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This article traces the development of orbital surgery and its subsequent modifications. It also points out the importance of defining one's goal before embarking on orbital surgery. Although generally considered part of ophthalmology, surgery on the orbit has been relatively neglected and not routinely practiced. This article reviews the history of development of orbital surgery, both the revolutionary ideas and the evolutionary changes. There are multiple orbital lesions that do not need to be treated with surgery at all. These days chemotherapy, radation therapy, or even immunotherapy may be more appropriate. The most common orbital pathology, that is thyroid orbitopathy, the physician needs to decide whether or not the orbit needs to be decompressed or whether there are problems related to motility that can be dealt with by eye muscle surgery. [ABSTRACT FROM AUTHOR]

Purpose: Analysis of different clinical types of orbital dermoid cyst, and studying the impact of preoperative classification on the proposed surgical procedure.Methods: A retrospective study of orbital dermoid cyst cases. The clinical and imaging data were reviewed. The different types of dermoid were recorded as superficial or deep, lateral or medial, exophytic or endophytic. The deep dermoids were classified according to their site and continuity of the cyst wall. The operative approach, intraoperative, and/or postoperative complications were recorded.Results: The study included 153 cases of orbital dermoid. The superficial lesions represented 68.6%, of which 74.3% were lateral and 61.0% were endophytic. Intraoperative cyst perforation was recorded in 56.3% of exophytic cases approached through crease incision, and recurrence occurred in 6.3%. Defective cyst wall was found in 31.25% of deep orbital dermoid. Surgery was complicated by cyst rupture when excision was attempted, and recurrence was recorded in one case. Exposure, intended evacuation, and dissection of the cyst wall were better surgical approaches for these cases without reported complications.Conclusion: Preoperative classification of orbital dermoid had an important effect on the surgical procedure. Endophytic superficial lesions were approached through crease incision without complications, while exophytic lesions were better approached through infrabrow incision. Deep orbital lesions with defective wall were better approached through exposure, intended evacuation, dissection, and excision of the remaining cyst wall. [ABSTRACT FROM AUTHOR]

Introduction: The recommended urgent surgical management of ocular motility restriction due to orbital muscle entrapment or impingement associated with orbital wall fracture needs to be elucidated.Aim: To evaluate the importance of the time from injury to surgery for the outcome in ocular motility and diplopia, the time lapse of ocular motility, diplopia and hypesthesia recovery.Material and Methods: Patients with entrapment or impingement of orbital contents due to orbital wall fracture were followed up prospectively over 1year regarding ocular motility, diplopia, hypesthesia and cosmetic deformity.Results: 21 patients (10 entrapments and 11 impingements) were included and treated surgically. The median time from injury to surgery was 36 (8-413)h for the entrapment group and 168 (48-326)h for the impingement group. The median time from study inclusion to surgery was 0 (0-1) days for the entrapment group and 1.0 (0.2-4.8) days for the impingement group. All the patients had ocular motility limitation and diplopia at the inclusion. Ocular motility improved gradually and was normal at final visit. Diplopia resolved gradually in all patients except in two with non-disturbing diplopia, at the final visit. Forced duction test was positive in 90% of the patients in the entrapment group and 70% in impingement group. At final visit, hypesthesia was found in none of the patients in the entrapment group but in 4 patients in the impingement group.Conclusions: In this, the first prospective long term follow up of orbital wall fractures with ocular motility restriction, we did not find any significant correlation between the time from injury to surgery and the outcomes in ocular motility and diplopia. An entrapment requires surgery as soon as possible; however, the surgical reduction is at least as important as surgical timing. Surgery should be delayed until it can be performed by an experienced surgeon. Ocular motility restriction causing diplopia due to impingement is not an ophthalmologic emergency and surgery is recommended if the diplopia and ocular motility has not improved over time. Clinical examination of ocular motility and not CT scan findings is crucial to determine whether a limitation of ocular motility exists or not. [ABSTRACT FROM AUTHOR]

