Computerized tomography in the diagnosis of the congenital fibrosis syndrome

A patient with congenital ptosis and inferior rectus fibrosis is described. Marked atrophy of the left inferior rectus muscle was demonstrated by orbital computerized tomography (CT). Computerized tomographic findings in this patient and a series of 20 patients with no ocular disease and normal motility indicate that CT is a valuable tool for the evaluation of extraocular muscle size when qualitative comparison is made between corresponding muscles in the same patient.     

Computerized tomography of the orbit.

The potential for using CT to diagnose orbital lesions is clearly demonstrated in this chapter. The patients discussed were all suffering from proptosis and had other complaints such as visual disturbances, pain, or ophthalmoplegia. CT is superior to ultrasonography in its ability to reproduce anatomical structures, including the retroocular space, bony walls of the orbit, and extraorbital regions, such as ethmoid sinuses and the cranial cavity. Such reproduction helps distinguish lesions arising within the orbit from those invading the orbit from outside. CT not only defines the extent of a lesion but also provides information about the physical properties of the tissue. The remarkable difference on CT between proptosis caused by thyrotoxic disease and that caused by intraorbital tumor or pseudotumor is a striking example of the way in which CT may contribute to more accurate diagnosis.     

Computerized tomography in the assessment of orbital lesions

Intraorbital and periorbital structures can be examined very accurately by computerized tomography and magnetic resonance imaging. On the basis of the data acquired during axial (or coronal) CT examination, reformations in any given plane are possible and the relations between a space-occupying lesion and intraorbital structures such as the globe, optic nerve, or extraocular muscles can be clearly demonstrated, as shown by several examples. The main advantage of CT over MRI is the shorter examination time. Hence CT is currently to be preferred for initial examinations.     

Dry anophthalmic socket syndrome – morphological alterations in meibomian glands

PurposeTo evaluate morphological alterations of meibomian glands (MGs) in the dry anophthalmic socket syndrome (DASS).MethodsFifteen unilateral anophthalmic patients wearing cryolite glass prosthetic eyes were enrolled. All patients with clinical blepharitis or other significant eyelid abnormalities were excluded. In vivo laser scanning confocal microscopy (LSCM) of the MGs in the lower eyelids both on the anophthalmic side and the healthy fellow eye was performed to quantify acinar unit density, acinar unit diameter, acinar unit area, meibum secretion reflectivity, the inhomogeneous appearance of the glandular interstice, and inhomogeneous appearance of the acinar walls.ResultsThe lower eyelids of the anophthalmic sockets revealed a significant reduction of the acinar unit density (p = 0.003) as well as a significantly more inhomogeneous appearance of the periglandular interstices (p = 0.018) and the acinar unit walls (p = 0.015) than the healthy fellow eyelid. However, there were no significant differences regarding the acinar unit diameter, acinar unit area, and meibum secretion reflectivity of the MGs on the anophthalmic side compared to the healthy fellow eyelid (p ≥ 0.05, respectively).ConclusionsThe eyelids of anophthalmic sockets without clinical blepharitis demonstrate a reduced density of MG acinar units and a more inhomogeneous appearance of the periglandular interstices and the acinar unit walls. This can cause meibomian gland dysfunction contributing to DASS and suggests early treatment of these symptomatic patients, even in the clinical absence of any blepharitis signs.Subject terms: Inflammation, Conjunctival diseases, Eyelid diseases     

Computerized tomography in the evaluation of penetrating ocular injuries.

An evaluation was made of the cases of 80 consecutive patients (82 eyes) who underwent acute surgical intervention for penetrating eye injuries. Of these cases, 46 patients had computerized tomography (CT) of the orbit performed in addition to routine preoperative ophthalmic examination. Eyes with more severe injuries and eyes in which the posterior segment was not visualized on the preoperative ophthalmic examination were more likely to undergo CT evaluation. CT scanning frequently demonstrated posterior segment pathology not observable by ophthalmic examination. The following CT findings were associated with poor visual or anatomic outcome: (1) posterior segment hemorrhage; (2) vitreous space distortion; and (3) lens disruption. This study suggests that CT scanning may provide useful information as to the nature and extent of injury in cases of penetrating ocular trauma.     

Computerized tomography of the orbita (author's transl)]

Computerized tomography of the orbita is today the most accurate method to determine the causes of exophthalmus. It can detect and localise precisely congenital, inflammatory and neoplastic disease of the orbita and its surroundings. Specific diagnosis is not always possible; it may be attained, if complementary neuroradiological methods are applied. Higher spatial resolution will probably allow to apply computerized tomography also to other, more discrete orbital diseases.     

Conjunctival cysts in anophthalmic orbits.

Five out of 149 patients (3%) who received an intraorbital implant to prevent or treat the disfiguring symptoms associated with the postenucleation socket syndrome developed intraorbital conjunctival cysts. All five patients had received a secondary implant two 14 months previously. After excision of the cysts four patients required additional surgery for lack of conjunctiva and/or recurrent cyst formation. The clinical findings, mechanism of development, and management of this rare but serious complication of socket surgery are described.     

Computerised tomography in Tolosa-Hunt syndrome

Twelve patients who satisfied the clinical criteria of Tolosa-Hunt syndrome (THS), underwent axial computerised tomography (CT) scan of the head. Two patients had abnormalities detected in the cavernous sinus on the affected side which supported the clinical diagnosis. This coupled with steroid responsiveness and long-term asymptomatic follow-up firmly established the diagnosis of THS. We discuss the computerised tomographic findings seen in THS and the relevance of using accurate imaging techniques as the first line of investigation in these cases.