Diseases of Orbit

Yang Wei

ophthalmology department
in affiliated hospital of Southwest Medical
University
E-mail: yangwei1325@126.com 1
 Definition

 Orbit is make of orbit bone and contents.

 seven bones: frontal bone ， sphenoid, zy
gomatic bone ， maxillary ， palate bon
e ， lacrimal bone ， ethmoid
 contents ： eyeball, optic nerve ， extraoc
ular muscle ， vessel, nerve, fascia ， fat
 Physiology of Symptoms

• proptosis is the hallmark of orbital

disease
• the position of the eye is determined
by the location of the mass
• limitation of ocular movement,
diplopia (double vision) and pain
 Diagnostic Studies

1.Imaging

• Computerzied tomography (CT)

• Magnetic resonance imaging (MRI)

• are the major advance in orbital

diagnosis
 MRI VS CT

• strength ： superior on changes in

soft tissues and the optic nerve than
CT.
• contraindication ： in the presence of
a ferrous and magnetic intraorbital or
intracranial foreign body.
CT
MRI
 2. Ultrasonography

B-ultrasound

• was benefited in diagnosis of the

vitreous and retina.
• has largely been replaced by CT
and MRI in diagnosis of orbital
disease.
3. Venography
• is occasionally used in defining the
extent of orbital venous disease

4. Angiography
• selective carotid angiography with
bone subtraction is sometimes
necessary to diagnose orbital
vascular disorders
5. Radiography

• plain x-rays may be sufficient for

initial diagnosis of orbital
fractures
• almost was substituted by CT and
MRI
6. fine-needle aspiration

• cytopathology can be inconclusive

but is often invaluable especially in
orbital tumor
 Orbital Diseases

thyroid related immune orbitopathy (TRIO)

• etiology ： autoimmune disease,caused by

hyperthyroidism especially the
Graves‘disease
• pathology ： inflammation of extraocular
muscle,fat, lacrimal gland and connective
tissue in orbit
 clinical symptoms

1. lid retraction-eyeball proptosis

• proptosis associated with thyroid

disease is accompanied by lid
retraction, which serves to
distinguish it from other causes of
proptosis.
lid retraction
2. diplopia and restricted ocular movement

• usually first attack the inferior rectus

• diplopia usually begins in the upper field
of gaze
3. conjunctival and corneal lesion

 conjunctival edema and congestion

 exposure keratitis
 corneal ulcer
4. compression of the optic nerve

• caused by orbit edema and high

pressure
• pupillary defect, impairment of color
vision, slight loss of visual acuity,
blindness
compression of the optic nerve
 Treatment

systemic disease

 treat of the hyperthyroidism first.

 TRIO

medicine,x-ray and surgery

• an important goal of treatment is to

avoid exposure keratitis
• diplopia, proptosis, and compressive
optic neuropathy
exposure keratitis
• early stage: vein methylprednisolone impact
therapy (IVMP) for 3 days to relieve
inflammation
• early compression neuropathy may also be
relieved by radiation therapy
• several approaches have been devised to
expand the orbital volume by fracture of the
bony wall
• strabismus surgery should not be
undertaken until the myopathy has stabilized
 Pseudotumor

• a frequent cause of proptosis in adults

and children is inflammatory
pseudotumor
• is a nonneoplastic process
• produces the sentinel sign of an orbital
neoplasm
• the site of inflammation is usually
diffuse and not necessary to excision
 Treatment

• systemic drug:
1. non-steroidal anti-inflammatory drugs
(NSAIDs)
2. corticosteroids

• systemic radiation
• surgery
 Orbital Cellulitis

• is the acute inflammation of orbital

soft tissue
• usually sudden onset, and is common
in children in clinic.
• immediate treatment is essential.
• is not difficult to diagnosis for the
clinical findings are characteristic.
Orbital Cellulitis
 Clinical symptom

• edema, red and swollen, hyperemia,

pain, leukocytosis, chemosis,
proptosis
• limitation of eye movement, reduction
of vision
• brain abscess and meningitis
 Diagnose

• CT scan and MRI are most important

and the common method

• characteristic clinical symptom

 Treatment

• treatment should be initiated before the

causative organism is identified.

• as soon as nasal, conjunctival, and

blood cultures are obtained,
intravenous antibiotics should be
administered
2. hot compresses

3. early surgical drainage

 Cavernous Hemangioma

• is a benign disorder
• grow slowly
• usually become symptomatic
Cavernous Hemangioma
 Clinical Findings
proptosis, hyperopia
 Treatment

Surgical excision
 Capillary Hemangioma

Capillary hemangiomas are common

benign tumors that sometimes involve
the eyelids and orbit .
 Clinical Findings

• Over 90% become apparent before the

age of 6 months.

• regress slowly over 6-7 years

• reddish, more bluish

• strabismus, proptosis, amblyopia.

Capillary Hemangioma
 Treatment

1. small superficial lesions require no

treatment and are best allowed to naturally
regress

2.deep orbital lesions are often associated

with significant morbidity with or without
treatment
• prolonged compression, systemic
corticosteroids, sclerosing
agents, cryotherapy, laser
surgery, radiation, and surgical
resection.