ORBIT AS A MIRROR OF SYSTEMIC DISEASES: Epidemiologic, Clinical and Radiological Ali Akbar Ameri – M.D. Jalal Jalal Shokouhi- M.D.

Eye involves by: 1. Infection:Toxoplasmosis,Toxocaria,TB, Syphilis, Leprosy, HIV, CMV, Non-infectious: Endocrine (Thyroid),Diabetes, RA, SLE, Wegners, Pansystemic sclerosis, Vasculitis, Sarcoidosis, Behcets disease,Vogt koyangi harada syndrome, phakomatosis, MS

Orbital malformation Craniostensois. Fibrous dysplaisa. Enucleation (prosthesis.) Microphtolmia. Tumors 1-Malignant. 2-From adjacent mass "sinus … 3-Neuro fibromatosis. Small orbit Neurofibromatosis. Large orbit Neurofibromatosis Intra orbital calcification.

Calcification 1- Cataract 2- Foreign body 1- opaque 2- non opaque 3- Gel 3- Phelebolitis 4- Phthisis bulbi 5- Retinoblastoma 6- Infections 7- T.B. Syphilis 8- Neoplasm 9- Meningioma- Dermoid 10- Parasite 11-Hydatid cyst cysticercosis

Imaging modalities 1. X-Ray 2. High frequency US(Biomicroscope),color doppler, biometry. 3. X-Ray CT 2D,3D 4. MRI (Biometry)

X-RAY: 1. Fractures 2. Foreign bodies (old fashion: suite, contact lens) 3. Skull combined anomalies. 4. Optic foramen views 5. DSA

High frequency us. 1) Globe: biometry(A-Scan, B-scan),color doppler,3D,3D color doppler. 2) Anterior and posterior chamber ultrasound microscope (21-48 MHZ)for ciliary bodies. 3) Vitrus and retrobulbar us.

X-Ray CT in 2D,3D,bony and soft tissue i. Anatomy ii. Pathology iii. Fractures iv. Foreign bodies (axial-coronal) v. CTA for large vessels, small vessels by DSA.

MRI 1. Anatomy 2. Diseases, tumors 3. Functional 4. Tractography(3-9.4 tesla) 5. MRA and MRV for large vessels in intra-cranial

Flurcein Angiography Out of Radiology for Retina

Conclusion : modality of choice I. X-Ray CT for foreign body(MRI is contraindicated in the first step),micro calcifications and fractures. II. MRI for tumors, biometry, functional imaging, visual tract imaging. III. DSA(X-Ray angiography)for vascular lesions of orbit(intra cranial by CTA,MRA,MRV) IV. US for biometry, iris and anterior, posterior chamber lesions, color doppler of central retina artery and tumor vessels (3D color doppler) V. Flurcein angiography for retinal map(out of radiology )

Look at eyes and make diagnosis You should be a technician and a clinician

Red eyes Infection and conjunctivitis hang over. Glaucoma-allergies Meningitis, Foreign body.Reiter Becht's syndrome- tolosa hunt vogt koyanagi harda syndrome chemical infiltration. Cavernous sinus thrombosis S.V.C obstruction. vitamin C deficiency. Red blood shot eyes MS. Autoimmune eyes. Lupus

Black eyes Eye injury. Blow to the eye. Microphthalmia Waandenburg syndrome-rubella- C.M.V. Trisomy 13 (pata syndrome) Fetal alcohol syndrome.

The aims of this presentation are: Clinic + Technique +Image Take home message Looking to the eyes: 1- M.S. 2- Infection. 3-Bulging 4- Depression and … Imaging: 1- Calcification. 2- Foreign body. 3- Hyper and hypo telorism. 4- Exophtolmous and proptosis 5- Enophtolmous. 6- Tumors. etc..

اي چشم تو چشمم، چشم عالم را چشم من چشم نديدم به چشم تو به چشم من چشم نديدم به چشم تو به چشم چشمم ز ميان چشم، چشم تو گزيد چشمم ز ميان چشم، چشم تو گزيد اين‌چشم‌چه‌چشمي‌است‌چه‌چشمي‌است‌چه‌چشم اين‌چشم‌چه‌چشمي‌است‌چه‌چشمي‌است‌چه‌چشم