A case of retained wooden foreign body in orbit

A 41-year-old man visited our clinic complaining of esodeviation of the right eye. He had been operated on for corneal laceration 3 years before. One month later, exodeviation of the right eye had developed. The result of computed tomography (CT) was reported as orbital abscess and cellulitis. Although antibiotic treatment was administered for 2 weeks, the exodeviation didn't improve. On ocular examinations performed in our hospital in November-2001, his right eye was esotropic and had a relative afferent pupillary defect. Vision of the right eye was decreased to 0.02. Fundus examination showed optic atrophy. A new CT scan disclosed a foreign body introduced into the right medial orbital wall, nasal cavity and ethmoidal sinus. Although foreign body was surgically removed, vision and eye movement were not improved. In the case of a patient who has undergone orbital trauma, complete history taking and physical examinations must be performed. On suspicion of a foreign body, imaging study such as CT or MRI must be performed. However, because CT findings can be variable, careful follow-up is needed.     

Medical treatment of pediatric subperiosteal orbital abscess secondary to sinusitis

BACKGROUND: Subperiosteal abscess may accompany orbital cellulitis secondary to sinusitis. Common surgical principles include incision and drainage of all abscesses. Previous evidence suggests that some orbital abscesses may be treatable with intravenous antibiotics, especially in young children. Children's hospital records were reviewed to determine which abscesses may be treated medically. PATIENTS AND METHODS: Records of patients admitted for orbital cellulitis from 1993 to 1996 were reviewed. Patients with subperiosteal abscess on CT scan were included. Clinical outcomes for initial surgical versus medical management of medial abscesses were compared. Differences in age, hospital stay, and intracranial involvement were analyzed for medial versus nonmedial abscesses. RESULTS: All patients had abscesses adjacent to infected sinuses. Eighteen young children had medial abscesses. Twelve of 13 were cured by initial medical treatment; 4 of 5 underwent successful initial drainage. Outcomes were not statistically different (P > .490). Seven children with nonmedial abscesses were older (P < .001) and had more complicated courses than those with medial abscess. Three of 6 children with superior orbital abscess also had intracranial abscess. Intracranial complication was more likely with superior versus medial orbital abscess (P < .01). CONCLUSIONS: Medial subperiosteal orbital abscesses secondary to sinusitis in children 6 years of age and younger are highly amenable to treatment with intravenous antibiotics. Older children and children with nonmedial abscesses may have more complicated infections. Children with superior orbital abscesses are at higher risk for intracranial abscess.     

Intraorbital wood. Detection by magnetic resonance imaging

The authors present two cases in which intraorbital wooden foreign bodies remained undetected after initial ophthalmologic examination and radiologic investigation which included plain orbital x-rays, orbital computed tomography (CT) scans, and, in one case, orbital ultrasound. In each case, subsequent magnetic resonance imaging (MRI) showed a well-delineated low-intensity lesion suggestive of a retained foreign body. Investigation of a case of suspected wooden foreign body in the orbit should include an MRI scan if there is no contraindication, and no foreign body has been defined on CT scan, ultrasound, or plain orbital films.     

Ethmoidal osteoma with intraorbital extension: excision through a transcutaneous paranasal incision

PURPOSE: To describe a case of conjunctival hyperaemia and proptosis of the right eye. METHODS: Three-dimensional computed tomography (CT) was performed to reveal the size and position of a lesion of osseous density extending into the right orbit. The lesion was then excised using a right paranasal transcutaneous approach. RESULTS: The pathology report suggested ethmoidal osteoma. The postoperative course was uncomplicated and the lesion did not recur during a 5-year follow-up period. Repeated postoperative ophthalmic examinations revealed preservation of visual acuity and visual fields postoperatively. DISCUSSION: Diagnosis is based on imaging studies, especially CT and three-dimensional CT scans. A three-dimensional CT scan is critical in understanding the actual dimensions of the tumour and its relations with other structures. Surgical removal is indicated in cases with orbital matrix compression and displacement. A transcutaneous paranasal approach allows for increased exposure of affected structures.     

