ABSTRACT
OBJECTIVE: Axial globe subluxation may complicate thyroid orbitopathy. This acute event is defined by anterior displacement of the globe equator beyond the orbital rim, lid retraction behind the equator, and tethering of the optic nerve. The authors explored the factors leading to spontaneous globe subluxation in patients with thyroid orbitopathy. DESIGN: A clinical review. MAIN OUTCOME MEASURES: The medical charts and axial and coronal orbital computed tomographic (CT) scans of all the patients with spontaneous globe subluxation were reviewed. The patients were categorized according to their CT scans into type I ("lipogenic" variant) or type II ("myogenic" variant). RESULTS: Four (0.1 %) of approximately 4000 patients with thyroid orbitopathy presented with spontaneous globe subluxation. All of these patients had increased orbital fat without significant enlargement of the extraocular muscles. Thus, they represent type-I thyroid orbitopathy. CONCLUSIONS: Globe subluxation in thyroid orbitopathy requires compliance of the orbital soft tissues and extensibility of the extraocular muscles. These are characteristics of type-I orbitopathy. The increased fat content results in more compliance of the soft tissues, and the normal caliber of the muscles allows them to become more extensible. This permits the acute contraction of the eyelids posterior to the equator of the globe. Patients with type-I orbitopathy and extensive proptosis may be at relatively greater risk of having globe subluxation develop.
Subject(s)
Exophthalmos/diagnostic imaging , Graves Disease/complications , Orbit/diagnostic imaging , Acute Disease , Adipose Tissue/diagnostic imaging , Adult , Exophthalmos/etiology , Eye Movements , Female , Humans , Male , Oculomotor Muscles/diagnostic imaging , Tomography, X-Ray Computed , Visual AcuityABSTRACT
PURPOSE: To determine the complications observed with using porous spherical orbital implants (hydroxyapatite and porous polyethylene) and the factors leading to their occurrence. METHODS: A total of 101 cases of porous spherical orbital implantation by five ophthalmic surgeons were reviewed retrospectively. The demographic data, diagnosis, prior surgery, type and technique of surgery, implant characteristics and prosthesis fitting were described in patients with complications. RESULTS: Eleven of the 101 patients had implant exposure. There were six male (1 with bilateral involvement) and four female patients, ranging in age from 2 to 71 years. Preoperative diagnosis included trauma in five patients, nontrauma in five, and tumor in one. Seven had prior eye surgeries. Three patients underwent evisceration, whereas eight underwent enucleation. Eight hydroxyapatite and three porous polyethylene implants were used with diameters of 16 to 20 mm. Three were unwrapped, six were wrapped in sclera, and two were wrapped in preserved fascia. Exposures, which generally occurred within 1 year, were grouped into small (1-5 mm), medium (6-10 mm), and large (> 10 mm). One delayed case occurred after drilling. Small stable exposures were managed conservatively. Larger exposures were managed either by implant revision or replacement. All patients were fit ultimately with a prosthesis. Histopathologic findings of explanted spheres showed fibrovascularization limited to the periphery with moderate inflammatory reaction. CONCLUSION: Complications were significantly higher in cases of eviscerations than enucleations. Complications occurred in implants either unwrapped or wrapped in homologous grafts. None of the autologous wrapping had exposure. Secondary procedures may initiate exposure when fibrovascular status of implant is inadequate.
Subject(s)
Orbit/surgery , Prostheses and Implants/adverse effects , Adolescent , Adult , Aged , Child, Preschool , Durapatite , Eye Enucleation , Female , Humans , Male , Middle Aged , Neovascularization, Pathologic/etiology , Orbit Evisceration , Orbital Diseases/etiology , Orbital Diseases/pathology , Polyethylenes , Porosity , Retrospective Studies , Surgical Wound Dehiscence/etiology , Surgical Wound Dehiscence/pathologyABSTRACT
BACKGROUND: Magnetic resonance imaging (MRI) has excellent spatial and soft tissue resolution in the periocular and orbital region, especially when combined with surface coil techniques. Other methods, including computed tomography, dacryocystography, and dacryoscintigraphy provide limited information in the area of the lacrimal drainage system. Magnetic resonance imaging was used in conjunction with other imaging modalities to compare the anatomic detail and clinically relevant information obtained about various pathologic processes in the lacrimal drainage area. METHODS: Patients with a variety of lacrimal drainage disorders underwent MRI with either head or surface coils. Contrast agents also were used in selected cases. Seven case reports are presented. RESULTS: Magnetic resonance imaging provided detailed information about local anatomy, extent of pathology, and, in some cases, etiology of the pathology. CONCLUSIONS: Magnetic resonance imaging with surface coils provides detailed soft tissue information when compared with dacryocystography and computed tomography in the area of the lacrimal drainage system. In selected cases of lacrimal drainage system pathology, MRI may provide data that affect patient management.
