Orbital Diseases

Question 1

Define the term orbital diseases?

Answer 1

The orbit refers to the bony cavity in the skull that houses the eye and surrounding structures. Orbital diseases can arise directly from the orbit or as a result of systemic illnesses.

Question 2

Describe some common signs and symptoms of orbital diseases?

Answer 2

Symptoms: 
Double vision
Pain/discomfort
Decreased vision
Soft tissue swelling and erythema

Signs:
Proptosis (bulging of eyes as seen in exopthalamus)
Endothalmos
Opthalmoplegia (paralysis of extraocular muscles)
Fundus changes

Question 3

List the vacular causes of orbital diseaes?

Answer 3

Orbital venous anomalies (varices): congenital enlargements of pre-existing venous channels. Usually occurs bilaterally. Risk of thromboses and bleeding.

Carotid cavernous fistula: abnormal anastamosis between the carotid and cavernous sinuses.

Can be:
-Direct rapid flow shunt due to trauma.

• Indirect slow flow shunt due to a congenital abnormality which will be prone to rupture.
• Enchephalocele: Herniations of intercranial contents through congenital skull defects. Transmission of CSF pulsation causing a pulsating proptosis (bulging of the eyes)

Question 4

List the inflammatory and infective causes of orbital disease?

Answer 4

Orbital cellulitis:
Infection behind the orbital septum (bony). Often secondary to ethmoiditis.
Symptoms include: severe malaise, fever and orbital signs (proptosis).
Medical emergency as can be sight and life threatening. Complications include brain abscess, meningitis, and cavernous sinus thrombosis.

Idiopathic orbital inflammatory disease (IOID):
Non neoplastic or infective.
Pseudotumor and should be a diganosis of exclusion.
Abrupt painful onset usually in 20-60yo.
Treat with anti-inflammatory and steroids.

Question 5

List the common orbital diseases? Autoimmune

Answer 5

Thyroid Eye Disease:
Eye changes which occur due to thyroid disease, usually in Grave’s but it can occur in hypothyroidism also.

Common signs and symptoms:
Lid lag or retraction
Periorbital oedema
Exopthalamus (1/3 of patients with Graves)
Exposure keratopathy (dry cornea)

Compression of optic nerve causing an optic neuropathy occurs in 5% of those with exopthalamus. Important to do a full eye assessment, acuity, colour, reflexes, fields and fundoscopy.

Treatment: can correct with normal thyroid levels overtime, but exopthalamus will persist in 70%. Other treatments include surgical decompression and high dose topical steroids can be used.

Question 6

List neoplastic causes of orbital disease?

Answer 6

Orbital tumours are classified based on the tissues involved.

Vascular:

Capillary haemangioma: benign orbital tumour in children, may have spontaneous resolution, treatment is with steroids.

Cavernous haemangioma: orbital tumour in adults. More in F.

Lacriminal gland tumours:
Adenoma or carcinoma. Both need resection, radiotherapy also for carcinoma.

Neural:

Optic nerve glioma: high association with neurofibromatosis type 1 (genetic condition in which you suffer from tumour growing along nerves). Presents with gradual visual loss in 1st decade of life.

Optic nerve sheath meningioma: typically middle aged women. Treatment varies from observation to resection depending on aggressiveness of the tumour.