disorders of the orbit

8/11/2019 Disorders of the Orbit

1/41

DISORDERS OF THE ORBI


2/41

--

Six P

s: pain, proptosis, progression, palpation, pulsation, .

Pain: inflammatory, infection, oribital hemorrhage,

ma gnan acn ma g an umors anProptosis--Hertel exophthalmometer

Axial proptosis-an intraconal space-occupying lesion,

Eccentric proptosis--- an ant.space-occupying lesion.


3/41

RBI -- Pr r i n

Days to weeks--idiopathic orbital inflammatory dis.,

cellulitis, hemorrhage, thrombophlebitis, thyroid

, , ,

rhabdomyosarcoma, or granulocytic sarcoma.

ver mon s o years- ermo s, en gn m xe umors,

neurogenic tumors, cavernous hemanglomas, lymphoma,

fibrous histiocytoma, or osteomas.


4/41

-- Superonasal quadrant--- mucoceles, mucopyoceles,

, ,, .

Superotemporal quadrant--- dermoids, prolapsed

lacrimal gland, lacrimal gland tumors, lymphoma,or idio athic orbital inflammation disease


5/41

--

Without bruits-neurofibromatosis,meningoencep a oce es, or remova o t e

With or without bruits-carotid cavernous

fistulas, dural arteriovenous fistulas, and

.


6/41

Clinical evaluation of orbital disease

1. History: (1)pain, (2)mode of onset of proptosis.

(1) large ipsilateral globe,,

(3) contralateral enophthalmos (blow-out fracture)


7/41

3. Evaluation of ocular motility: restrictive

- ,

4. Visual acuity5. Dynamic properties -valsalva maneuver or jugular

,, ,6. Forced duction test

7. Differential IOP test


8/41

thyroid function (T3,T4, TSH); antithyroglobulin,antimicrosomal antibodies(60%-70% of patients

antineutrophil cytoplasmic antibody (ANCAs),

serum assay, Wegener granulomatosis


9/41

D sth roido hthalmo ath

Classification Eyelid retraction

involvement

Proptosis

Restrictive myopathy


10/41

Hypertrophy of EOM Cellular infiltration


11/41

Systemic steroids Radiotherapy


12/41

Orbital infection and inflammations

Preseptal cellulitis: affects children. secondary tolid infection such as hordeolum, skin laceration or

an insect bite .

Examination: periorbital swelling, tenderness


13/41

Orbital cellulitis: ethmoidal sinusitis, maxillarysinusitis, dacryocystitis, dental infection, post-trauma.

Most common causative organisms: streptococcus

pneumonia, streptococcus aurcus, streptococcuspyogenes;( age of 5 years--Haemophilus influenzae),

aspergillosis.

Examination--proptoisis, eyelids-swollen, erythematous,warm, tender. EOM--restricted and painful. CBC, CT,

oo an nasa cu ures.

Treatment--- bacteria-systemic antibiotics; fungus--iv

amp o er c n , w e exc s on.


14/41

idiopathic, non-specific, inflammatory, orbital diseasePresentation--20-50 years of age. Painful lid edema,

EOM--limitation ro tosis. Children: 1 3 bilateral

involvement.--- .

Treatment--observation, systemic steroids, radiotherapy,

cy o ox c rugs.


15/41

Unilateral ptosis, diplopia, redness and pain overthe involved muscle.

-

field of action of the involved muscle.

: us orm en argemen o e nvo ve musc e.

Treatment-s stemic steroids or NSAID.


16/41

Tolosa-Hunt syndrome involve the orbital apex, sup. Orbital fissure, such as

, , .Presentation-ipsilateral periorbital or hemicranial pain.

xam nat on--proptos s,ocu ar cran a nerve pa s es,pupillomotor dysfunction. Sensory loss of 1 and 2divisions of V nerve.

Treatment---s stemic steroids.


17/41

Orbital tumors

Classificationascu ar capillary haemangioma

cavernous aemagn oma lymphagioma venous anoma es


18/41

Lacrimal gland

pleomorphic adenoma

mixed-cell tumormailgnant

Rhabdomyosarcoma


19/41

Cystic lesions dermoid cyst--the common benign tumor blood cyst

mucocele


20/41

Neural optic nerve glioma optic nerve sheath meningioma

MetastaticTumor its vasion from ad acent structures


21/41

Ca illar haeman nioma

the most common primary benign tumor of the orbit

Presentation-during the perinatal period with a

,combination of both.

---

lid.Superficial straw-berry naevi may also be.


22/41

Natura course--- uring t e irst year o i e,

it starts to involute spontaneously Completeresolution

.

Association-subglottic haemangiomas,thrombocytopenia, high-output cardiac

failure.