Subject(s)
Lacrimal Apparatus Diseases/diagnosis , Lacrimal Apparatus/pathology , Magnetic Resonance Imaging , Nasolacrimal Duct/pathology , Abscess/diagnosis , Adult , Aged , Aged, 80 and over , Child , Female , Gadolinium DTPA , Humans , Male , Mucocele/diagnosis , Neoplasms/diagnosis , Organometallic Compounds , Papilloma/diagnosis , Pentetic Acid/analogs & derivatives , Tomography, X-Ray ComputedSubject(s)
Endometriosis/etiology , Orbital Fractures/surgery , Orbital Neoplasms/etiology , Prostheses and Implants/adverse effects , Silicone Elastomers , Adult , Endometriosis/diagnostic imaging , Female , Humans , Orbital Neoplasms/diagnostic imaging , Postoperative Complications , Tomography, X-Ray ComputedABSTRACT
Histological specimens of eyelids from patients with congenital genuine ptosis and acquired involutional ptosis are compared. In congenital ptosis there is evidence of true muscular dystrophy of the levator muscle as demonstrated by: loss of cross striations, random decrease in muscle fibre diameter, sarcolemmal retraction, nuclei alignment, and fibrous and fatty tissue displacement of the striated fibres. In involutional ptosis disinsertion of the levator aponeurosis from its normal insertion on the inferior-anterior surface of the tarsus is demonstrated. Correlation between clinical presentation and surgical correction is explained in light of these findings.
Subject(s)
Blepharoptosis/pathology , Eyelids/pathology , Blepharoptosis/congenital , Blepharoptosis/surgery , Eyelids/surgery , HumansABSTRACT
Mucoepidermoid carcinoma of the lacrimal sac was diagnosed in a 62-year-old woman who presented with epiphora and a fixed painless mass in the area of the lacrimal sac. Histopathologic findings included nests and islands of neoplastic cells in a fibrotic stroma. The tumor nests contained both glandular spaces and solid epithelial areas. Treatment entailed dacryocystectomy with silastic intubation and subsequent medial maxillectomy and ethmoidectomy. The patient was tumor free on 1-year follow-up. Clinical features, histopathological findings, prognosis, and management of this rare tumor are reviewed in this article.
Subject(s)
Carcinoma/pathology , Eye Neoplasms/pathology , Lacrimal Apparatus , Carcinoma/surgery , Eye Neoplasms/surgery , Female , Follow-Up Studies , Humans , Intubation , Lacrimal Apparatus/surgery , Middle Aged , PrognosisABSTRACT
The intralesional injection of corticosteroids has been employed successfully in treatment of adnexal neonatal hemangiomas since 1979. This form of treatment is easily administered, is repeatable and free from serious complications. We present an exceptional case in which full-thickness eyelid necrosis ensued following intralesional injection of corticosteroids in a capillary hemangioma. After eyelid reconstruction the patient's visual axis has remained unobstructed, and amblyopia has been thus far averted.
Subject(s)
Betamethasone/adverse effects , Eyelid Neoplasms/drug therapy , Eyelids/pathology , Hemangioma/drug therapy , Triamcinolone/adverse effects , Betamethasone/therapeutic use , Female , Humans , Infant , Necrosis , Triamcinolone/therapeutic useABSTRACT
Computed tomographic (CT) scans of 19 patients with 10 right and nine left orbital implants were reviewed. Except for orbital soft-tissue swelling due to recent surgery or infection, CT scans obtained with both the implant and prosthesis in place showed relative symmetry of the postoperative side and the native globe. Benign air collections were often associated with either the implant or prosthesis interface or with seating of the prosthesis in the conjunctival fornices. Six patients had either cartilage, silicone, or glass beads placed surgically along the orbital floor to elevate the implants, four having had prior depressed orbital floor fractures. CT identified implant migration in five patients. The orbital prosthesis, usually constructed of solid methylmethacrylate, is fitted over the implant and simulates the appearance of the eye of the contralateral side. The operative anatomy and its relation to the CT appearance of the implant and external prosthesis are reviewed.