A 40-year-old man presented with right eye axial proptosis and ophthalmoplegia for 3 months. Imaging study showed a right intraconal mass with the erosion of the orbital floor. Incisional biopsy revealed mucoepidermoid carcinoma. Nasal endoscopy was normal and systemic tumor screening was negative for a primary source. The patient underwent right orbital exenteration, uncinectomy, nasal and maxillary mucosal biopsy. Malignant cells were found present in the mucosa of maxillary sinus roof and uncinate bone. The postoperative positron emission tomography scan showed residual active lesion in right orbital apex and maxilla but no primary lesion elsewhere. The patient subsequently underwent 35 cycles of postoperative radiotherapy. Primary mucoepidermoid carcinoma of the orbit is rare and typically arises from the lacrimal gland or sac. Those tumors not arising from lacrimal apparatus should be presumed metastatic in origin, and the thorough systemic survey should be undertaken in the search for the primary tumor. [ABSTRACT FROM AUTHOR]

In this paper, a computer-aided system for orbital prosthesis rehabilitation is introduced. With the system, a 3D model of the orbital prosthesis can be easily reconstructed from the CT image of a patient by referring to the normal eye of the patient, and the rehabilitation result by the model can be simulated before the surgery. This facilitates surgeons to design appropriate orbital prosthesis and improve rehabilitation esthetics. Based on the system, the preoperative surgery planning for orbital implant can also be made. This improves the reliability, safety and intuition of the rehabilitation surgery well. The system has been applied to clinical CT images of patients, and the experimental results show effectiveness and acceptability of the system in the clinic. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study described here was to report the outcomes of surgery for orbital fat prolapse by conjunctival fixation to the sclera. Patients and methods: Twenty-three consecutive eyes of 19 patients with orbital fat prolapse were retrospectively reviewed. All cases were treated with the same simple procedure without resection through conjunctival incision: fixation of conjunctiva to the sclera with interrupted sutures of 10-0 nylon in two rows located approximately 12-14 mm posterior to the limbus. These sutures formed an embankment to keep the prolapsed fat posteriorly. Postoperative results were determined by slit-lamp examination and recurrence of prolapse was defined as the presence of orbital fat anterior to the embankment. Results: During the mean follow-up period of 19 months (range: 1-59 months), one case experienced recurrence which required further surgery. None of the other cases experienced recurrence, and there were no intraoperative or postoperative complications. Conclusion: Conjunctival fixation to the sclera was a simple and effective surgical technique for orbital fat prolapse, with less invasion compared to the conventional method that requires conjunctival incision. [ABSTRACT FROM AUTHOR]

Purpose. Blowout fracture characterized by concurrent floor and medial wall fractures is a rare entity. We compared surgical outcomes between a single approach and a double approach in patients with orbital fracture by measuring the postoperative orbital volume. Methods. We confirmed that 21 (8.5%) of a total of 246 patients with orbital fractures had fractures of the medial wall and floor through a retrospective chart review. Of these, 10 patients underwent the single approach and the remaining 11 patients had the double approach. We performed a statistical analysis of changes between the preoperative and postoperative orbital volumes at a 6-month follow-up. Results. Compared with the contralateral, nonaffected side, the orbital volume was 115.3 (±6.09)% preoperatively and 106.5 (±6.15)% postoperatively in the single approach group and 118.2 (±11.16)% preoperatively and 108.6 (±13.96)% postoperatively in the double approach. These results indicated that there was a significant difference between the preoperative and postoperative orbital volumes in each group (P<0.05). However there was no significant difference between the single approach and the double approach (P>0.05). Conclusions. Our results showed that there were no significant differences in surgical outcomes between the two modalities. The treatment modality may be selected based on the surgeons’ preference, as well as the fracture type. [ABSTRACT FROM AUTHOR]

Advances in ophthalmic surgery, together with achieving greater patient safety, have changed the requirements of regional anaesthesia of the eye, orbit, and periocular skin. Patient comfort, safety, and low complication rates are essentials of regional anesthesia, which includes invasive procedures that generate intraoperative and postoperative analgesia, as well as akinesia. We present the currently used local anesthesia (topical and subcutaneous infiltration of local anesthetics) and regional anesthetic techniques in ophthalmic procedures, describing the techniques, advantages, disadvantages, and complications in ophthalmic regional blocks, as well as some educational measures to implement them to reduce the risk of ocular complications. Currently, there is no absolutely safe ophthalmic regional block, and the anesthetic modality should be assessed on a patient and surgeon basis. Local anesthesia is the reversible loss of sensation in certain area of the body to minimize pain and obtain patient comfort. It can be achieved through topical application or injection of anesthetic agents that block the nerve impulses to that tissue. [ABSTRACT FROM AUTHOR]

