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ORBIT P A THOLOG Y

ORBIT P A THOLOG Y. EXOFTALMIA PROPTOSIS. Exoftalmometrul HERTEL. Subjects. Dysthyroid ophthalmopathy Orbital inflamatons Orbital tumors. Dysthyroid ophthalmopathy. Autoimmune disease associated with thyroid gland dysfunction

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ORBIT P A THOLOG Y

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  1. ORBIT PATHOLOGY

  2. EXOFTALMIAPROPTOSIS

  3. Exoftalmometrul HERTEL

  4. Subjects • Dysthyroidophthalmopathy • Orbital inflamatons • Orbital tumors

  5. Dysthyroidophthalmopathy • Autoimmune disease associated with thyroid gland dysfunction • Dystyroid orbitopathy or ophthalmopathy; Graves’ ophthalmopathy; • Most common unilateral or bilteral proptosis affecting women (8:1) • 80% with hyperthyroidism

  6. Symptoms: • foreign-body sensation • tearing • red eye • diplopia • Signs: • Eyelid disorders:retraction, lagophtalmos • Eye surface disorders: dry eye,chemosis • Ocular motility disorders: restricted eye movement • Optic neuropathy: RAPD, IOP increase

  7. tendinous insertion of the extraocular muscle at the globe is not thickened, which is characteristic of thyroid-related orbitopathy • medium to high internal reflectivity of the extraocular muscle belly • enlarged bellies of the extraocular muscle • enlarged extraocular muscles • LAB TESTS: TSH; TRH; triiodothyronine

  8. treatment • Exposure keratopathy: lubrication, punctal oclusion, blepharorraphy • Eyelid retraction:surgical eyelid lengthening • Diplopia and strabismus: prism glasses, surgery • Optic neuropathy: steroids, orbital decompresion, external-beam radiation (15Gy)

  9. Orbital inflamatons • Infections: • preseptalcellulitis • orbital cellulitis • Sterilinflamation: • orbital pseudotumor • dysthyroidophthalmopathy

  10. Preseptalcellulitis • Usually after eyelid trauma (cosmetics) • Clinical: (only the eyelid is ivolved) • pain • eyelid swelling • redness • ptosis • Treatment: • antibiotics • warm compresses

  11. Orbital cellulitis • Infection posterior to the orbital septum • Secondary to: • sinusitis • dacryocystitis • dental caries • orbital trauma • preseptal celullitis • Clinical: (lid, eye and orbit involvment) • decrease AV • chemosis • painful an limited ocular movements • RAPD

  12. Orbital pseudotumor • Idiopathic orbital inflamation: acute or cronic • Unique or associated invovments: • orbital fat • optic nerve sheats • extraocular muscles • lacrimal gland • sclera • Clinical: depends of tissue involvment

  13. Treatment: • Corticosteroids • Iunosupresors: cyclosporine • Inflamatory radiotherapy • Surgical: orbit decompresion

  14. Orbital tumors • Cavernous hemangioma • Mucocele • Neurilemmnoma (schwannoma) • Meningioma • Limphoid tumors • Metastatic tumors

  15. Cavernous hemangioma • The most comon orbital tumor • 4-6th decades of life • Woman • Cinical simptoms: • Progressive proptosis • Compresive optic neuropathy • Diplopia • Hyperpia • Strabismus • Increase IOP

  16. Orbital CT: well circumscribed mass • B-scan ultrasonography: high internal reflectivity • Treatment: surgical excizion

  17. Mucocele • Cystic sinus mass caused by obstruced excretory ducts • History of sinusitis (frontal, ethmoidal) • Supero-nasal development • Can products: • bony erosion • orbital invasion • Treatment : surgical excizion

  18. THE DISEASES OF THE LACRIMAL SYSTEM

  19. Dacriocystitis • supurative inflammation of the lachrymal sac frequently associated with perisacular cellulite (dacriopericystitis) • Clinical • swelling and congestive skin of the the canthal and inferocanthal region • intense spontan pain. • press on the swelling region a terrible pain appears and pus come out through the lachrymal puncta

  20. Treatment • Massage of lachrymal sac region, antibiotics and anti-inflammatory drops and ointments. • Cateterism and irigation of the lachrymal drenage system with antibiotics using special probes (Bowman). • Surgical dacriocystorinostomy

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