and facilitates the planning of the surgical approaches by improving the visualization of pathologic orbital structures. lcarlos@correo.uniovi.es

Cadaver↗

PubMed1983

Diagnosis of exophthalmos using orbital ultrasonography and treatment of malignant exophthalmos with steroid therapy, orbital radiation therapy, and plasmapheresis.

For the quantitative analysis of the extraocular muscle changes in Graves' disease, we used B-mode ultrasonography. 113 patients investigated in this study had no signs or symptoms of ophthalmopathy except proptosis. Muscle index was calculated as a sign of extraocular muscle enlargement. Muscle index of Graves' disease was significantly larger than that in controls (6.03 +/- 2.83 and 3.10 +/- 1.29, respectively). The muscle index in Graves' patients without clinical signs of exophthalmos was significantly increased when compared to control subjects, although both groups had the same degree of proptosis. The data show a uniform enlargement of the extraocular muscles in Graves' disease. The degree of proptosis is in close proportion to the quantitative change of the orbital soft tissue. Seven patients with malignant exophthalmos were treated with steroid therapy, supervoltage orbital radiotherapy or plasmapheresis. All patients had moderately severe ophthalmopathy due to Graves' disease. Both steroid therapy and orbital radiation therapy were effective in improving the symptoms of orbital soft tissue involvement and for diplopia. The effect of orbital radiation therapy was insufficient for the amelioration of proptosis in spite of a no significant decrease. The improvement of proptosis was evident only after 3-7 months of the radiotherapy. Plasmapheresis was effective in improving the ulceration of cornea and proptosis, but this was a transient effect.

Exophthalmos↗

PubMed1983

B-scan ultrasonic evaluation of a dilated superior ophthalmic vein in orbital and retro-orbital arteriovenous anomalies.

All patients between 1977 and 1982 who presented with unilateral exophthalmos were evaluated with contact B-scan ultrasonography. Of these, eight patients were diagnosed as having retro-orbital or orbital arteriovenous anomalies (two carotidcavernous sinus fistulas, four dural arteriovenous malformations, and two orbital arteriovenous malformations). On B-scan ultrasound, all of these patients demonstrated a dilated superior ophthalmic vein. None of the other patients with unilateral proptosis demonstrated this finding. With recent advances in treatment of these conditions, early diagnosis becomes increasingly important. Contact B-scan ultrasonography (which is widely available, convenient, and expedient) can be used for early diagnosis of arteriovenous anomalies in the orbit and cavernous sinus areas. Other ultrasonic techniques such as A-scan, standardized A-scan, or immersion B-scan, are equally reliable in the recognition of a dilated superior orbital vein. In the authors' opinion, however, these are less convenient, more time consuming, and require more expertise for similar results.

Adult↗

PubMed1994

Orbital marginotomies for treatment of orbital and periorbital lesions.

Access osteotomies allowing temporary displacement of various segments of the orbital rim provide direct visualization of deep orbital and paraorbital regions. These marginotomies are classified, according to the orbital region involved, as lateral, medial, superior, or inferior, and they provide adequate exposure of the corresponding orbital wall and its surrounding structures. Since these procedures are without complications and cause no unpleasant cosmetic effects, they are highly recommended for the treatment of various lesions in this area as well as for correction of malformations.

Bone Plates↗

PubMed2005

Chronic subperiosteal hematic cyst formation twelve years after orbital fracture repair with alloplastic orbital floor implant.

An 89-year-old female patient with a history of a left orbital floor fracture repair with synthetic implant 12 years prior, presented with a three-week history of blurry vision, inferior conjunctival chemosis and proptosis of the left eye. CT scan revealed a well-circumscribed subperiosteal lesion with superior elevation of the orbital floor implant. The patient underwent transconjunctival orbital surgery with removal of the implant and drainage of the subperiosteal hemorrhagic cyst. The patient had an uncomplicated postoperative course, with resolution of the proptosis, chemosis, and return of normal vision. This case represents an unusual late complication of orbital fracture repair with associated reduced visual acuity.

Aged↗

PubMed2002

[Pterional orbital decompression in traumatic orbital hematomas].

