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Orbital Disease


Presentation

  • A 63-year-old man with HZO presented with involvement of cranial nerves II, III, IV, V, and VI, with proptosis, raised intraocular pressure, and chemosis.[ncbi.nlm.nih.gov]
  • Common presenting symptoms and associated neuro-orbital diseases also are summarized.[jhu.pure.elsevier.com]
Epilepsy
  • The disease was complicated with epilepsy, vision loss, and trismus. Treatment with various immunosuppressive agents was unsuccessful. Eventually the patient was effectively treated with infliximab.[ncbi.nlm.nih.gov]
Trismus
  • The disease was complicated with epilepsy, vision loss, and trismus. Treatment with various immunosuppressive agents was unsuccessful. Eventually the patient was effectively treated with infliximab.[ncbi.nlm.nih.gov]
Diplopia
  • Case 1: A 63-year-old woman was admitted to the Neurology Service for worsening diplopia over the previous six months, with a working diagnosis of myasthenia gravis or multiple sclerosis.[endocrine-abstracts.org]
  • Overview Orbital pathology can result in neuro-ophthalmic manifestations such as optic neuropathy and ocular misalignment, leading to vision loss and diplopia.[medlink.com]
  • Patients may have diplopia. In burnt-out Graves orbitopathy, many of the same signs persist, except that the inflammation is gone and the eyes and orbits appear quiet. However, the proptosis, lid retraction, and diplopia still remain.[emedicine.medscape.com]
  • These include eye irritation/dryness, eye pressure, tearing, redness, eyelid swelling and retraction, bulgy or protruded eyes (proptosis), double vision (diplopia) and blurred or even loss of vision.[tabanmd.com]
  • Proptosis, diplopia, and vision loss are also possible. In cases of reactive lymphoid hyperplasia or IgG4-related orbital disease, there are typically few symptoms other than proptosis or swelling.[merckmanuals.com]
Strabismus
  • Our team of doctors includes leading experts in ophthalmic plastic surgery, endoscopic orbital surgery, strabismus, thyroid gland disorders, neurosurgery, and head and neck oncology.[masseyeandear.org]
  • J Pediatr Ophthalmol Strabismus 1987;24(4):194–197. PubMed Google Scholar 55. Wright JE, McNab AA, McDonald WI. Optic nerve glioma and the management of optic nerve tumours in the young. Br J Ophthalmol 1989;73(12):967–974.[link.springer.com]
  • Second stage surgery is for those with restrictive strabismus causing diplopia (double vision) not corrected by prism glasses. The third stage operation is eyelid surgery, both reconstructive and cosmetic.[tabanmd.com]
  • Treatment Amblyopia, strabismus, anisometropia: treat; otherwise, may observe, since involution will occur.[entokey.com]
  • D. ( 1993 ) Treatment of thyroid ocular myopathy with adjustable and nonadjustable suture strabismus surgery . Transactions of the American Ophthalmological Society 91 : 67 – 84 . Liu , D. ( 1993 ) Surgical correction of upper eyelid retraction .[cambridge.org]
Eye Pain
  • If you’re experiencing any eye pain or vision problems, your doctor may order blood tests and take blood samples. An infection in your eye can cause serious complications.[healthline.com]
  • Symptoms may include: Eye pain Double vision Restricted motion in the eye Swollen and red eyelids Testing for orbital inflammatory pseudotumors Your doctor will want you to have several imaging tests to confirm that it is a pseudotumor, including: CT[upmc.com]
  • Patients with scleritis describe severe, boring eye pain which often radiates to the forehead and head. This pain may keep them awake at night.[antimicrobe.org]
Unilateral Proptosis
  • Signs and Symptoms Sudden onset of unilateral proptosis. Eyelid swelling, injection, ecchymosis. Pain and decreased vision are uncommon. Demographics Onset: age 7 to 8 years.[entokey.com]
  • Vision may be blurred. [ 4 ] Look for a (usually unilateral) proptosis, severe conjunctival oedema (chemosis) and limited eye movement caused by a combination of cranial nerve palsy and physical limitation of movement.[patient.info]
Stroke
  • Diffusion weighted imaging and perfusion-weighted imaging are improving the evaluation of acute stroke.[ncbi.nlm.nih.gov]

