1. The anatomy of the orbit
1- The Roof:
2- The Lateral Wall
3- The Floor:
4- The Medial Wall:

2. Clinical signs of orbital disease
1- Soft tissue involvement:

3. Clinical signs of orbital disease
2- Proptosis:

4. Clinical signs of orbital disease
2- Proptosis:

5. Hertel exophthalmometer

6. Pseudo proptosis

7. Clinical signs of orbital disease
3- Enophthalmos:
a- Small globe, congenital anomaly e.g. microphthalmos or nanophthalmos.
b- Structural bony abnormalities
c- Atrophy of orbital contents
d- Cicatrizing orbital lesions

8. Clinical signs of orbital disease
4- Ophthalmoplegia:

9. Clinical signs of orbital disease
4- Ophthalmoplegia:

10. Clinical signs of orbital disease
4- Ophthalmoplegia:
a- Orbital mass
b- Restrictive myopathy in thyroid diseases.
c- Ocular motor nerves lesions
d- Tethering of extraocular muscles
e- Splinting of optic nerve by optic nerve sheath meningioma

11. Clinical signs of orbital disease
5- Visual dysfunction (reduced visual acuity):
a- Exposure keratopathy duo to sever proptosis.
b- Compressive optic neuropathy.
c- Choroidal folds at macula.

12. Clinical signs of orbital disease
5- Visual dysfunction (reduced visual acuity):
a- Exposure keratopathy duo to sever proptosis.

13. Clinical signs of orbital disease
5- Visual dysfunction (reduced visual acuity):
b- Compressive optic neuropathy.
c- Choroidal folds at macula.

14. Clinical signs of orbital disease
6- Dynamic properties:
a- Increasing venous pressure:
b- Pulsation:
c- Bruit:

15. Clinical signs of orbital disease
7- Fundus changes:
a- Optic disc atrophy duo to compression.
c- Choroidal folds
d- Retinal vascular changes
b- Optociliary shunt;

16. Clinical signs of orbital disease
8- Dystopia:

17. Clinical signs of orbital disease
8- Dystopia:

18. Orbital infection 1- Preseptal cellulites:
2- Bacterial orbital cellulitis:
3- Rhino-orbital mucormycosis:

19. Orbital infection 1- Preseptal cellulites:
2- Bacterial orbital cellulitis:
3- Rhino-orbital mucormycosis:

20. Preseptal cellulitis

23. Orbital infection
2- Bacterial orbital cellulitis:

26. Orbital infection
3- Rhino-orbital mucormycosis:

27. Orbital inflammatory diseases
1- Idiopathic orbital inflammatory disease IOID
2- Acute dacryoadenitis:

28. 1- Idiopathic orbital inflammatory disease IOID
Non-neoplastic, non-infectious, space occupying orbital lesions.
In adults, unilateral involvement is the rule.
In children, there is bilateral involvement in 30% of cases.

29. Signs:
a- Periorbital swelling, chemosis and conjunctival inflammation.
b- Proptosis.
c- Painful ophthalmoplegia.
d- Optic nerve dysfunction

31. Clinical course: Spontaneous remission : Wks
Intermittent episodes (on/off).
prolonged inflammation : (Frozen orbit )

32. Differential diagnosis:
a- Bacterial orbital cellulitis.
b- Severe acute thyroid eye disease (TED).
c- Systemic disorders (Wegener's granulomatosis, polyarteritis nodosa).
d- Malignant orbital tumors.
e- Ruptured dermoid cyst.

33. Management: - Systemic steroids: Radiotherapy: Cytotoxic drugs:
Biopsy : DDX

34. 2- Acute dacryoadenitis:
Part of IOID 25%
Isolated 75%

35. Signs - Swelling dystopia Injection of the palpebral portion
Decreased lacrimal secretion

36. Differential diagnosis:
a- Infection of the lacrimal gland.
b- Ruptured dermoid cyst.
c- Malignant tumors of the lacrimal gland.

37. Treatment
Of Acute Dacryoadenitis

38. Thyroid eye diseases Thyrotoxicosis (Graves' disease):
- It is an autoimmune disorder.
- Usually presents in the 3rd-4th decades of life.
- Affects women more than men. –
It is the most common cause of unilateral and bilateral proptosis.
The occurrence of signs of Graves' disease in a patient who is not clinically hyperthyroid is referred to as euthyroid or ophthalmic Graves' disease.

39. Increased intraorbital pressure
Thyroid eye diseases
Pathogenesis:
1- Inflammation of extraocular muscles
2- Inflammatory cellular infiltration:
Increased intraorbital pressure

40. Thyroid eye diseases Clinical manifestations:
1- Congestive (inflammatory or acute) stage: remit within 3 years
2- Fibrotic (chronic) stage:

41. Thyroid eye diseases Clinical manifestations:
1- Congestive (inflammatory or acute) stage: remit 3 years

42. Thyroid eye diseases Clinical manifestations:
2- Fibrotic (chronic) stage:

43. Thyroid eye diseases There are mainly five clinical manifestations:
1- Soft tissue involvement.
2- Lid retraction.
3- Proptosis.
4- Optic neuropathy.
5- Restrictive myopathy.

44. Thyroid eye diseases
1- Soft tissue involvement.

45. Thyroid eye diseases
2- Lid retraction. 50%

46. Thyroid eye diseases
3- Proptosis.

47. Thyroid eye diseases
3- Proptosis.

48. Thyroid eye diseases
4- Optic neuropathy. 5%

49. Thyroid eye diseases
5- Restrictive myopathy.

50. Thyroid eye diseases
5- Restrictive myopathy.