新生儿继发于筛窦炎的眼眶脓肿(英文)

骨膜下脓肿是眼眶蜂窝织炎的一种,以脓和渗出液汇集在眼眶内骨膜下为特点。对于新生儿,眼眶脓肿非常罕见。我们报告1例年龄为26d的右眼患有严重眼眶蜂窝织炎的女患儿。眼眶和副鼻窦CT扫描显示右眼眶蜂窝织炎并内侧骨膜下和眼眶后部脓肿。眼分泌物培养见葡萄球菌生长,经用先锋霉素和甲硝唑静脉注射和经内窥镜鼻窦手术行急诊脓肿引流,恢复良好。通过内窥镜的鼻窦引流手术是预防更严重的并发症的首选治疗。     

Orbital foreign body masquerading as conjunctival melanoma 60 years after injury

A 74-year-old man presented with a 6-month history of a pigmented conjunctival lesion on his left eye. The lesion was initially suspicious for conjunctival melanoma. The patient admitted to a remote history of trauma from a airgun pellet over 60 years ago. Anterior examination revealed a 6 x 6 mm pigmented left conjunctival lesion and B-scan of the lesion was suggestive of a retained orbital foreign body. The lesion was removed through a transcaruncular medial orbitomy and pathology showed a retained orbital foreign body. A newly pigmented conjunctival lesion although initially concerning for melanoma represented a retained orbital body that surfaced many years after the initial orbital trauma.     

眼眶骨瘤的手术技巧和疗效分析

目的 探讨眼眶骨瘤的手术技巧和疗效.方法 系列病例研究.回顾性分析19例眼眶骨瘤患者的临床资料,患者的诊断均经手术和病理检查结果证实.结果 骨瘤位于眶内侧10例,眶顶4例,眶外侧5例.手术入路为前路开眶8例,外侧开眶7例,内侧开眶2例,鼻侧切开2例.完全切除病变12例,大部分切除7例.结论 眼眶骨瘤临床诊断容易,但手术治疗困难,选择合适的手术入路、娴熟的手术技巧,可避免术中和术后合并症的出现.     

Endoscopic and trans-fornix removal of a giant orbital-ethmoidal osteoma

A 39-year old female was referred with a 2 year history of slowly progressive headache, exophthalmos, diplopia and restricted eye movements with exotropia of the right eye. Orthoptic examination revealed restricted elevation and mildly restricted adduction of the right eye. CT and MRI demonstrated a large (35 x 20 x 23 mm) calcified infraorbital lesion extending into the ethmoidal sinus. Because the visual field defects were progressive and the acuity OD dropped to 20/80 surgical intervention was necessary. The osteoma was successfully removed using an inferior and medial orbitotomy with swinging eyelid combined with an endoscopic approach. In a second procedure the orbital floor was reconstructed with a porous polyethylene (Medpor) implant. A final procedure consisted of a 3 mm recession of the left superior rectus muscle and infundibulotomy by the sinus surgeon to open the blocked maxillary sinus. After 6 months visual acuity OD had returned to 20/20. Orthoptic examination showed normal binocular function.     

An extraordinary orbital foreign body

The authors report a unique case of a broken motorbike handle that presented as a bilateral orbital foreign body. A 30-year-old male sustained an injury to the right side of his face when he skidded from his motorbike while riding. He had bilateral sudden loss of vision and presented to emergency services with bilateral proptosis, motility restriction, and a right lower eyelid laceration. CT scan revealed a 7-cm-long motorbike handle lodged in the retrobulbar space of both orbits, close to the cribriform plate. Left lateral orbitotomy was performed to remove the foreign body; the right eye regained normal vision and function. The unique features of this case include the nature of the foreign body, its bilateral location, its proximity to the optic nerve and cribriform plate, and the challenges in its removal. The clinical presentation and management is presented, along with the surgical video.     