Subject(s)
Eye, Artificial , Orbit/diagnostic imaging , Prostheses and Implants , Tomography, X-Ray Computed , Cartilage , Foreign-Body Migration/diagnostic imaging , Glass , Humans , Methylmethacrylate , Methylmethacrylates , Microspheres , Postoperative Complications/diagnostic imagingABSTRACT
We report two patients who underwent orbital exploration yielding the diagnosis of sclerosing orbital pseudotumor. The presenting symptoms were exophthalmos, visual loss, abnormal ocular mobility, and ocular pain. Computed tomographic (CT) scans showed masses in the orbital apex. Steroids were ineffective. Orbital pseudotumor is a heterogeneous diagnostic category of lymphoid infiltrations of the orbit with a wide spectrum of pathological conditions and intraorbital locations. The clinical presentation typically includes the sudden onset of pain, diplopia, lid edema, and exophthalmos. Visual loss is uncommon. Most cases resolve spontaneously or respond to steroid treatment. Although fibrosis may be a prominent histological finding, the literature contains little information concerning its significance. We discuss the evidence for considering the sclerosing pseudotumors to be a significant variant with unique clinical behavior. Although features suggestive of pseudotumor were present in our case, the presence of visual loss and an apical mass shown on the CT scan led to the presumptive diagnosis of tumor and exploratory operation. Neurosurgeons should be aware of this entity as a cause of visual loss and orbital mass. Proper suspicion may in some cases permit transorbital biopsy and avoid craniotomy, inasmuch as operation is of no therapeutic benefit in this disease.
Subject(s)
Fibroma/surgery , Orbital Neoplasms/surgery , Adult , Diagnosis, Differential , Female , Fibroma/pathology , Humans , Male , Middle Aged , Orbit/pathology , Orbital Neoplasms/pathology , Sclerosis , Tomography, X-Ray ComputedABSTRACT
A 63-year-old man had a solitary extramedullary plasmacytoma of the conjunctiva for several years with no history of ocular inflammation or systemic abnormalities. Immunoperoxidase staining was consistent with a neoplastic lesion. This is the only well documented such case in the recent literature to the best of our knowledge. This rare condition is contrasted with reactive plasma cell granuloma, a benign inflammatory condition, which comprises most of the cases previously reported as plasmacytomas. Since extraskeletal plasmacytomas may be the first manifestation of multiple myeloma, these patients deserve appropriate diagnostic evaluation and close follow-up.
Subject(s)
Conjunctival Neoplasms/pathology , Eyelid Neoplasms/pathology , Plasmacytoma/pathology , Humans , Male , Middle AgedABSTRACT
Superior sulcus deformity is a late sequela of surgical anophthalmos. Many methods have been proposed to treat this difficult problem. A technique using autogenous costal cartilage that has resulted in satisfactory repair is presented. In addition to standard photographs and exophthalmometry measurements to follow these patients, a specific device to accurately measure orbital volume gain after operation was fashioned.
Subject(s)
Cartilage/transplantation , Ophthalmologic Surgical Procedures , Orbit/surgery , Ribs/transplantation , Adult , Eye Injuries/surgery , Eyelids/surgery , Humans , Male , Middle Aged , Postoperative Complications/surgeryABSTRACT
Desmoplastic melanoma is a rare and unusual variant of malignant melanoma. Its occurrence has not been previously reported in the ophthalmological literature, nor has an occurrence previously been shown to arise from mucosal melanosis. A case is reported of a patient who appeared to have a recurrent chalazion. The clinician should be alert to this entity when evaluating nodular eyelid lesions especially in the presence of acquired melanosis.
