Orbit

The Orbit

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

Clinical signs of orbital disease

1- Soft tissue involvement:

Clinical signs of orbital disease

2- Proptosis:

Clinical signs of orbital disease

2- Proptosis:

Hertel exophthalmometer

Pseudo proptosis

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

Clinical signs of orbital disease

4- Ophthalmoplegia:

Clinical signs of orbital disease

4- Ophthalmoplegia:

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


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.

Clinical signs of orbital disease

5- Visual dysfunction (reduced visual acuity):
a- Exposure keratopathy duo to sever proptosis.

Clinical signs of orbital disease

5- Visual dysfunction (reduced visual acuity):
b- Compressive optic neuropathy.
c- Choroidal folds at macula.

Clinical signs of orbital disease

6- Dynamic properties:
a- Increasing venous pressure:
b- Pulsation:
c- Bruit:


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

Clinical signs of orbital disease

8- Dystopia:

Clinical signs of orbital disease

8- Dystopia:

Orbital infection

1- Preseptal cellulites: 2- Bacterial orbital cellulitis: 3- Rhino-orbital mucormycosis:

Orbital infection

1- Preseptal cellulites: 2- Bacterial orbital cellulitis: 3- Rhino-orbital mucormycosis:



Preseptal cellulitis

Orbital infection

2- Bacterial orbital cellulitis:

Orbital infection

3- Rhino-orbital mucormycosis:

Orbital inflammatory diseases

1- Idiopathic orbital inflammatory disease IOID 2- Acute dacryoadenitis:

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.

Signs:

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

Clinical course:

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

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.

Management:

- Systemic steroids: Radiotherapy: Cytotoxic drugs: Biopsy : DDX

2- Acute dacryoadenitis:

Part of IOID 25% Isolated 75%

Signs

- Swelling dystopia Injection of the palpebral portion Decreased lacrimal secretion

Differential diagnosis:

a- Infection of the lacrimal gland. b- Ruptured dermoid cyst. c- Malignant tumors of the lacrimal gland.

Treatment

Of Acute Dacryoadenitis

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.

Thyroid eye diseases

Pathogenesis: 1- Inflammation of extraocular muscles 2- Inflammatory cellular infiltration: Increased intraorbital pressure

Thyroid eye diseases

Clinical manifestations: 1- Congestive (inflammatory or acute) stage: remit within 3 years 2- Fibrotic (chronic) stage:

Thyroid eye diseases

Clinical manifestations: 1- Congestive (inflammatory or acute) stage: remit 3 years

Thyroid eye diseases

Clinical manifestations: 2- Fibrotic (chronic) stage:

Thyroid eye diseases

There are mainly five clinical manifestations:


1- Soft tissue involvement. 2- Lid retraction. 3- Proptosis. 4- Optic neuropathy. 5- Restrictive myopathy.

Thyroid eye diseases

1- Soft tissue involvement.

Thyroid eye diseases

2- Lid retraction. 50%

Thyroid eye diseases

3- Proptosis.

Thyroid eye diseases

3- Proptosis.

Thyroid eye diseases

4- Optic neuropathy. 5%

Thyroid eye diseases

5- Restrictive myopathy.


Thyroid eye diseases
5- Restrictive myopathy.