The results are presented for pterional orbital decompression in 12 patients with symptomatic traumatic retrobulbar hematoma after various traumatic mechanisms. Pre- and postoperative course, neuroradiological findings, additional brain or facial injuries as well as outcome of eye function are analyzed in detail. Mean time delay between trauma and decompression was 56 h (2.4 days), with a wide range from 2 h to 15 days. Preoperative exophthalmos and pupillary disturbances as well as restrictions of extraocular movements decreased in all patients after orbital decompression and removal of the retrobulbar hematoma if the bleeding was localized. Visual acuity remained normal or showed significant improvement in seven patients, four of whom experienced complete recovery. In three patients the eye remained amaurotic. No complications related to the operation were seen. The pterional orbital decompression described here represents an effective alternative approach for patients with sight-threatening retrobulbar hematoma, especially in cases where it is necessary to gain space for the orbit in addition to evacuating space-occupying blood or bone clots and treating neighbouring lesions. Immediate detection and adequate treatment of orbital hematomas is mandatory to achieve an acceptable outcome of eye function.

Adolescent↗

PubMed1976

Orbital neurofibromatosis: involvement of the orbital floor.

Neurofibromatosis has been reported to involve the eye and orbit by causing irregularities of the sphenoid and other facial bones and enlargement of the foramina. To our knowledge, abnormalities of the orbital floor, however, have not been attributed to this disease in the literature until now. Two patients with neurofibromatosis had orbital floor involvement. Multiple neurofibromas eroding the orbital floor threatened vision in one patient. The other case, seen after trauma, had a condition simulating that of a blow-out fracture. Diagnostic workup with adequate roentgenography, especially tomography, helped to establish the diagnosis. We believe this is of importance in modifying the surgical approach, obviating the need for surgical intervention at times.

Female↗

PubMed2006

[Squamous cell carcinoma of the conjunctiva with orbital invasion: orbital exenteration or minimally invasive procedure?].

BACKGROUND: Here we present a case of a female patient with squamous cell carcinoma with orbital invasion who insisted on a globe-sparing excisional biopsy rather than a more invasive procedure. CASE: A 48-year-old patient presented with a conjunctival tumor at the medial canthus of the right eye. The visual acuity in this eye was 1.0. MRI showed a 25 mm x 12 mm tumor, with orbital invasion, no metastasis, but on CT scan damage of the lamina papyracea was suspected. Histology of a punch biopsy confirmed a moderately differentiated, squamous cell carcinoma. As requested by the patient, simple tumor excision with a 5-mm safety margin, reconstruction of the lower fornix with amniotic membrane, and adjuvant mitomycin C therapy were performed. Intraoperatively the medial orbital wall was found to be intact. No local or systemic recurrence has occurred 3.5 years postoperatively. The patient's VA is still 1.0; no visual field defects are detectable, and there are only minor upper lid levator restriction and diplopia in maximum upgaze. CONCLUSION: In view of this case the choice of surgical treatment for malignant tumors of the conjunctiva with orbital invasion - between exenteration or a minimally invasive procedure - should be carefully discussed with the patient. A follow-up of 5 years is strongly recommended.

Carcinoma, Squamous Cell↗

PubMed1987

Blowout fracture of the orbital floor with entrapment caused by isolated trauma to the orbital rim.

There are two main theories on the cause of blowout fractures of the orbit: the "hydraulic" theory and the "buckling force" theory. Although both mechanisms have been shown responsible for experimental blowout fractures, the role of isolated rim trauma in producing clinical blowout fractures with entrapment of orbital soft tissues continues to be questioned. I examined a 69-year-old patient who developed a blowout fracture with clinical evidence of entrapment after isolated trauma to the orbital rim. Five days previously the patient had had a cataract extraction and implantation of an intraocular lens in the ipsilateral eye, which remained undisturbed by the trauma. This case supports the role of a buckling force to the rim in producing orbital blowout fractures. Review of the circumstances of injury in large series of blowout fractures suggests that this mechanism may be operative in the majority of cases.

Accidental Falls↗

PubMed1990

Computerized tomographic analysis of orbital hypertelorism repair: spatial relationship of the globe and the bony orbit.

