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Orbital Inflammatory Syndromes
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Jaspreet Sukhija, Savleen Kaur
Imaging features of sino-orbital diseases are nonspecific and may be confused with varied orbital pathologies, most commonly idiopathic orbital inflammatory disease. CT scan usually reveals a heterogeneous, enhancing mass with density similar to EOMs. Concomitant sinus disease has been reported in 60–90% of patients by various authors.28 MRI provides better details of the posterior orbit, optic canal, and cavernous sinus. Subtle signs of sinus involvement, such as enhancement of the sinus lining and focal hypointense areas within it, may be picked up on MRI.
One or More Bulging Eyes
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Beware that the more sinister causes of proptosis such as lymphoma and other malignancies may initially respond somewhat to systemic steroid with shrinkage and therefore apparent clinical improvement, though of course masking the true disease and making subsequent biopsy and histological diagnosis more challenging. This is of particular relevance when steroid is used to treat presumed idiopathic orbital inflammatory disease without excluding other more dangerous differentials.
Lacrimal Disorders in Children
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Caroline J. MacEwen, Paul S. White
Lacrimal tumours are extremely rare in children. Orbital ‘pseudotumour’ (the preferred name is now idiopathic orbital inflammatory disease), causing painful swelling, is rare but may affect the lacrimal gland.4 It is a non-infective inflammatory disease of unknown aetiology that occurs in the orbit and responds to steroids. Malignant epithelial tumours, including mixed-cell adenocystic and other carcinomas, have been recorded in childhood.5 Lacrimal gland enlargement is also found in conditions such as sarcoidosis and leukaemia. Prolapse of the lacrimal gland, which is commonly bilateral, may present as a subconjunctival mass in the upper outer fornix. This may occur with craniofacial anomalies due to reduced orbital volume and increased orbital pressure.
A rare case of intramuscular orbital amyloidosis presenting as progressive esotropia in an adult
Published in Orbit, 2023
Md. Shahid Alam, Prabrisha Banerjee
A 43-year-old gentleman presented to our clinic with a 6-year history of diplopia and progressive inward deviation of the right eye. He did not have any systemic disorder. Before presenting to us, he had been evaluated for VIth nerve palsy. However, his neuroimaging was non-contributing, and computed tomography (CT) orbit had revealed thickening of the entire lateral rectus muscle. He was diagnosed with an idiopathic orbital inflammatory disease. Despite long-term treatment with oral steroid, the clinical response was poor and the esotropia progressed. On examination, the best-corrected visual acuity in both eyes was 20/20, J6. Right face turn and right esotropia of approximately 95 prism diopters were noted (Figure 1a). There was 3 mm of proptosis with gross limitation of abduction in the right eye (Figure 1b & c). The rest of the anterior and posterior segment examination was unremarkable. There was no regional lymphadenopathy. magnetic resonance imaging (MRI) orbit demonstrated bulky right lateral rectus muscle which was isointense on T1 and hypointense on T2 weighted images (Figure 1d & e), with patchy enhancement (Figure 1f). There was a doubt of orbital metastasis based on imaging features, and a positron emission tomography (PET) scan was ordered which turned out to be normal.
Lymphoma and inflammatory disorders presenting in the orbit– a comparison of characteristics from a 10-year series in a tertiary hospital
Published in Orbit, 2022
Samantha Hunt, Ioana Pereni, Rebecca Ford, Helen Garrott
This was a retrospective case note review undertaken in a tertiary referral center. Our cohort may not be representative of the wider population, as patients which are particularly challenging to biopsy or diagnose are referred in from other units. Some patients were only reviewed once post-operatively before returning for disease management by their local hospital, meaning that datasets may be incomplete. As only patients that underwent orbital biopsy have been included, a few patients who did not undergo biopsy are not represented here – these include patients with isolated myositis who were managed empirically with steroids, and those with purely apical lesions and a clear diagnosis due to systemic disease or other less invasive test results. There were a variety of histological subtypes of lymphoma but small numbers meant it would not be possible to generate a meaningful comparison. As such, those with lymphoma were analyzed as one group; potential differences in presentation between individual subtypes have not been evaluated here, and future work could explore this using larger patient numbers. Many patients were classified on histopathology as having idiopathic orbital inflammatory disease, and numbers of specific OID pathologies were low, giving limited power to statistical analyses. Numerical analysis of visual acuities was unable to utilize data from patients with PL or NPL vision as this cannot be quantified, potentially resulting in positively skewed data; to ameliorate this, the same data has been reported by grouping visual acuities into good/moderate/poorly sighted groups to ensure these patients are captured.
A Rare Fungal Orbital Infection in an Immunocompetent Young Male Caused by Lichtheimia corymbifera (Absidia corymbifera)
Published in Ocular Immunology and Inflammation, 2022
Vazhipokkil Anju Chandran, Kirthi Koka, Lily Therese, Bipasha Mukherjee
Imaging of the orbits and paranasal sinuses is useful in detecting the extent of invasion, though it is not specific about the nature of the ongoing pathology. Bacterial orbital cellulitis appears as isointense lesions on T1 weighted MRI imaging and hyperintense to extraocular muscles on T2 weighted scans with post-contrast enhancement.8 Fungal lesions, on the contrary, appear hypointense on both T1 and T2 weighted MRI imaging.2 The differential diagnosis of hypointense orbital lesions include idiopathic orbital inflammatory disease, granulomatous diseases, and rarely, metastases. It is important to understand the etiology of orbital cellulitis to prevent inadvertent use of drugs like steroids, which can prove fatal in cases of fungal pathologies.