Evaluation of Orbital Disorders

The evaluation of an orbital disorder should distinguish orbital from periorbital and intraocular

lesions. This distinction provides a framework for development of a differential

diagnosis. The evaluation begins with a detailed history to establish a probable diagnosis

and guide the initial workup and therapy. Such a history should include

onset, course, and duration of symptoms (pain, altered sensation, diplopia, changes

in vision) and signs (erythema, palpable mass, globe displacement)

prior disease (such as thyroid eye disease [TED] or sinus disease) and therapy

injury (especially head or facial trauma)

systemic disease (especially cancer)

family history

Old photographs are frequently helpful for evaluating onset of globe displacement and

establishing duration of the disease. Pooyan 6696 1526-7

History

Pain

Pain may be a symptom of inflammatory and infectious lesions, orbital hemorrhage,

malignant lacrimal gland tumors, invasion from adjacent nasopharyngeal carcinoma, or

metastatic lesions.

Progression

The rate of progression can be a helpful diagnostic indicator. Disorders with onset occurring

over days to weeks are usually caused by nonspecific orbital inflammation (NSOI),

cellulitis, hemorrhage, thrombophlebitis, rhabdomyosarcoma, neuroblastoma, metastatic

tumors, or granulocytic sarcoma. Conditions with onset occurring over months to years

are usually caused by dermoid cyst, benign mixed tumor, neurogenic tumor, cavernous

hemangioma, lymphoma, fibrous histiocytoma, fibrous dysplasia, or osteoma.

Periorbital Changes

Periorbital changes may provide clues indicative of the underlying disorders. Table 2-1

lists various signs and their common causes.