Computerized tomographic scans provide a new means of evaluating the spatial and geometric relationships between the movement of the bony orbit and its soft tissue contents (the globe and extraocular muscles) [1, 12]. Preoperative and postoperative computerized tomographic scans were analyzed in four patients to explore these relationships. Measurement of the changes in distance between the globes correlated most closely with the change in the distance between the lateral orbital walls; resection of medial (inter-orbital) bone provides space into which the globe is translocated. The medial rectus muscle may be bowed across the medial wall osteotomy line, creating a functional shortening of the muscle; this finding may explain the esotropia that is commonly seen after this procedure [2, 3]. These observations should have a direct impact on the understanding and planning of orbital hypertelorism correction.

Adult↗

PubMed1998

Orbital melanoma presenting as orbital cellulitis: a clinicopathologic report.

Most choroidal melanomas are diagnosed when the tumor is still relatively small and confined to the globe. Rarely, these tumors can escape detection and extend through the sclera. They can reach a large size and create significant orbital inflammation. The authors describe a 71-year-old man with orbital cellulitis secondary to a necrotic choroidal melanoma that invaded the orbit. This tumor had minimal intraocular involvement with a large extrascleral component. On histopathologic analysis, the lesion was best classified as a spindle B melanoma with epithelioid areas (mixed melanoma). The patient was treated with an enucleation and postoperative radiation. This report demonstrates that malignancies in the orbit can present as acute infections. Early suspicion, diagnosis, and treatment of these lesions offer the best chance for survival.

Aged↗

PubMed1997

Orbital tuberculoma masquerading as an orbital malignancy.

BACKGROUND: Orbital tuberculosis is exceedingly rare in areas where tuberculosis is non-endemic. A case of childhood orbital tuberculosis is reported, which the authors believe to be the first reported case of orbital tuberculosis in the Australasian region. METHODS/RESULTS: The patient a 6-year-old boy presented with proptosis and was initially mistaken to have an orbital malignancy. Treatment with antituberculous drugs resulted in resolution of the condition. CONCLUSION: This case served as a timely reminder of the need to keep awareness of the extrapulmonary manifestations of tuberculosis alive even in developed countries. A high index of suspicion for this eminently treatable disease in the appropriate clinical situation is particularly important when migrant communities from high-prevalence areas are involved.

Antitubercular Agents↗

PubMed2002

Orbital exenteration for secondary orbital tumors: a series of seven cases.

BACKGROUND: Exenteration is indicated in patients with malignant neoplasms of orbital contents. It entails the removal of the eyeball together with its extraocular muscles and other soft tissues. Exenterations can be classified into (1) total, (2) subtotal, and (3) supertotal exenteration. Retrospectively study, we reviewed 7 patients that had received exenteration/subtotal exenteration with spontaneous granulation/myocutaneous flap implantation or eyelid-sparing exenteration with myocutaneous flap. Primary lesions, histopathological examination results, treatments, and recurrences are discussed. METHODS: A retrospective study of the years 1987 through 2000 disclosed 7 patients that underwent exenteration/subtotal exenteration. The patients ranged in age from 41 to 68 years. Two patients underwent total exenteration without socket augmentation; 4 patients underwent exenteration/ subtotal exenteration with immediate facial reconstruction, and 1 with delayed facial reconstruction. RESULTS: Classification of the 7 patients showed that 2 had basal cell carcinoma of the skin, 2 had squamous cell carcinoma of the conjunctiva, 1 had squamous cell carcinoma of the paranasal sinus, 1 had rhabdomyosarcoma of the paranasal sinus, and 1 had intracranial meningioma. Radiotherapy was performed in 6 of the patients and chemotherapy in 2. Central nerve system invasion was noted in 2 patients, and 1 died due to it. CONCLUSION: Secondary orbital tumors involved the orbit from adjacent tissues: paranasal sinuses, nasopharynx, lacrimal sac, conjunctiva, eyelid, intraocular tissue, and intracranial tissues. Combined surgeries are necessary for complete tumor removal. And the imaging studies should include the field of the orbit, sinus, and brain to search for the primary lesions.

Adult↗

PubMed1987

Paranasal sinusitis, orbital abscess, and inflammatory tumors of the orbit.

