orbit and lids and lacrimal disorders by dr. abdulmajid alshehah ophthalmology consultant anterior...
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Orbit and lids and lacrimal disorders
ByDr. ABDULMAJID ALSHEHAH
Ophthalmology consultantAnterior Segment and Uveitis consultant
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The orbit
Anatomy Function• protection to the globe• attachments which stabilize
the ocular movement;• transmission of nerves and
blood vessels.
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The orbit
• Clinical features of orbital disease• Proptosis• Enophthalmos• Pain• Eyelid and conjunctival changes• Diplopia• Reduced visual acuity
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The orbit
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The orbit
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Proptosis (exopthalmos)• protrusion of the eye caused by a space-
occupying lesion• can be measured with an
exophthalmometer.• 3 mm difference between the two eyes is
significant.
• Direction of proptosis• Transient proptosis (orbital varices)• Fast onset proptosis (malignant,
inflammatory)• Slow onset proptosis (benign)• Pain associated with proptosis ( orbital
cellulitis)
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Thyroid ophthalmopathy
Pathogenesis • Disorders of the thyroid
gland can be associated with an infiltration of the extraocular muscles with lymphocytes and the deposition of glycosaminoglycans.
• An immunological process is suspected but not fully determined.
Clinical features• Proptosis (most common
cause in adults)• Lid retraction (characteristic
stare)• Lid lag• Double vision• red painful eye (exposure)• Reduced visual acuity (optic
nerve)
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Thyroid ophthalmopathy
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Thyroid ophthalmopathy
• Treatment of associated ocular emergencies (optic nerve compression and corneal exposure)
1- systemic steroid2- radiotherapy3- orbital decompression4- heavy lubrication
• Long term treatmentOnly after stabilization, muscle and lid surgery
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Diplopia (Muscle pathology)
Thyroid ophthalmopathy (Graves’ ophthalmopathy)
Idiopathic Orbital Inflammatory Disease ( orbital pseudotumor)
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Enophthalmos
• Congenital (small eye)• After trauma ( blow out
fracture)
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Orbital pain
• Infection• Tumors (malignant)• inflammation
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Eyelid and conjunctival changes
• Redness• Swelling(orbital cellulitis, preseptal
cellulitis, carotid cavernous fistula)
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Reduced visual acuity
• Corneal exposure• Compression or inflammation of optic nerve• Macular distortion
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Orbital tumors
• lacrimal gland tumors• optic nerve gliomas• meningiomas• lymphomas• Rhabdomyosarcoma (most common orbital malignancy in
childhood)• metastasis from other systemic cancers (neuroblastomas in
children, the breast, lung, prostate or gastrointestinal tract in the adult).
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QUSTIONS
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The eyelids
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ABNORMALITIES OF LID POSITION
• Ptosis • Entropion
• Ectropion
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INFLAMMATIONS OF THE EYELIDS
• Blepharitis
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BENIGN LID LUMPS AND BUMPS
Chalazion Xanthelasmas
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MALIGNANT LID TUMOURS
• Basal cell carcinoma (rodent ulcer)
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ABNORMALITIES OF THE LASHES
• Trichiasis
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QUSTIONS
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The lacrimal system
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The lacrimal drainage system
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NLD obstruction
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Congenital NLD obstruction
• 5% of all full-term newborns.
• 90% open spontaneously in the first year of life.
• Tx: massage and antibiotics drops if infected.
• Sometimes need probing and tubing
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Adult NLD obstruction
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Dacryocystitis
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Questions