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Orbital disorders

Last updated: October 28, 2020

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The orbital cavity (eye socket) is the bony cavity that encloses the bulb and accessory organs of the eye, including the ocular muscles, lacrimal glands, nerves, vessels, and retrobulbar adipose tissue. Diseases of the orbital cavity include Graves ophthalmopathy, orbital cellulitis, rhabdomyosarcoma, and lacrimal sac disorders. Typical symptoms associated with these diseases include exophthalmos and diplopia. Treatment differs according to the underlying disease and includes conservative measures (antibiotics), surgery, radiotherapy, and chemotherapy.

Disorders of the lacrimal system are discussed in a separate article.

References:[1][2][3][4]

Orbital cellulitis Preseptal cellulitis
Definition
Etiology
Epidemiology
  • More common in children than adults
Clinical features
Diagnosis
  • Primarily a clinical diagnosis
  • Laboratory tests: leukocytosis; positive blood and tissue fluid cultures
  • CT scan: confirm diagnosis and look for complications, e.g., orbital abscess or intracranial extension
Treatment
Complications Although preseptal cellulitis can cause severe complications, these are rare, which is why the condition is rarely life-threatening.

Reduced vision, diplopia, ophthalmoplegia, and proptosis are typical features of orbital cellulitis. They do not occur in preseptal cellulitis!

In patients with orbital cellulitis, the development of headache, ophthalmoplegia, facial hypesthesia in regions innervated by V1 and V2, and/or seizures should raise suspicion for cavernous sinus thrombosis.

References:[5][6][7][8][9][10]

  • Definition: malignant mesenchymal tumor of primitive skeletal muscle cells (rhabdomyoblasts) that have failed to fully differentiate
  • Epidemiology
    • Most common soft tissue sarcoma and malignant orbital tumor in children
    • Primarily occurs in the first decade of life.
  • Clinical features
    • Frequently in the orbital cavity; , but can also be in the head and neck, urogenital region , or extremities
    • Minimally painful, rapidly increasing, gross swelling
    • Orbital rhabdomyosarcoma
      • Growing orbital mass that may be painful and have potential hemorrhage
      • Proptosis or dysconjugate gaze
  • Diagnosis
  • Treatment
    • Surgery (complete excision) if a functional and cosmetic result is possible
    • Combination of radiation and chemotherapy following a diagnostic biopsy if complete excision is not feasible
  • Prognosis: more favorable for localized tumors of the orbit , and less favorable for metastatic disease

References:[11][12][13][14][15]

  1. Davies TF. Pathogenesis and Clinical Features of Graves' Ophthalmopathy (Orbitopathy). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/pathogenesis-and-clinical-features-of-graves-ophthalmopathy-orbitopathy.Last updated: December 18, 2015. Accessed: February 18, 2017.
  2. Davies TF. Treatment of Graves' Orbitopathy (Ophthalmopathy). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/treatment-of-graves-orbitopathy-ophthalmopathy.Last updated: October 14, 2016. Accessed: February 18, 2017.
  3. Ing E. Thyroid-Associated Orbitopathy. In: Roy H, Thyroid-Associated Orbitopathy. New York, NY: WebMD. http://emedicine.medscape.com/article/1218444. Updated: September 30, 2016. Accessed: February 18, 2017.
  4. Thyroid-Associated Orbitopathy. https://radiopaedia.org/articles/thyroid-associated-orbitopathy-1. Updated: January 1, 2018. Accessed: March 6, 2018.
  5. Kwitko GM. Preseptal Cellulitis. In: Ing E, Preseptal Cellulitis. New York, NY: WebMD. https://emedicine.medscape.com/article/1218009. Updated: December 1, 2017. Accessed: December 7, 2017.
  6. Gappy C, Archer SM, Barza M. Orbital cellulitis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/orbital-cellulitis.Last updated: January 4, 2016. Accessed: February 18, 2017.
  7. Gappy C, Archer SM, Barza M. Preseptal Cellulitis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/preseptal-cellulitis.Last updated: October 17, 2017. Accessed: December 7, 2017.
  8. Harrington JN. Orbital Cellulitis. In: Ing E, Orbital Cellulitis. New York, NY: WebMD. http://emedicine.medscape.com/article/1217858-overview#a7. Updated: March 11, 2016. Accessed: January 27, 2017.
  9. Cox GM, Perfect JR. Fungal Rhinosinusitis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/fungal-rhinosinusitis.Last updated: August 13, 2017. Accessed: December 7, 2017.
  10. Preseptal and Orbital Cellulitis. http://www.msdmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis. Updated: October 1, 2017. Accessed: December 7, 2017.
  11. Cripe TP. Pediatric Rhabdomyosarcoma. Pediatric Rhabdomyosarcoma. New York, NY: WebMD. http://emedicine.medscape.com/article/988803. Updated: May 1, 2016. Accessed: February 18, 2017.
  12. Drake AF. Pathology: Rhabdomyosarcoma. Pathology: Rhabdomyosarcoma. New York, NY: WebMD. http://emedicine.medscape.com/article/873546-overview#showall. Updated: March 9, 2016. Accessed: February 18, 2017.
  13. Okcu MF, Hicks J, Horowitz M. Rhabdomyosarcoma in childhood and adolescence: Clinical presentation, diagnostic evaluation, and staging. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/rhabdomyosarcoma-in-childhood-and-adolescence-clinical-presentation-diagnostic-evaluation-and-staging.Last updated: July 9, 2015. Accessed: February 18, 2017.
  14. Okcu MF, Hicks J, Horowitz M. Rhabdomyosarcoma in childhood, adolescence, and adulthood: Treatment. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/rhabdomyosarcoma-in-childhood-adolescence-and-adulthood-treatment.Last updated: December 11, 2015. Accessed: February 18, 2017.
  15. Okcu MF, Hicks J, Horowitz M. Rhabdomyosarcoma in childhood and adolescence: Epidemiology, pathology, and molecular pathogenesis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/rhabdomyosarcoma-in-childhood-and-adolescence-epidemiology-pathology-and-molecular-pathogenesis.Last updated: June 29, 2016. Accessed: February 18, 2017.
  16. Herold G. Internal Medicine. Herold G ; 2014