Orbit and lids and lacrimal disorders

1. Orbit and lids and lacrimal disorders By Dr. ABDULMAJID ALSHEHAH Ophthalmology consultant Anterior Segment and Uveitis consultant

2. The orbit Anatomy Function protection to the globe attachments which stabilize the ocular movement; transmission of nerves and blood vessels.

3. The orbit • Clinical features of orbital disease • Proptosis • Enophthalmos • Pain • Eyelid and conjunctival changes • Diplopia • Reduced visual acuity

4. The orbit

5. The orbit

6. 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)

7. Thyroid ophthalmopathy Pathogenesis 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) • 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.

8. Thyroid ophthalmopathy

9. Thyroid ophthalmopathy • Treatment of associated ocular emergencies (optic nerve compression and corneal exposure) 1- systemic steroid 2- radiotherapy 3- orbital decompression 4- heavy lubrication • Long term treatment Only after stabilization, muscle and lid surgery

10. Diplopia (Muscle pathology) • Thyroid ophthalmopathy (Graves’ ophthalmopathy) • Idiopathic Orbital Inflammatory Disease ( orbital pseudotumor)

11. Enophthalmos • Congenital (small eye) • After trauma ( blow out fracture)

12. Orbital pain • Infection • Tumors (malignant) • inflammation

13. Eyelid and conjunctival changes • Redness • Swelling (orbital cellulitis, preseptal cellulitis, carotid cavernous fistula)

14. Reduced visual acuity • Corneal exposure • Compression or inflammation of optic nerve • Macular distortion

15. 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).

16. QUSTIONS

17. The eyelids

18. ABNORMALITIES OF LID POSITION • Ptosis • Entropion • Ectropion

19. INFLAMMATIONS OF THE EYELIDS • Blepharitis

20. BENIGN LID LUMPS AND BUMPS Chalazion Xanthelasmas

22. MALIGNANT LID TUMOURS • Basal cell carcinoma (rodent ulcer)

23. ABNORMALITIES OF THE LASHES • Trichiasis

24. QUSTIONS

25. The lacrimal system

26. The lacrimal drainage system

27. NLD obstruction

28. 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

29. Adult NLD obstruction

30. Dacryocystitis

32. Questions