We present the clinical, radiological, and histopathological findings from a case of unilateral inflammatory mass of the right orbit, originating in the ipsilateral paranasal sinuses. A connection between inflammatory tumors of the orbit and paranasal sinusitis has been suspected for many years. This case shows a definite association between chronic paranasal sinusitis, orbital cellulitis, subperiosteal abscess, and formation of an inflammatory orbital tumor. Early diagnosis combined with appropriate therapeutic measures is essential in order to prevent adverse consequences, which can include severe visual loss.

Abscess↗

PubMedDate not supplied

Orbital pseudotumor: association of orbital vein deformities and myositis.

Twenty adult patients with orbital pseudotumor were studied with orbital venography and magnification arteriography. Computed tomography (CT) scans were obtained in 14 patients. Occlusive and constrictive changes of the proximal segments of the superior ophthalmic veins were the most frequent vascular abnormalities. The affected ophthalmic arteries were often attenuated but not occluded. Myositis and surrounding connective tissue inflammatory changes are thought to result in sufficient mass effect to cause the venous stasis with narrowing and subsequent occlusion. Such venographic changes are not distinctive for orbital pseudotumor but may also be seen in cases of thyrotoxicosis, Tolosa-Hunt syndrome, and orbital tumors.

Adult↗

PubMed2004

Treatment of recalcitrant idiopathic orbital inflammation (chronic orbital myositis) with infliximab.

PURPOSE: To report results of treatment with a monoclonal antibody (infliximab) directed against tumor necrosis factor alpha in seven patients with chronic and difficult-to-control idiopathic orbital inflammation (orbital myositis). DESIGN: Observational case series. METHODS: Retrospective data were collected from seven patients who had idiopathic orbital inflammation and who were evaluated at three medical centers. All patients were treated with infliximab after the failure of traditional therapy, which included corticosteroids, radiotherapy, or anti-inflammatory chemotherapeutic agents. RESULTS: All seven patients had a favorable response to treatment with infliximab. One patient with Behcet disease required supplemental oral corticosteroids. Pain, swelling, and need for concomitant corticosteroids were the primary measures of treatment success. Symptoms of comorbid disease in four patients also improved (Crohn disease in two, Behcet disease in one, and psoriasis in one). There were no untoward effects of treatment after a mean follow-up of 15.7 months (range, 4 to 31 months). CONCLUSIONS: Treatment with infliximab appears to offer another therapeutic option in cases of recalcitrant or recurrent idiopathic orbital inflammation in which conventional treatment fails.

Adult↗

PubMed2002

Orbital rhabdomyosarcoma metastatic to the contralateral orbit: a case report.

OBJECTIVE: To report a rare presentation of metastatic orbital rhabdomyosarcoma and the corresponding findings on magnetic resonance imaging (MRI). DESIGN: Interventional case report. RESULTS: A 29-year-old white man was diagnosed with rhabdomyosarcoma of the left sinus and orbit for which he was treated with chemotherapy and radiation. Eighteen months after diagnosis, he returned with subacute right eye pain and dysmotility of his extraocular muscles. MRI revealed solitary enlargement of the right medial rectus muscle, and thyroidopathy was suspected. Over the next 2 months, symptoms progressed, and proptosis developed. MRI showed infiltration of seven extraocular muscles. A biopsy of right orbital tissues and the right medial rectus muscle was performed. Special tissue typing confirmed metastatic alveolar rhabdomyosarcoma. The patient underwent palliative radiation therapy and chemotherapy, but he ultimately died of disseminated disease. CONCLUSIONS: Rhabdomyosarcoma can rarely metastasize to the extraocular muscles. Earlier recognition of orbital metastasis through radiographic and biopsy findings, along with prompt and aggressive treatment, may prevent fulminant spread of rhabdomyosarcoma.

Adult↗

PubMed1983

Exenteration of the orbit in selected cases of severe orbital contracture.

Severe orbital contracture is treated with graft-covered conformers fixed to the orbit with wires, pins or a headcap. In spite of these vigorous techniques, failures occur. Exenteration was used in four cases of severe orbital contracture with deformity and restricted function of the eyelids. The patient was fitted in six to eight weeks with a prosthesis made from methyl methacrylate and silicone. The margins of the prosthesis were inconspicuous in contrast to older prostheses made entirely of methyl methacrylate. The flexible silicone was well tolerated by the skin of the orbital margins. Patient acceptance and cosmetic appearance has been excellent.

Adult↗