DISEASES OF THE

ORBIT
AHMED SHAKIR AL-WASSITI
FRCS(GLASGOW), FIBMS, FICO, MBCHB
 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
Soft tissue involvement
Proptosis
Enophthalmos
Dystopia
Ophthalmoplegia
Dynamic changes
Optic nerve and fundus changes
Clinical signs of orbital disease
1- Soft tissue involvement:

•lid and periorbital oedema

•skin discoloration
•Ptosis
•chemosis (oedema of the
conjunctiva and caruncle)
•epibulbar injection
 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:

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- Retinal vascular changes c- Optociliary shunt;

b- Optic disc atrophy duo to compression. d- Choroidal folds
 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:
Preseptal cellulitis
 Orbital infection
2- Bacterial orbital cellulitis:
Orbital infection
3- Rhino-orbital mucormycosis:
 Black
eschar
Exenteratin in unresponsive
cases
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
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%
Differential diagnosis:
a- Infection of the lacrimal gland.
b- Ruptured dermoid cyst.
c- Malignant tumors of the lacrimal gland.
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.
• Steroids

• Radiotherapy

• Combination of
immunosuppressive,
radiotherapy and
steroid

• Orbital decompression
Thyroid eye diseases
4- Optic neuropathy. 5%
 Thyroid eye diseases
5- Restrictive myopathy.
CT orbit TED
Evisceration
Enucleation
Exenteration
Evisceration
Enucleation