Workup

  • Treatment and Management When rhabdomyosarcoma is suspected, an immediate biopsy should be performed (complete or near-complete excisional biopsy), with an appropriate metastatic workup to stage the disease.[entokey.com]
  • A thorough workup is essential in all patients presenting with these orbital signs, beginning with a detailed review of systems, a full ophthalmic exam and dedicated orbital imaging.[reviewofophthalmology.com]
  • Clinical Presentation All patients with suspected NSOI require a full ophthalmic assessment/workup. NSOI is typically characterized by the abrupt onset of pain, proptosis and other inflammatory signs such as swelling and erythema.[eyewiki.aao.org]

Treatment

  • Two cases are described to illustrate this procedure and the response to treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Orbital rhabdomyosarcomas and related tumors in childhood: relationship of morphology to prognosis—an Intergroup Rhabdomyosarcoma study. Med Pediatr Oncol 1997;29(1):51–60. PubMed CrossRef Google Scholar 24.[link.springer.com]
  • Prognosis is very poor. Metastases : In children the orbit may be the site of secondary deposits from neuroblastoma or acute leukaemia.[patient.info]
  • Prognosis is based on staging of disease and histopathologic features with range from best to worse prognosis: adult pleomorphic embryonal (including botyroid) alveolar.[entokey.com]
  • If detected early these cancers can be removed surgically and offer a good prognosis or outcome. Although eye cancers and tumors are rarely fatal if detected early, they can result in loss of vision.[news-medical.net]
  • Evaluation of 17 reported orbital cases revealed that the presence of ANCA antibodies was associated with ischaemia and may have a poor visual prognosis. Relapses are common in Churg–Strauss, occurring in about 25% of affected individuals.[nature.com]

Etiology

  • With the exception of higher incidence of inflammatory etiologies, these data are largely consistent with prior published reports.[ncbi.nlm.nih.gov]
  • For each disorder, the etiology, clinical manifestations, imaging characteristics, differential diagnoses, and management options are described and discussed.[books.google.com]
  • Etiology Idiopathic but has been associated with blunt or surgical trauma (blepharoplasty) in healthy patients. Group β -hemolytic Streptococcus.[entokey.com]
  • Force duction test can distinguish between the causes of which the results of the test will be positive if the etiology is due to mechanical restrictions.[transbiomedicine.com]

Epidemiology

  • In this article, we are describing epidemiology and differential diagnostics of IgG4-related orbital disease with particular focus on pseudotumors, MALT lymphomas and lymphocyte/plasma cell infiltrations of the orbit.[ncbi.nlm.nih.gov]
  • […] anti-inflammatory drugs, cytotoxic agents (chlorambucil, cyclophosphamide), corticosteroid sparing immunosuppressants (methotrexate, cyclosporine, azathioprine), IV immune-globin, plasmapheresis, and biologic treatments (such as TNF-α inhibitors). [6] Epidemiology[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • The possible role for B-cell depletion in both TED and IgG4-ROD suggests a degree of overlap in the underlying immune-related pathophysiology that is yet to be defined.[ncbi.nlm.nih.gov]
  • Although an endoscopic approach to the medial and inferior walls can be performed in isolation, a balanced approach, incorporating a lateral decompression with repositioning of the lower lid, can be required. [10, 11] See also the following: Pathophysiology[emedicine.medscape.com]
  • Future directions of experimental work require detailed real-time immunologic monitoring in order to determine the pathophysiology of disease and formulate increasingly sophisticated options for targeted therapy.[nature.com]

Prevention

  • A flat-surfaced wax compensator assures uniform electron penetration across the field, and a sunken lead alloy eye block prevents excessive dose to the central structures of the anterior segment.[ncbi.nlm.nih.gov]
  • . • Early detection may prevent or reduce visual dysfunction. • Orbital pathology may lead to restrictive ocular movements manifesting as diplopia. • Orbital pathology can easily be missed if the orbit is not considered as a site of pathology. • Proptosis[medlink.com]
  • XRT may also be useful in preventing progressive expansion of muscles and recurrence of vision loss following surgical orbital decompression in patients with compressive optic neuropathy.[thyroideyedisease.org]
  • How to prevent diplopia in endoscopic transnasal resection of tumors involving the medial orbital wall. The Laryngoscope , Vol. 124, Issue. 9, p. 2017. CrossRef Google Scholar Chemli, H. Breton, P. and Bouletreau, P. 2013.[cambridge.org]
  • The amount and duration of pressure must be monitored to prevent inadvertently compression of the ophthalmic artery.[emedicine.medscape.com]

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