内镜在眼眶深部植物性异物摘出中的应用

目的探讨内镜在眼眶深部植物性异物摘出术中的临床应用价值。方法术前行眼眶CT或MRI冠状和水平扫描准确定位，应用硬性内窥镜沿异物窦道或皮肤切口进入眶内，沿异物长轴方向夹取异物。结果5例眼眶异物均成功摘出，同时在内窥镜下清除窦道内肉芽及坏死组织，手术后伤口均一期愈合，无手术并发症。结论应用内镜取眼眶深部异物损伤小，恢复快，异物容易取尽无残留：     

Transitory vision loss by orbital osteoma

The authors present a case of a 50-year-old woman with orbital osteoma complaining of gaze-evoked transitory vision loss of the right eye lasting for 6 months. The patient presented with normal visual acuity, pupils, eye movements, color vision, visual evoked potentials and visual fields. Orbital ultrasound showed a nasal intraorbitary neoformation, with low echogenicity and well-defined borders, suggesting an ethmoidal mucocele. Only a computed tomographic scan allowed the correct diagnosis, revealing a 2.7 cm x 2.2 cm calcified mass in the medial half of the right orbit, compatible with an osteoma. The x-ray view of the orbit confirmed the diagnosis. Although osteomas are slow-growing tumors, we decided to remove it because of the size, the complaints, and the patient's wishes. The tumor was approached and excised through an anterior medial orbitotomy. It was histopathologically shown to be a compact osteoma. The transitory vision loss resolved after surgery.     

儿童球结膜下迷芽瘤34例手术治疗分析

目的 探讨儿童球结膜下迷瘤的临床、病理及CT特点和手术治疗.方法 回顾性分析经手术治疗及病理证实的儿童球结膜下迷芽瘤34例.结果 34例中男17例、女17例,均为单发.发现肿块的平均年龄3个月(年龄范围8d至2岁);就诊平均年龄2岁6个月(年龄范围2月至12岁).均因发现球结膜下包块就诊.瘤体位于颞侧33例、鼻侧1例.多位于近外眦部球结膜下,与球结膜粘连,与眼球筋膜无粘连,与眶内脂肪相连.术前19例行眼眶CT横断面扫描,CT上病灶表现为附着于眼环颞侧的新月形低密度影,CT值-53～-106HU.外缘结膜下均有1～2mm厚的囊壁.6例行增强扫描,增强后囊壁均中度强化.病理分类皮脂瘤29例,异位泪腺1例,异位唾液腺2例,皮脂瘤伴异位唾液腺1例,骨瘤1例.无自然消退现象.术后1例复发,1例睑球粘连,1例哭无泪,1例干眼症并丝状角膜炎,无其他并发症发生.结论 儿童球结膜下迷芽瘤是一种少见的先天性良性肿瘤,多为皮脂瘤.皮脂瘤的临床特征为结膜下缓慢生长软性的淡黄色扁平隆起,瘤组织南脂肪及纤维构成.CT检查可显示病灶的大小、范嗣、性质,以及与眼环、外直肌、泪腺等的关系,有助于提高手术成功率,减少并发症.最佳治疗是手术切除.     

Orbital helical computed tomography in the diagnosis and management of eye trauma