A 34-year-old female presented with firecracker injury with curved metallic foreign body embedded in the left orbit and protruding out through the upper eyelid. The report highlights notable aspects in diagnosis, decision-making, and successful removal of this unusual case of retro-orbital foreign body. [ABSTRACT FROM AUTHOR]

Access to the superior mid-orbit is required for procedures on the levator muscle in the correction of upper eyelid ptosis and in surgery aimed at local lesions in this region. The purpose with this human cadaver study was to clarify the anatomical substrate for a surgical approach to the levator muscle and the upper mid-orbit structures, in which the orbital septum and the retroseptal fat pad is not harmed during surgery. Macro-anatomical dissections and histological examinations were performed on five human orbits from three formalin embalmed cadaver heads. It was found that the orbital septum extends posteriorly from its junction with the levator aponeurosis. This posterior continuation of the orbital septum encloses the superior orbital fat pad and separates this from the anterior surface of the levator muscle. In between the orbital septum and the levator, there is a dissection space that provides a minimal invasive access corridor to the structures in the upper mid-orbit. [ABSTRACT FROM AUTHOR]

Introduction: This article reports experience relating to the measurement of orbital volume by means of cone beam computed tomography (CBCT) and Cranioviewer program software in patients who have undergone enucleation and orbital implantation. Patients and Methods: CBCT scans were made in 30 cases, 10 of which were later excluded because of various technical problems. The study group therefore consisted of 20 patients (8 men and 12 women). The longest follow-up time was 7 years, and the shortest was 1 year. In all 20 cases, the orbital volume was measured with Cranioviewer orbital program software. Slices were made in the ventrodorsal direction at 4.8 mm intervals in the frontal plane, in both bony orbits (both that containing the orbital implant and the healthy one). Similar measurements were made in 20 patients with various dental problems. CBCT scans were recorded for the facial region of the skull, containing the orbital region. The Cranioviewer program can colour the area of the slices red, and it automatically measures the area in mm. Results: In 5 of the 20 cases, the first 4 or all 5 slices revealed that the volume of the operated orbit was significantly smaller than that of the healthy orbit, in 12 cases only from 1 to 3 of the slices indicated such a significant difference, and in 3 cases no differences were observed between the orbits. In the control group of patients with various dental problems, there was no significant difference between the two healthy orbits. The accuracy of the volume measurements was assessed statistically by means of the paired samples t-test. Summary: To date, no appropriate method is avaliable for exact measurement of the bony orbital volume, which would be of particular importance in orbital injury reconstruction. However, the use of CBCT scans and Cranioviewer orbital program software appears to offer a reliable method for the measurement of changes in orbital volume. [ABSTRACT FROM AUTHOR]

Background: Anophthalmia in childhood whether congenital or acquired is not just a question of cosmesis. Loss of an eye can effect the maturation of the soft tissues and bony structure surrounding the affected orbit. Therefore, a comprehensive approach including medical and surgical interventions is required to rehabilitate a child early in life. Materials and Methods: A literature survey of the past 40 years on the topic of congenital anophthalmia with focus on medical and surgical volume augmentation of the orbit was conducted. Results: Newer technologies including hydrogel implants and saline-filled tissue expanders have allowed for more rapid expansion of the pediatric orbit often with minimally invasive surgical procedures. However, traditional approaches including conformer therapy are still the primary intervention in these complicated cases. Conclusion: Anophthalmia in childhood requires a close interaction between ophthalmologist and ocularist as well as a motivated patient and family. With early intervention a good cosmetic outcome with periocular symmetry is obtainable. [ABSTRACT FROM AUTHOR]

We describe the clinicopathological features of a solid variant of orbital angioleiomyoma. A review of clinical records, diagnostic, and radiographic studies combined with histopathological evaluation with standard histochemical staining and immunohistochemistry was conducted. A 22-year-old male patient presented with a mass in the region of the left lacrimal gland that was gradually increasing over the past 2 years. Radiological and clinical examinations showed no signs suspicious of a malignancy and fine needle aspiration cytology was inconclusive. Therefore, an excision biopsy was performed. On histopathological examination, the picture was consistent with a benign spindle cell tumor. Immunohistochemistry showed positivity for CD 34 and CD 31 (markers for vascular endothelium). The tumor also showed positivity for smooth muscle actin and Ki-67 proliferative index was low. Angioleiomyomas are rarely encountered in the orbit and has features seen in leiomyoma as well as some vascular tumor elements. In most cases, surgical excision is usually curative. [ABSTRACT FROM AUTHOR]

