1,721,220 research outputs found
Diagnosis and treatment of orbital hemorrhagic lesions
No full textOrbital hemorrhagic lesions include a group of heterogeneous conditions that may be idiopathic or caused by trauma, surgery, or preexisting vascular tumors or malformations. We report clinical, computed tomographic, and magnetic resonance imaging features of eight cases of orbital hemorrhage (2 cystic lymphangiomas, 2 subperiosteal hematomas, 1 traumatic hematoma, 1 hemorrhagic varix, 1 cholesterol granuloma, and 1 postsurgical hemosiderin deposit). The differential diagnosis of orbital hemorrhagic lesions may be difficult because of their relative rarity and nonspecific presentation. In particular, on computed tomography, cholesterol granulomas may simulate a lacrimal gland epithelial tumor and subperiosteal hematomas, a lymphoid tumor. Magnetic resonance imaging is an ideal imaging technique because of its ability to identify blood and blood products in all stages of degradation. Treatment can be limited to observation in varices, lympohangiomas, and trauma if vision is not threatened; otherwise, surgical blood drainage should be attempted. Cholesterol granulomas are best treated by curettage through an extraperiosteal orbitotomy. For subperiosteal acute or subacute hemorrhages, surgical drainage is recommended if the blood is not spontaneously reabsorbed within a few weeks
Colobomatous ocular cyst excision with globe preservation
No full textColobomatous ocular cyst is a rare malformation consisting of a cavity lined by neuroectodermic tissue and communicating with the vitreous cavity, generally associated with microphthalmos. The usual treatment for unsightly cases is enucleation and cyst excision, followed by prosthesis fitting. The authors treated a case of colobomatous ocular cyst associated with a mild microphthalmos by cyst excision and pedicle ligature, via a transconjunctival orbitotomy. The postoperative appearance was satisfactory. Pathology confirmed a thick fibrous wail with calcifications, lymphocytic infiltrates, and neruofilaments and internally lined by dysplastic retinal elements. A conservative approach is advised for colobomatous cysts associated with a globe almost normally in size, in order to avoid cosmetic complications associated with enucleation in childhood
Gunshot orbital wounds
No full textFour cases of orbital gunshot wounds are described in this article. The first patient attempted suicide. The bullet crossed his right orbit and ethmoidal sinus and stopped in his left ethmoidal sinus, partially penetrating in the left orbit. The right eye had no light perception because of an undirect optic neuropathy. The second patient was shot during a war by a sniper in his left orbit. His left eye had no light perception because of a total retinal detachment-the bullet had remained deep in the orbit. In these first two cases, the projectile was successfully removed by a transconjunctival orbitotomy. The third patient and fourth patient accidently shot themselves several years previously. They both had a severe bilateral traumatic optic neuropathy. Plain X-ray films and coronal and axial computed tomography scan with bone window are the most effective imaging techniques in foreign body location and orbital, bulbar, and cranial damage evaluation. Foreign body removal should be always considered because of local and general reactions caused by lead and copper; but intraoperative projectile localization may result unexpectedly difficult. Early medical treatment of traumatic optic neuropathies is advised
Optic-nerve Sheath Meningiomas - Clinical-features and Functional Prognosis
No full textSeventeen cases of optic nerve sheath meningiomas were reviewed, in order to identify their clinical presentation, CT and MRI features, and to evaluate their visual prognosis in untreated cases and after surgery. The most common clinical features were represented by optic disk pallor and/or edema (16 cases), unilaterally reduced visual acuity (14 cases), afferent pupillary defect (12 cases), visual field alterations (nine cases out of 12), proptosis (12 cases), motility disturbances (eight cases), amaurosis fugax (five cases). On CT and MRI, eight tumors appeared fusiform, four excrescent, four tubular, one massive. The optic nerve could be recognized within the tumor in nine cases out of 16 on CT, and in eight out of nine on MRI. Contrast enhancement was observed in most cases. On T-2-weighted MRI, meningiomas proved to be hyperintense in four cases and isointense to fat in the remaining five. A histological diagnosis was obtained in eight cases: seven belonged to the meningotheliomatous type; the remaining to a transitional type. The visual prognosis in untreated patients was extremely variable and unpredictable on the basis of clinical, radiological or epidemiological factors. Of the six cases who had undergone neurosurgery, none experienced a visual improvement; two cases suffered a sudden visual deterioration. Optic nerve sheath meningiomas should be suspected when unilateral visual impairment is associated with optic disk alterations and proptosis. Contrast-CT is the first advised diagnostic step, followed by contrast-MRI if the diagnosis should be unclear
Epithelial malignancies of the lacrimal gland: survival rates after extensive and conservative therapy