OBJECTIVE: To prospectively determine the accuracy of helical computed tomography (CT) and multiplanar reconstruction and its value in surgical planning for the management of ocular trauma with suspected intraocular and orbital foreign bodies using surgical and clinical follow-up findings as the gold standard. DESIGN: Prospective, observational case series. PARTICIPANTS: Thirty-six patients with ocular trauma and suspected foreign bodies were studied. INTERVENTION: All patients were examined using a standardized scanning protocol with helical CT direct scanning in the axial plane and multiplanar reconstruction of coronal and sagittal planes. MAIN OUTCOME MEASURES: The images were analyzed for the presence and number of intraocular and orbital foreign bodies, anatomic location, and foreign body size. The surgical and clinical follow-up findings (contact lens examination, gonioscopy, indirect ophthalmoscopy and scleral depression, perimetry, color testing, measurement of size) were used as the gold standard to which the image results were compared. RESULTS: Helical CT showed a single intraocular foreign body in 14 patients, a single orbital foreign body in 9 patients, and multiple orbital foreign bodies in 2 patients. Intraocular or orbital foreign bodies were excluded in 11 patients. Twenty foreign bodies were correlated with surgical results. Surgical and clinical follow-up findings were in agreement with helical CT results regarding the detection and determination of the number of presumed foreign bodies. Localization to intraocular versus orbital compartment and proximity to the optic nerve was accurate in all patients. Determination of size of the foreign bodies on the helical CT images was reliable and repeatable. CONCLUSIONS: Helical CT axial scanning with multiplanar reconstruction is accurate at detecting and localizing intraocular and orbital metallic, glass, and stone foreign bodies. This imaging method aids the surgeon in choosing the surgical approach to retained intraocular and orbital foreign bodies.     

Esophageal Adenocarcinoma and Urothelial Carcinoma Orbital Metastases Masquerading as Infection

Orbital metastases can masquerade as other orbital processes. We present two cases of orbital metastases, the first being the first reported adenocarcinoma of the esophagus presenting as an orbital metastasis prior to the primary being known, and the other as the first urothelial carcinoma to present as orbital cellulitis. The first patient presented with left upper eyelid pain. CT scan identified a superolateral subperiosteal fluid collection without concomitant sinus disease, which was drained in the operating room. Two weeks later repeat CT scan showed recurrent orbital subperiosteal fluid. It was drained and a biopsy showed necrotic adenocarcinoma. The second case presented with a painless right proptosis, decreased vision, and globally decreased ocular motility 3 days after bladder resection for urothelial carcinoma. CT scan demonstrated pan sinusitis with a soft tissue mass in the apex of the right orbit with extension through the superior orbital fissure. After no improvement on antibiotics endoscopic drainage was performed. Pathology revealed metastatic urothelial carcinoma within the orbital fat.     

重视眼科影像学检查提高临床诊断率

目的 总结分析眼科临床出现的误诊和漏诊病例的原因,应重视影像学检查,弥补临床常规检查诊断的不足.方法 对2007年至2008年两年间门诊和住院病人通过各种影像学检查纠正诊断的37例患者进行分析,年龄6～75岁,男性17例,女性20例.结果 在37例患者中,有8例为颈动脉海绵窦瘘(2例外伤性,6例自发性)被诊断为结膜炎或巩膜炎;6例外伤性眶壁线性骨折的儿童被诊断为眼肌麻痹或肌肉断裂,给予保守治疗10至20d无效;2例淋巴瘤和3例泪腺样囊性癌患者被诊断为眼眶炎性假瘤;2例横纹肌肉瘤诊断为眼眶炎症;2例脉络膜黑色素瘤因延误治疗出现眶内蔓延;2例额窦黏液囊肿和1例下直肌缺如诊断为麻痹性斜视;蝶窦颅底病变和眼内占位各1例诊断为知觉性斜视;视神经脑膜瘤和颅内鞍区蝶窦占位各1例诊断为球后视神经炎;1例泪囊鳞癌诊断为泪囊炎;4例骨内血管瘤患者CT软组织窗扫描考虑为骨瘤;2例外伤眶内异物漏诊.结论 通过分析总结可见,颈动脉海绵窦瘘、外伤性眶壁线性骨折、外伤眶内异物等通过病史询问,仔细检查和临床经验辅之以影像学检查可以得到正确诊断;有些病变则应对诊断治疗过程中出现的不同表现和不典型症状,要及时鉴别诊断,进行各种影像学检查,排除其他疾病的存在,避免误诊和漏诊.总之,影像学检查是一种有效和必要的,特别是对眶内和颅内病变的揭示有重要价值,在临床工作中应给予重视.     

