Pathology of the orbit PDF 2024

Pathology of the orbit E Kruger 2024 Conditions Pre-septal and orbital cellulitis Preseptal cellulitis Diagnosis Management Orbital cellulitis https://youtu.be/uH4-ciPYI9I?si=6xPVPAC_N7tf37Pp Pathogenesis  Possible causes: Secondary to sinusitis (most...

Pathology of the orbit E Kruger 2024 Conditions Pre-septal and orbital cellulitis Preseptal cellulitis Diagnosis Management Orbital cellulitis https://youtu.be/uH4-ciPYI9I?si=6xPVPAC_N7tf37Pp Pathogenesis  Possible causes: Secondary to sinusitis (most common) Spread from a local or remote infection After trauma Post-surgical complication (S. Pneumoniae, S. aureus, S. Pyogenes and H. Influenza) May cause: Aetiology Cavernous sinus syndrome Meningitis Encephalitis  Symptoms Rapid onset pain Visual impairment Fever and Malais (the patient also feels unwell) Clinical Signs Unilateral tender, warm and red periorbital features oedema (+) RAPD Pain on motility Ophthalmoplegia Proptosis with possible diplopia ONH oedema  Hospitalization IV antibiotics Treatment Surgical drainage if indicated https://www.facebook.com/Ophthalmologynotes/photos /a.825372004241364/1393591504086075/?type=3 Cavernous sinus syndrome and thrombosis https://youtu.be/GLqZmJluYHY?si=-b4BJmDKZD7wJrBU  The cavernous sinus is one of several drainage pathways for the brain that is situated in the centre Receives venous drainage from the brain Cavernous sinus Blood filled space that contains internal carotid syndrome artery surrounded by sympathetic fibres (cranial nerves) Presents as proptosis, chemosis, ophthalmoplegia, Horner syndrome or trigeminal sensory loss Pathology or lesion within the cavernous sinus Disrupts the function of other anatomical structures Most common cause: tumour Other causes: trauma, self-limiting inflammatory disease Very uncommon Female prominence Causes and clinical features cause Clinical Features Meningioma, chordoma, neuroma, pituitary adenoma, Tumor metastases, lymphoma, nasopharyngeal carcinoma, chondrosarcoma, hemangioma, neuroblastoma Inflammatory Disease Tolosa-Hunt syndrome, sarcoidosis Basal skull fracture, operative trauma to cavernous sinus Trauma after skull base surgery Intracavernous aneurysm, carotid-cavernous fistula, Vascular cavernous sinus thrombosis Mucormycosis, aspergillosis, actinomycosis, nocardiosis, Infection mycobacterium, herpes zoster Endophthalmitis Definition Bacterial or fungal infection inside the eye involving the vitreous and / or aqueous Occur after penetrating injury, surgery or extension of corneal infection Treatment remains the same in all forms of endophthalmitis Penetrating injury Develops in 1 out of 10 cases Bacterial (staphylococcus and/or Bacillus) Management: Prophylactic antibiotics Removal of foreign object / foreign body Intravitreal antibiotics https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/Penetra ting-ocular-trauma/index.htm Postoperative Even with early treatment outcome is poor Blindness and even loss of eye due to virulent organisms following cataract surgery Aggressive treatment should be started as soon as possible Signs and symptoms More severe than in the case of blebitis (infection without vitreous involvement) While milky blebs, as is seen with Blebitis is of greater severity Severe injection (hyperaemia) Severe anterior uveitis with substantial https://www.reviewofoptometry.com/article/is-help-on- hypopyon the-way  Vitritis (cellular infiltration of the vitreous body) Tx: antibiotic injection in vitreous cavity repeating after 48 hours Posterior vitrectomy with topical steroids after 48 hours Oral antibiotics for 10 – 14 days Lacrimal gland Infective Ocular Inflammatory Disease (IOID) Acute dacryoadenitis Idiopathic or viral Unilateral or bilateral depending on the cause Reduced lacrimal secretion with discharge often reported Rapid onset discomfort https://encrypted- tbn0.gstatic.com/images?q=tbn:ANd9GcTGILwbL0TCmHeLuPtFgUdrMSjZmzLXiHG1Dg&usqp=CAU  Lacrimal gland Infective Ocular Inflammatory Disease (IOID) Anophthalmic socket https://webeye.ophth.uiowa.edu/eyeforum/cases/279-anophthalmic-socket.htm Evisceration https://preview.redd.it/35riuy6x7z181.gif?format=png8&s=421332356476e6668956dfdd155fd6bed131b3f1  Enucleation https://cdn.sanity.io/images/0vv8moc6/optometrytimes/1297de6337251348f681 cc7c1cc32981cd63dbb4-1339x914.jpg Exenteration Removal of the globe and entire contents of the orbit Anterior tumours may allow for sparing of posterior tissue Posterior tumours may allow for sparing of the eyelid that are then used to line the socket Indicated in the following cases: Malignancy where treatment is not effective Rehabilitation Cosmetic shell – provides volume and improves cosmetic appearance Orbital implants counteract orbital volume deficit after enucleation or evisceration After enucleation of evisceration a prosthesis shaped to fit each individual socket and matching the other eye After enucleation there may be a volume deficit Thank you