Subject(s)
Cysts/diagnosis , Eyelid Diseases/diagnosis , Eyelid Neoplasms/pathology , Melanoma/pathology , Diagnosis, Differential , Eyelid Neoplasms/diagnosis , Eyelid Neoplasms/surgery , Female , Humans , Meibomian Glands , Melanoma/diagnosis , Melanoma/surgery , Middle Aged , Neoplasm InvasivenessABSTRACT
Close collaboration between the ophthalmologist and ocularist is essential to achieve the best results in the correction of facial contour deformities with prefabricated, sculptured implants. We used previously described techniques to make such implants with RTV-382 silicone and methyl methacrylate resin to correct facial defects. One patient with bony defects of the forehead and superior orbital rim, and another patient with a superior sulcus deformity illustrate the value of these procedures.
Subject(s)
Eyelids/surgery , Orbit/surgery , Prostheses and Implants , Silicones , Surgery, Plastic/methods , Adult , Eye, Artificial , Face/abnormalities , Facial Injuries/surgery , Female , Humans , Models, Anatomic , Prosthesis DesignABSTRACT
Nineteen eyelids were examined histologically in cases of involutional blepharoptosis. Aponeurogenic defects were demonstrated in the majority of cases. A revised classification of acquired blepharoptosis, and the procedure of choice for the correction of this entity are discussed.
Subject(s)
Blepharoptosis/pathology , Eyelids/pathology , Blepharoptosis/classification , Blepharoptosis/surgery , Eyelids/surgery , HumansABSTRACT
Total retinal detachment and neovascular glaucoma occurred after a penetrating injury to the left globe that left the eye blind and painful. A retrobulbar injection of alcohol and enucleation modified but did not relieve the orbital discomfort. At surgery, we discovered a neuroma with cartilaginous metaplasia involving the supratrochlear nerve. Excision of this mass produced relief of symptoms. This is, to our knowledge, the first reported case of a neuroma with cartilaginous metaplasia involving the supratrochlear nerve.
Subject(s)
Cranial Nerve Neoplasms/surgery , Eye Injuries/complications , Neuroma/surgery , Ophthalmic Nerve/surgery , Adult , Cranial Nerve Neoplasms/pathology , Ethanol/therapeutic use , Eye, Artificial , Humans , Male , Middle Aged , Neuroma/pathology , Ophthalmic Nerve/pathology , Orbit/innervation , Pain, Intractable/complications , Pain, Intractable/therapyABSTRACT
At the McGill University neuro-ophthalmology unit, 52 patients with superior oblique palsy were seen during the 2-year period October 1973 to August 1975; these included patients with congenital, traumatic, vascular, and other more rare causes of trochlear paralysis. Half of the patients with congenital palsy had diplopia, requiring treatment, although surgery was rarely necessary. Patients with palsy due to trauma, the major cause in our series, included four with bilateral involvement. With the exception of recovery in a single muscle of one patient in this group with traumatic palsy, no spontaneous recoveries have been observed. Treatment modalities have been tried, including observation alone, occlusion for symptomatic relief of diplopia, use of prisms, and recession of the ipsilateral inferior oblique muscle. Four patients with palsy of presumed vascular cause recovered spontaneously within a 4-month period. All patients who were surgically treated improved.
Subject(s)
Diplopia/etiology , Oculomotor Muscles/innervation , Paralysis , Trochlear Nerve , Adolescent , Adult , Aged , Craniocerebral Trauma/complications , Diplopia/diagnosis , Diplopia/therapy , Female , Humans , Male , Methods , Middle Aged , Optic Disk , Paralysis/congenital , Paralysis/etiology , Visual FieldsABSTRACT
A group of 16 heroin-dependent patients undergoing voluntary detoxification were studied to detect "toxic" quinine amblyopia." No true "amblyopia" was found but 8 of 16 (50%) patients had positive Amsler grid tests. This was called "toxic maculopathy." A control group of US Army reservists showed 1 of 25 (4%) to have positive Amsler chart tests. The difference between the two groups is significant and probably represents a chronic, low dose quinine macular toxicity. The strongly suggested relationship between chronic low doses of quinine and subtle macular changes led us to create a second study to document objective abnormalities. This study is presented in Part II.