Orbital Diseases

Contents of orbit: eye ball, E.O.Muscles, Optic nerve,other nerves & vessels

Functions: Globe protection, Transmission of nerves & vessels, attachment of EOM

Classification of Orbital Diseases

1. Infections: orbital cellulitis
2. Inflammations: Thyroid eye disease, Idiopathic inflammatory orbital disease
3. Primary orbital tumors: Lacrimal gland tumors  Optic N tumors (Giloma , Meningioma)  Rhabdomyosarcoma
4. Sec. orbital tumors: Leukemia, Neuroblastoma, Retinoblastoma, Ca Breast & lung
5. Vascular lesions: Cavernous Hemangioma, Capillary Hemangioma, Varices, Carotid Cavernous Fistula

Proptosis

Abnormal protrusion of globe

It may be Unilateral or Bilateral

Unilateral – caused by orbital cellulitis, idiopathic orbital inflammatory disease, tumors of structures of orbit , orbital haemorrahge

Bilateral – thyroid eye disease , cavernous sinus thrombosis

Proptosis and Exophthalmos

Abnormal protrusion of eye ball is called proptosis or exophthalmos.

The term exophthalmos is reserved for prominence of the eye secondary to thyroid disease

Hertel exophthalmometry – measures degree of proptosis

Proptosis in children

1. Orbital cellulitis
2. Capillary haemangioma
3. Optic nerve glioma
4. Rhabdomyosarcoma
5. Leukaemias
6. Metastatic neuroblastoma
7. Plexiform neurofibromatosis
8. Retinoblastoma

Proptosis in adults

1. Thyroid eye disease,
2. Idiopathic inflammatory orbital disease
3. Cavernous haemangiomas
4. Lacrimal gland tumors
5. Lymphoid tumors
6. Meningiomas
7. Metastases –  from breast, lung, GIT

Types of Proptosis

Axial proptosis - eye is pushed directly forwards – lesions situated in optic nerve and intra conal space, diffuse lesion

Non axial-

Extra conal lesion  pushes eye in opposite direction;                                   

• Nasal- lacrimal gland tumor            
• Temporal – Ethmoid sinus mucocele       
• Down – Meningocele                                   
• Up-Maxillary sinus muccele                                                                            

Other signs of Orbital Diseases

1. Impaired mobility d/t involvement of EOM leading to Diplopia
2. Dec. vision d/t optic N. compression or exposure keratitis
3. Pain d/t exposure keratitis,malignany,cellulitis
4. Enophthalmos – backward displacement of globe e.g. orbital floor fracture

Investigations

• Careful history recording
• Systemic examination
• ENT examination
• B-scan ultrasound
• Imaging of bony structures- plain x ray , CT scan
• Imaging of soft tissues –CT scan, MRI
• Biopsy (FNAC)

Orbital cellulites

Definition: Purulent inflammation of the soft tissue of the orbit

Causes:

• Spread of infection from neighboring structures like nasal sinuses, eyelids, eyeball, face, teeth
• Deep penetrating injuries
• Metastatic infection – septicemia

Organisms: Pneumococci, Staphylococci, Stertococci, H.Influenze, Anaerobes

Types of Orbital Cellulitis

Two types- pre septal cellulitis and orbital cellulitis

1. Pre septal –structures anterior to orbital septum, characterized by erythema,  chemosis, conjunctival discharge without restriction of ocular movements and visual impairment

2. Orbital – behind orbital septum, characterized acute onset of severe pain, warm tender globe, fever, diminution of vision, massive swelling of lids, chemosis, proptosis, restriction of ocular movements, diplopia

Complications

• Panophthalmitis
• Extension into brain through meninges , cavernous sinus thrombosis may develop
• In diabetic patients fungal superinfection may develop
• Septicemia
• Orbital abscess

Investigations

• CBC (WBC)
• Blood Culture and sensitivity
• CT scan orbit (orbital abscess)

Treatment

1. Immediate Hospitalization
2. Frequent monitoring of Vitals & visual functions
3. Broad spectrum I/V antibiotics: Penicillin or Cephalosporins, Aminoglycosides , Metronidazole
4. If abscess has formed or nonresolving cases– Incision and Drainage of orbital abscess & sinuses