Reactivation of Thyroid Associated Orbitopathy Following Trauma with Intraorbital Foreign Body

A 63-year-old female with mild, bilateral, stable thyroid-associated orbitopathy sustained trauma resulting in glass foreign bodies embedded on the left ocular surface and left lateral orbital extraconal and intraconal space. After 2 orbitotomies including a failed attempt to remove the intraconal foreign body and poor response to oral steroids, she developed severe, progressive left periorbital edema and 9?mm of relative proptosis. Serial, post-operative imaging demonstrated worsening inflammatory changes along the surgical tract, which slowly improved over several months, with simultaneously worsening proptosis and enlargement of the left inferior and medial rectus muscles consistent with worsening thyroid orbitopathy. She subsequently underwent unilateral 3-wall orbital decompression with improvement in her symptoms. Periorbital trauma with orbital foreign bodies and related surgical trauma may result in reactivation of thyroid-associated orbitopathy.     

Acute adduction deficit in a 7-week-old infant

A 7-week-old infant with sudden onset adduction deficit and proptosis is reported. The main differential diagnoses included orbital myositis, orbital cellulitis, capillary haemangioma and rhabdomyosarcoma. A CT scan revealed a postseptal cellulitis-like picture with thickening of the medial rectus muscle. He was given a course of antibiotics, withholding steroids and biopsy. His condition resolved completely on high-dose antibiotics alone. To our knowledge this is the youngest patient with infectious orbital myositis and postseptal cellulitis described in the literature. The clinical course emphasizes the importance of administering sufficiently high doses of antibiotics.     

An intraorbital metallic foreign body

A 30-year-old male presented with diplopia for 20 days post occupational accident involving left side of his nose, while he was working with a nail gun. He was fully conscious and did not have any neurological deficits. Patient narrated the mechanism of injury and was sure that the nail fell down after hitting the left side of his nose. He had normal vision, but extra ocular movements were restricted and painful. Computed tomography (CT) scan revealed a curved metal object lodged in the posterior aspect of the left orbit extending diagonally from medial wall to the anterior-superior aspect of the orbital roof. The object was removed via a small surgical approach, inflicting least possible surgical trauma. Post surgery, the patient recovered with complete resolution of diplopia. The original aspects of this case are the lack of signs of a foreign body entry and its relative harmlessness in spite of its large size.     

Acute adduction deficit in a 7-week-old infant

A 7-week-old infant with sudden onset adduction deficit and proptosis is reported. The main differential diagnoses included orbital myositis, orbital cellulitis, capillary haemangioma and rhabdomyosarcoma. A CT scan revealed a postseptal cellulitis-like picture with thickening of the medial rectus muscle. He was given a course of antibiotics, withholding steroids and biopsy. His condition resolved completely on high-dose antibiotics alone. To our knowledge this is the youngest patient with infectious orbital myositis and postseptal cellulitis described in the literature. The clinical course emphasizes the importance of administering sufficiently high doses of antibiotics.     

下睑缘入路治疗眶内下壁联合骨折

目的评价采用下睑缘切口治疗眶内、下壁联合骨折的效果。设计回顾性病例系列。研究对象18例眶内、下壁联合骨折的患者。方法所有患者均经下睑缘切口行眶壁骨折整复术,术中充分游离、保护泪囊,于眶内、下壁浅面植入复合羟基磷灰石人造骨片,术前、术后行双眶水平及冠状位CT、头面部三维cT检查并进行比较。主要指标临床症状及并发症。结果术后随访3～18个月,所有患者下睑皮肤瘢痕不明显,术后均未出现人造骨片排异或移位,无一例患者术后出现溢泪,复视、眼球内陷等症状均得到改善。结论单独采用下睑缘切口治疗眶内、下壁联合骨折是可行的,但仅适于眶下壁联合眶内壁下份骨折,尤其是伴发眶内、下壁隅角骨折的复合型骨折。