Orbit and lids and lacrimal disorders By Dr. ABDULMAJID ALSHEHAH Ophthalmology consultant Anterior Segment and Uveitis consultant
Dec 31, 2015
Orbit and lids and lacrimal disorders
ByDr. ABDULMAJID ALSHEHAH
Ophthalmology consultantAnterior Segment and Uveitis consultant
The orbit
Anatomy Function• protection to the globe• attachments which stabilize
the ocular movement;• transmission of nerves and
blood vessels.
The orbit
• Clinical features of orbital disease• Proptosis• Enophthalmos• Pain• Eyelid and conjunctival changes• Diplopia• Reduced visual acuity
The orbit
The orbit
Proptosis (exopthalmos)• protrusion of the eye caused by a space-
occupying lesion• can be measured with an
exophthalmometer.• 3 mm difference between the two eyes is
significant.
• Direction of proptosis• Transient proptosis (orbital varices)• Fast onset proptosis (malignant,
inflammatory)• Slow onset proptosis (benign)• Pain associated with proptosis ( orbital
cellulitis)
Thyroid ophthalmopathy
Pathogenesis • Disorders of the thyroid
gland can be associated with an infiltration of the extraocular muscles with lymphocytes and the deposition of glycosaminoglycans.
• An immunological process is suspected but not fully determined.
Clinical features• Proptosis (most common
cause in adults)• Lid retraction (characteristic
stare)• Lid lag• Double vision• red painful eye (exposure)• Reduced visual acuity (optic
nerve)
Thyroid ophthalmopathy
Thyroid ophthalmopathy
• Treatment of associated ocular emergencies (optic nerve compression and corneal exposure)
1- systemic steroid2- radiotherapy3- orbital decompression4- heavy lubrication
• Long term treatmentOnly after stabilization, muscle and lid surgery
Diplopia (Muscle pathology)
Thyroid ophthalmopathy (Graves’ ophthalmopathy)
Idiopathic Orbital Inflammatory Disease ( orbital pseudotumor)
Enophthalmos
• Congenital (small eye)• After trauma ( blow out
fracture)
Orbital pain
• Infection• Tumors (malignant)• inflammation
Eyelid and conjunctival changes
• Redness• Swelling(orbital cellulitis, preseptal
cellulitis, carotid cavernous fistula)
Reduced visual acuity
• Corneal exposure• Compression or inflammation of optic nerve• Macular distortion
Orbital tumors
• lacrimal gland tumors• optic nerve gliomas• meningiomas• lymphomas• Rhabdomyosarcoma (most common orbital malignancy in
childhood)• metastasis from other systemic cancers (neuroblastomas in
children, the breast, lung, prostate or gastrointestinal tract in the adult).
QUSTIONS
The eyelids
ABNORMALITIES OF LID POSITION
• Ptosis • Entropion
• Ectropion
INFLAMMATIONS OF THE EYELIDS
• Blepharitis
BENIGN LID LUMPS AND BUMPS
Chalazion Xanthelasmas
MALIGNANT LID TUMOURS
• Basal cell carcinoma (rodent ulcer)
ABNORMALITIES OF THE LASHES
• Trichiasis
QUSTIONS
The lacrimal system
The lacrimal drainage system
NLD obstruction
Congenital NLD obstruction
• 5% of all full-term newborns.
• 90% open spontaneously in the first year of life.
• Tx: massage and antibiotics drops if infected.
• Sometimes need probing and tubing
Adult NLD obstruction
Dacryocystitis
Questions