No full textWe reviewed 96 cases of lacrimal gland tumors, 20 patients had epithelial malignancies (11 adenoid cystic carcinomas, 7 carcinomas in pleiomorphic adenomas, 1 mucoepidermoid tumor, 1 adenocarcinoma, and 1 carcinoma in an epidermoid cyst). Classic computed tomographic scan changes associated with lacrimal gland malignancies were found in only 55% of cases. The median survival was 6.75 years in the seven patients treated with extensive surgery (orbital exenteration, possibly associated with osseous resections) and nine years in the 12 cases treated with eye-saving procedures (tumor excision, possibly followed by radiotherapy). Our data demonstrated that extensive surgery for lacrimal gland malignancies does not improve survival. Therefore, a therapeutic protocol is suggested, in which all suspected epithelial tumors (discriminated from inflammatory and lymphoid lesions by computed tomographic scan findings) undergo dacryoadenectomy, without a previous biopsy. Subsequently, in the case of carcinomas, the choice between extensive and eye-saving procedures is based on the extent and aggressiveness of the tumor and clinical findings
Prognosis of orbital lymphoid hyperplasia
No full textBackground: Orbital lymphoid hyperplasia can be associated with systemic non-Hodgkin lymphoma (NHL), even when polyclonal proliferation is found in the orbit. Although irradiation is recommended, some orbital lymphoid hyperplasias are treated by steroids (when inflammation is clinically presumed) or left untreated. Methods: The incidence of concurrent NHL and the incidence of future NHL after oral prednisone, radiotherapy, or no treatment were retrospectively evaluated in 33 cases of lymphoid hyperplasia (22 benign lymphoid hyperplasias, BLH, and 11 atypical lymphoid hyperplasias, ALH), after follow-up of 2-13 years. Results: NHL occurred in 12 of 33 cases (36.4%). In seven patients it was concurrent; in five patients it occurred 2-6 years later. In the actuarial curve, at 5 years 55% of patients were free of lymphoma, at 10 years, 46%. NHL was more commonly observed when the lacrimal gland was involved (57% vs 21%; P=0.03). Of the 13 patients treated with oral steroids, 46% had complete response, 39% partial response, and 15% future NHL. Of the seven irradiated patients, five (71%) had complete response, two (29%) partial response, and none future NHL. Of the eight untreated patients, five (63%) had partial response and three (37%) future NHL. Irradiated lacrimal gland BLHs only achieved partial response, one having radiation-induced orbital inflammation. Conclusion: Because of a high risk of NHL, in all orbital lymphoid tumors systemic staging and follow-up are mandatory. The advised management is irradiation, except for Sjogren syndrome, an initially inflammatory lacrimal gland BLH, where a course of steroid is suggested before considering radiotherapy
Primary and secondary orbital melanomas: a clinical and prognostic study
No full textThe clinical, radiologic, and histologic features of 14 cases of orbital melanoma are reviewed. Two cases were presumed to be primary orbital melanomas because no primary pigmented lesion was found in the globe, conjunctiva, or skin. Five cases originated from a conjunctival melanoma, one case from an eyelid cutaneous melanoma, and the remaining six patients had extrascleral extension of a choroidal melanoma. Four patients at the time of first diagnosis already had extraorbital metastases (one patient with extrascleral extension of a choroidal melanoma also had a metastasis to the opposite orbit). The median time interval between diagnosis and metastasis was 14 months. Patients without metastatic disease received radical surgery (partial or total orbital exenteration, in addition to regional lymph node resection if indicated) or conservative treatment (tumor excision plus chemotherapy and interferon). Log-rank test showed an equally poor prognosis for both groups (median time to metastasis was, respectively, 19.5 and 8 months), with no statistically significant difference between the two groups. The authors' reconstructive techniques (dermis-fat grafting and transplantation of temporalis muscle) following partial- and total orbital exenteration are described
CT & MRI reliability in the diagnosis of lacrimal fossa tumors
No full textThis prospective study sought to verify whether computed tomography (CT) and magnetic resonance imaging (MRI) can be used as reliable means for planning a therapeutic approach to lacrimal fossa tumors. Twenty-six cases of lacrimal of a gland mass at first observation were studied. After clinical and radiologic evaluation, the most likely diagnosis was recorded for each patient before treatment. The conclusive diagnosis was based on a histologic examination or (only in case of acute pseudotumor) on a prompt and complete response to steroids. All lymphomas (seven cases) and pseudotumors (four cases) were correctly identified. Two cases of benign lymphoid hyperplasia were suspected to be pseudotumors. All epithelial tumors (six cases) were recognized, except for a pseudocystic necrotic carcinoma, which was suspected to be a dermoid. All dermoids (five cases) were identified. An intraosseous hemangioma was suspected to be an aneurysmal bone cyst, and a cholesterol granuloma was suspected to be a dermoid. CT and MRI, combined with clinical recognition of inflammatory signs, can provide sufficient information to guide the therapeutic approach to lacrimal fossa tumors. Identification of rare tumors and the differentiation of carcinomas from adenomas may result. General guidelines for treatment include: Excisional biopsy for rounded tumors with smooth margins (including cystic lesions) A steroid trial for recent wedge-shaped tumors Incisional biopsy for longstanding or steroid-resistant wedge-shaped tumors
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