Ideally the planning of decompression surgery should be adequate to the severity of the orbitopathy, its possible “lipogenic” or “myopathic” variants, the patient's specific orbital osteology and possible previous surgeries. Due to surgeon's experience and local traditions, however, a standardized rather than a tailored approach is often offered to the patient. An inferior fornix and/or upper skin crease incision can be used for infero medial and/or lateral, bony and/or fat decompression. As an alternative the swinging eyelid technique, offering an adequate access to the bony orbit and to the orbital fat compartments is a versatile technique that can virtually be used as a standard approach for the greatest majority of patients needing decompression surgery. Orbital decompression by coronal incision is an invasive technique and for this not to be used as a standard approach to orbital decompression. Nevertheless, it is not to be abandoned as it can be an additional tool in surgeons' hands when dealing with patients who can better benefit out of a particular, tailored rather than a standardised approach. Many are the circumstances in which this may happen. Major complications associated with the coronal approach have been mainly described in small series, where only a few patients per year were operated. In this respect it is therefore unavoidable to emphasize that each technique has its own learning curve and it may be difficult to differentiate the effects of each technique from the experience of the surgeon. [ABSTRACT FROM AUTHOR]

The surgical armamentarium for orbital decompression in Graves'orbitopathy (GO) includes techniques for orbital wall resection using local incisions, but also techniques for orbital rim advancement or resection of the greater sphenoid wing, which require a coronal or even transcranial approach. Up to now the choice of technique rather depends on the surgeon`s preference than on objective criteria. The goal of our CT-based research project is to define morphological orbital parameters which potentially could influence the result of a given technique for orbital decompression in thyroid eye disease. Based on the results individualized, anatomy-based surgical concepts could be established. [ABSTRACT FROM AUTHOR]

Abstract: Orbital implants have been used for cosmesis following surgical removal of the eyeball, or enucleation, for over a century. Implant design has progressed significantly in recent years with the use of porous devices, with the theoretical advantages of reduced complications and improved cosmesis. However, in some cases the theoretical benefits have not fully translated into clinical results. In this article the use of orbital implants in enucleation, with a particular focus on the newer porous biomaterials that have gained prominence over the last 15 years, is reviewed. Specific factors identified as affecting the performance of porous orbital implants include the material used, pore size, and morphology. Mechanical factors have received little consideration in the past and may form a basis for the use of higher compliance porous materials in the future. Of the porous materials in use, current clinical evidence is not sufficient to suggest either that porous implants are superior to non-porous implants, or that one material is more suited to the application than another. Future developments in this field require randomized controlled clinical trials with extensive follow-up as complications may not become evident until over 5 years post-implantation. [Copyright &y& Elsevier]

Purpose : A retrospective analysis of all cases of orbital exenteration performed at the National Scottish Ocular Oncology Center over an 11 year period. Methods : We sought all exenteration cases (1993—2003) from ocular oncology and oculoplastic databases. Fifteen exenterations were performed. One case record was irretrievable. Clinicopathological features and outcome of 14 patients were analyzed. All operations were performed by the same consultant. Results : The male to female ratio was 1:1 and the average age at surgery was 66 years. There was a left sided predominance of pathology demonstrated (right to left orbit ratio was 1:1.3. The average follow up period postsurgery was 35 months. The most common underlying diagnosis was malignant melanoma (9/14). Ocular/orbital discomfort was the most frequent presenting symptom (7/14); a mass lesion (10/14) was the most common presenting sign. The average duration of symptoms/signs prior to tertiary institution referral was 10.9 months (range: 0.5—60 months). Exenteration was performed on average 39.7 months (range: 0.13—204) after initial tertiary center presentation. This included patients managed from the outset who failed treatment(s) and then required exenteration. The eyelids were sacrificed in ten cases (10/14). Sockets were lined with eyelid skin (4/10), split skin (thigh) (3/10) or healed secondarily (7/10). Thirteen cases (13/14) had clear histological margins. The average post operative stay was 8.3 days. The most common complication was socket fistula formation (7/14). Ethmoid sinuses were always involved. The average time to fistula development was 4.9 months (sockets lined by skin = 2.2 months compared with sockets left to heal secondarily = 6.9 months). The majority of patients wore occlusive shields long term. Conclusion : The most common pathology necessitating exenteration was malignant melanoma. Most patients presented with a mass lesion. Histological tumor free margins were obtained in thirteen of fourteen cases. The most common complication was socket fistula formation. [ABSTRACT FROM AUTHOR]

