ORBIT PATHOLOGY 1

EXOFTALMIA PROPTOSIS

Exoftalmometrul HERTEL

Subjects Dysthyroid ophthalmopathyDysthyroid ophthalmopathy Orbital inflamatonsOrbital inflamatons Orbital tumorsOrbital tumors 5

Dysthyroid ophthalmopathy Autoimmune disease associated with thyroid gland dysfunction Dystyroid orbitopathy or ophthalmopathy; Graves’ ophthalmopathy; Most common unilateral or bilteral proptosis affecting women (8:1) 80% with hyperthyroidism 6

Symptoms: –foreign-body sensation –tearing –red eye –diplopia Signs: –Eyelid disorders: retraction, lagophtalmos –Eye surface disorders: dry eye,chemosis –Ocular motility disorders: restricted eye movement –Optic neuropathy: RAPD, IOP increase 7

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tendinous insertion of the extraocular muscle at the globe is not thickened, which is characteristic of thyroid-related orbitopathy medium to high internal reflectivity of the extraocular muscle belly enlarged bellies of the extraocular muscle enlarged extraocular muscles LAB TESTS: TSH; TRH; triiodothyronine 9

treatment Exposure keratopathy: lubrication, punctal oclusion, blepharorraphy Eyelid retraction:surgical eyelid lengthening Diplopia and strabismus: prism glasses, surgery Optic neuropathy: steroids, orbital decompresion, external-beam radiation (15Gy) 10

Orbital inflamatons Infections:Infections: –preseptal cellulitis –orbital cellulitis Steril inflamation:Steril inflamation: –orbital pseudotumor –dysthyroid ophthalmopathy 11

Preseptal cellulitis Usually after eyelid trauma (cosmetics) Clinical: (only the eyelid is ivolved) –pain –eyelid swelling –redness –ptosis Treatment: –antibiotics –warm compresses 12

Orbital cellulitis Infection posterior to the orbital septum Secondary to: –sinusitis –dacryocystitis –dental caries –orbital trauma –preseptal celullitis Clinical: (lid, eye and orbit involvment) –decrease AV –chemosis –painful an limited ocular movements –RAPD 13

Orbital pseudotumor Idiopathic orbital inflamation: acute or cronic Unique or associated invovments: –orbital fat –optic nerve sheats –extraocular muscles –lacrimal gland –sclera Clinical: depends of tissue involvment 15

Treatment: –Corticosteroids –Iunosupresors: cyclosporine –Inflamatory radiotherapy –Surgical: orbit decompresion 16

Orbital tumors Cavernous hemangioma Mucocele Neurilemmnoma (schwannoma) Meningioma Limphoid tumors Metastatic tumors 17

Cavernous hemangioma The most comon orbital tumor 4-6 th decades of life Woman Cinical simptoms: –Progressive proptosis –Compresive optic neuropathy –Diplopia –Hyperpia –Strabismus –Increase IOP 18

Orbital CT: well circumscribed mass B-scan ultrasonography: high internal reflectivity Treatment: surgical excizion 19

Mucocele Cystic sinus mass caused by obstruced excretory ducts History of sinusitis (frontal, ethmoidal) Supero-nasal development Can products: –bony erosion –orbital invasion Treatment : surgical excizion 20

THE DISEASES OF THE LACRIMAL SYSTEM 24

26 Dacriocystitis supurative inflammation of the lachrymal sac frequently associated with perisacular cellulite (dacriopericystitis) Clinical –swelling and congestive skin of the the canthal and inferocanthal region –intense spontan pain. –press on the swelling region a terrible pain appears and pus come out through the lachrymal puncta

28 Treatment Massage of lachrymal sac region, antibiotics and anti-inflammatory drops and ointments. Cateterism and irigation of the lachrymal drenage system with antibiotics using special probes (Bowman). Surgical dacriocystorinostomy