23/41

(1) most commonly secondary to induced

r .

(2) optic n. compression or

(3) exposure keratopathy.A v r m i l mi h

Severe necrosis of infection

-


24/41

(1) Steroid injection,(2) Systemic steroids,

,

(4) Radiotherapy


25/41

avernous aemangn omathe most common primarybenign orbital tumor in

.

Presentation--during middle age with a

s ow y progress ve un a era pro os s. n women e grow ra e

may be accelerated by pregnancy.

Examination--axial proptosis, may be

associated with optic disc edema and chorioretinal folds.Treatment --surgical excision.


26/41

benign vascular tumor

tendency to recurrent hamorrhage, poorly

---

Presentation---in childhood or early adult life

xam na on-- n . umor: cys c

conjunctival component in the upper nasal quadrant.

Post. Tumor: sudden onset of painful protosis and spontanous

hamorrha e within the tumor--chocolate c sts.

Treatment---surgery is difficult. Chocolate

cys s- ra ne . ar on ox e aser--su o a y exc s on.


27/41

Arteriovenous malformations (AVM): dilated .

Treatment-selective occlusion of the feeding vessels,.

Arteriovenous fistulas (AVF):- .

(2) degeneration--H/T. atheroselerosis.

Carotid cavernous fistula--AVF of the orbit andcavernous sinus.


28/41

Orbital varices:Cause: dilation of preexisting venous channel.

Valsalva manuver--- ro tosis

Treatment---conservation


29/41

most common epithelial turnor-benign mixed-cell tumor.

, , ,

slowly growth in the upper outer quadrant ) 1 year's duration.

Examination--most cases, arsing from the orbital portion ofthe lacrimal land. CT scan bon excavation of the lacrimal land

fossa.

--


30/41

adenoid cystic carcinoma

mucoepidermoid carcinoma

-

pleomorphic adenoma; rapidly growing lacrimal gland mass.


31/41

Examination--CT MRI bio s nerolo icalassessment.

Radical surgery: orbital exenteration or-

the prognosis-extremely poor

Radiotherapy:


32/41

most common primary malignant orbital tumor in

children. resen a on- e rs eca e o e w a rap y

progressive proptosis - .

Systernic investigations-evidence of metastatic spread:CT of the chest, abdomen, and pelvis; liver function tests; lumbarpuncture; bone marrow biopsy. and skeletal radiographs.

Treatment--radiotherapy and chemotherapy.

recurring or radiotherapyresistant tumor.The survival rate is90%--confined to the orbit and 65% in the presence of bonyes ruc on an ex ens on.


33/41

most commn orbital tumors of childhood; benign

i r m h ri m . Lined by keratinized stratified squamous epith.,

such as sweat glands, sebaceous glands and hairo ic es.

Epidermoid cyst do not contain adnexal structures. Examination -upper temporal orbit.

-


34/41

s ow-grow ng umor; young g r s; - opatients -associated neurofibromatosis type 1.

Presentation--visual loss in children, but this may not

- .

Examination---disc edema followed by pallor;

prop os s.

CT: fusiform enlargment of the optic nerve. MRI: demonstrating the post., extent of the


35/41

Treatment-

for several year,

growing tumor,

ra iot erapy an c emot erapy: intracraniaextension.


36/41

rare tumors; arise from the meningoendothelial cells of

-Presentation-slowly progressive, unliateral, visual loss.

xam na on- sc e ema, op coc ary s un vesse s

(capillaries connecting the central retinal vein with theperipapillary choroidal vessels), also seen in patients withoptic nerve glioma.

CT: tubular thichening and calcfication of the optic nerve.


37/41

Treatment--

o serva on: m e-age pa en s w s ow

growing tumors because the prognosis is good.(2)radiotherapy: with slow-growing tumors and

.

(3)surgical excision: blind of eye in young patients

w grow ng umor.


38/41

Childen: Neuroblastoma, Ewing's sarcomaacute myeloid leukemia

,

manifestation of the tumor. Breast

(Female), bronchus (Male), prostate (Male),

-, .


39/41

maxillary carcinoma, ethmoidal carcinoma


40/41

Craniofacial stenosesCrouzon syndrome-ptoptosis, corneal exposure,

hypertelorism, ET, optic atrophy.

' -anisometropic amblyopia, corneal exposureor optic atrophy.

a era ac a m cros om as

Treacher Collins syndrome-eyelid coloboma, strabismusand ambl o ia.

Goldenhar's syndrome--epibulbar dermoids,microphthalmos, anophthalmos, microcomea,

, . , .


41/41

Hypertelorismexcessive bony tissue of the medial orbital

between the eyes.

-- , m crop t a mos, m crocomea an

optic atrophy.

disorders of the orbit

Documents