Purpose: To describe the first confirmed case of solitary fibrous tumor in Saudi Arabia and in the Middle East, and to illustrate a surgical technique for atraumatic complete removal. Methods: A retrospective interventional case report that describes the first confirmed case of solitary fibrous tumor in the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. Results: The clinical presentation, computed tomography (CT) findings, and histopathological, immunohistochemical and electron microscopic findings to confirm the diagnosis, as well as the cryodissection surgical technique for atraumatic removal of solitary fibrous tumor used, are described. Conclusions: Solitary fibrous tumor should be considered in the differential diagnosis when a patient presents with unilateral proptosis and a well-circumscribed, intensely enhancing mass on CT imaging. Because of the risk of malignant transformation, surgical en bloc removal with minimal tissue damage is the treatment of choice. This may be achieved by means of cryo-extraction via a minimally invasive orbitotomy. [ABSTRACT FROM AUTHOR]

Purpose: Orbital implants are used as fillers following enucleation or evisceration surgeries to replace the lost volume for better cosmesis and motility of the artificial eye. Over the last decade porous hydroxyapatite (HAp) implants derived from the naturally occurring corals, are increasingly used. Recently synthetic HAp-based implants have been introduced. After fibrovasculrisation they have the added advantage of being directly integrated with the artificial shell, thereby increasing the motility to a great extent. The current study, evaluated the efficacy of two different models of synthetic HAp with 75% porosity and pore sizes ranging from 100 to 300 mm.Methods: Synthetic HAp powders were prepared with a novel wet chemical route. Two models of porous orbital implants with the characteristic designs for both evisceration and enucleation surgery were developed, characterised and implanted to consecutive 25 human subjects, 17 following evisceration, and 8 following enucleation. The postoperative performances of these implants were evaluated in respect to the degree of volume replacement (implant + prosthesis), presence/absence of lagophthalmos and lower eye-lid laxity, status of socket and fornices. Magnetic resonance imaging assessed the stability of the implants within the socket and progressive fibro-vascularisation within the porous scaffold as a function of time. Finally, motility of the implants as well as the prostheses (horizontal movements by Lister Perimeter) and subjective cosmetic results (qualitative) were also evaluated.Results: During the 2.5 years of follow-up study, no significant postoperative complications were noticed. One case, showed an anterior implant exposure of 3-4 mm, and was managed with donor scleral patch graft and one case of conjunctival thinning was corrected by re-suturing the conjunctival dehiscence. Fourteen of the 25 patients had a very good movement of the prostheses (> 20 degrees horizontal movement) and the other 11 patients had a fair motility (10 - 20 degrees). The degree of volume replacement (with prosthesis) was found to be very good in 21 patients and fair in other 4 patients. All patients reported cosmetic satisfaction.Conclusion: Synthetic HAp-based integrated orbital implants with this modified design were found clinically safe and cosmetically acceptable. [ABSTRACT FROM AUTHOR]

Background.We present an overview of the treatment and clinical outcome of 22 orbital inflammations and infections, carried out in our center from 1991 to 2002.Method. The surgical approach was determined by the location, and type of the lesion. Lateral orbitotomy was performed in 2 laterally located lesions, a transconjunctival approach in 8 medial, basal, extra-, intraconal lesions. Pterional intradural (5), and extradural (3) approaches were used in case of intracranial involvement or location in the orbital apex and optic canal. Lesions of the lid were operated via eyebrow incision.Findings. Bacterial infections were confirmed in 5 cases (1 mucocele, 3 abscesses, 1 necrotizing inflammation). 15 patients were diagnosed as chronic inflammatory pseudotumors, 6 of whom showed a granulomatous subtype, and 3 involvement of the optic nerve. All patients failed to reveal systemic disease and had a localized orbital inflammatory process. 7 of the patients responded rapidly to systemic corticosteroid treatment with no episodes of recurrence. 3 patients showed recurrence despite corticosteroids.Conclusions. Orbital infections are cured by antibiotic treatment. The course of inflammatory pseudotumor is variable and requires multidisciplinary treatment. Therapeutic options include surgical biopsy or debulking, corticosteroids, chemotherapy, and radiation therapy. [ABSTRACT FROM AUTHOR]

: PurposeIn 1All the cadaver orbits were provided by the Department of Anatomy of the Cerrahpasa University of Turkey. Our department contains the records and transferring permissions given from Turkish law court. this study, we aimed to investigate the muscular bridge between the inferior oblique (IO) and inferior rectus (IR) muscles of the eye.: DesignCohort study.: MethodsThe orbits of sixty intact cadavers with no history of eye muscle or orbital disorders during life were carefully dissected to expose the muscular bridge between the IO and IR muscles. Numbers of the bridges, their length and width were recorded.: ResultsWe observed muscular bridge between IO and IR muscles in 6.6% of 60 orbits. They originated from the lateral side of the IR muscle, and joined to posteromedial side of the IO muscle. Mean length and width were 14.2 ± 6.3 and 1.3 ± 0.2 mm, respectively.: ConclusionsMuscular bridges were found in 6.6% of orbits dissected. We conclude that muscular bridges are important due to potential cause of failed IO or IR muscles surgery. In this respect, before surgery of the extraocular muscles, the muscular bridges should be kept in mind and demonstrated by computed tomography or magnetic resonance imaging in transverse, sagittal, and coronal planes. [Copyright &y& Elsevier]

The loss of an eye is a highly traumatic event, with severe psychological and physical implications. From November 1996 to June 2002, 32 patients underwent eye enucleation and placement of a hydroxyapatite orbital implant wrapped in autologous fascia lata; this was then fixed to the four rectus muscles. Motility was noted in all reconstructed sockets, without implant related complications. The immediate post-operative period was uncomplicated and all patients were discharged within 48 to 72 h after surgery. The orbital implant remained well positioned without dehiscence and motility was satisfactory. The follow-up ranged from 8 months to more than 5 years. [ABSTRACT FROM AUTHOR]

Orbitary exenteration for tumor may concern ethmoidal wall, and may create a large communication between the orbital cavity and the cavum. We present the case of a patient scheduled for ocular prothetic surgery after an unilateral orbitary exenteration. After intravenous induction of the general anaesthesia, anaesthesiologist failed to achieve adequate facial mask ventilation because of a great gas leakage from cavum to orbital cavity. Inserting packing in the orbitary cavity allowed to decrease gas leakage and to get adequate facemask ventilation. We recommend orbitary radiographic and clinical evaluations for patient with orbitary exenteration before general anaesthesia to evaluate the communication between the orbital cavity and the cavum. Such an anatomic communication may result in inefficient facial mask ventilation. [Copyright &y& Elsevier]

Schwannomas are benign, encapsulated, primary neurilemmal tumors composed of proliferating Schwann cells. Schwannomas are commonly seen in the orbit, but are rare on the epibulbar surface. Herein, we report a case of a 12-year-old boy who presented to us with a slow-growing painless subconjunctival mass in the left eye. There was no intraocular extension of the mass and intra-operatively, the mass could be clearly delineated and was excised off the underlying sclera. Histopathological examination of the mass showed typical features of schwannoma and immunohistochemistry helped to confirm the diagnosis. There was no recurrence of the lesion observed at follow-up 26 months after surgery. Here, we describe this uncommon tumor and review the available literature. Although rare, an epibulbar schwannoma should be considered in the differential diagnosis of an amelanotic, painless subconjunctival nodular mass. Excision of the lesion is the recommended treatment. [ABSTRACT FROM AUTHOR]

Discusses the key factors in the management of orbital infections. Need for primary care physician to be suspicious of all periocular inflammatory swelling; Speed of infection spread; Sufficiency of information for the management of orbital infections; Surgical interventions.

Orbital abscess formation in neonates is rare, with only 12 cases reported in the literature. We present a case of orbital cellulitis with orbital abscesses following repair of congenital choanal atresia in a 2-week-old neonate. This is the first reported case of an orbital abscess following a sinus procedure in a neonate. [ABSTRACT FROM AUTHOR]

Glomangioma is a vascular hamartomatous tumor originating from the glomus body, a specialized thermoregulatory organ localized in the dermis and precoccygeal soft tissue. Glomus tumors are characteristically found in the hands and are very rarely reported in the head region. Here we describe a 29-year-old woman presenting with acute proptosis and pain in the left eye. A computed tomography scan of the orbit revealed a well-defined circumscribed mass, displacing the globe and lateral rectus muscle inferotemporally. The tumour was surgically removed through a lateral Kronlein approach. On histology, the lesion consisted of cavernous vascular spaces, partly filled with blood and thrombotic material, and a mixture of capillary-sized vessels and tumor cells; immunostaining for smooth actin showed a strong positivity in the cytoplasm of tumor cells, consistent with a diagnosis of glomangioma. Our case adds to the very few cases of orbital glomangioma reported in the literature and demonstrates that this tumor can be safely removed. [ABSTRACT FROM AUTHOR]

Purpose: To report the nature of periorbital trauma after pit bull attacks. While these attacks have been well-characterized in the popular media, no case series has documented the ophthalmic manifestations of this trauma. Methods: We retrospectively reviewed all cases of pit bull terrier attacks that presented to the oculoplastic and orbital surgery service at Albany Medical Center between 2008 and 2011. The age, gender, extent of the injuries, care provided, follow up interval, and complication rate were evaluated for each patient. Results: Seven patients were identified, with a mean age of 17.2 years. Six of the seven patients were in the pediatric age group. All patients suffered eyelid lacerations, and only one patient had additional injuries. Four patients (57.2%) suffered a canalicular laceration. Despite the lack of post-operative oral antibiotic use, no patient developed a wound infection. Conclusions: In the ophthalmic setting, pit bull terrier attacks most frequently involve children and result in eyelid lacerations. Canalicular injuries are common after these attacks. [ABSTRACT FROM AUTHOR]

Pyogenic granuloma (PG) of the eyelid and orbit is typically associated with trauma or surgery. We report a rare case of an orbital intraconal PG arising de novo in association with an orbital artery. [ABSTRACT FROM AUTHOR]

Purpose : To report the first case of metastasis from renal cell carcinoma to the lacrimal sac and review the therapeutic options. Methods : We have reviewed the case of a woman who was operated on for a renal cell carcinoma that developed epiphora and a lacrimal sac tumor, which corresponded to a metastasis from her previous tumor. Although renal cell carcinoma shows a great tendency for distant metastasis, this is the first reported case of metastasis to the lacrimal sac. Results : We comment on the rarity of the case and on the therapeutic alternatives for these cases according to the reviewed literature. Conclusion : Metastasis to the lacrimal sac are rather infrequent and should be borne in mind on the appearance of a tumor in this location in people with a history of malignancy. [ABSTRACT FROM AUTHOR]

Orbital ‘auto-decompression’ in TED (thyroid eye disease) is a well recognised phenomenon in older patients where lax orbital septa allow proptosis to decompress the orbit. Bony ‘auto-decompression’ in TED is a different entity which to the best of our knowledge has not been previously reported. We describe such a case which presented spontaneously, in the absence of trauma or bony pathology, and discuss possible causes. [ABSTRACT FROM AUTHOR]

Purpose: To report a unique approach to the orbital apex through the contralateral orbit. Methods: A 65-year-old male presented with right compressive optic neuropathy due to nasopharyngeal carcinoma spread. Clinical evaluation and imaging showed a right orbital apex mass. Surgery included apical orbital tumor debulking, and orbital decompression performed via the contralateral exenterated side. Postoperatively, symptoms were relieved. Conclusions: Orbitotomy via the contralateral exenterated orbit should be considered as a surgical option in these unique patients requiring direct access to the orbital apex. [ABSTRACT FROM AUTHOR]

A patient who suffered a 36 hour symptomatic bradycardia following secondary orbital implant is described. The possible causes and implications are discussed. [ABSTRACT FROM AUTHOR]

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