Orbital disorders

Last updated: May 31, 2023

Summarytoggle arrow icon

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.

Graves ophthalmopathytoggle arrow icon

Goals of therapy include treatment of hyperthyroidism, smoking cessation, eye protection, and decreasing inflammation.

Orbital and preseptal cellulitistoggle arrow icon

Orbital cellulitis vs. preseptal cellulitis [2]
Orbital cellulitis Preseptal cellulitis
  • More common in children than adults
Clinical features
  • Complications are rare

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.

Rhabdomyosarcomatoggle arrow icon

  • 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
  • Diagnostics
    • Open or core needle biopsy for light microscopy to look for rhabdomyoblasts (confirm the presence of rhabdomyosarcoma)
    • X-ray of the primary site and chest: to determine any bone and lung involvement for staging
    • CT of the primary site and chest: to search for any lung metastases and bone destruction and determine therapeutic response
    • MRI: better to determine specific location of mass and any soft tissue invasion
  • 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

Orbital compartment syndrometoggle arrow icon

Orbital compartment syndrome (OCS) is a sight-threatening ophthalmological emergency that can cause vision loss. If there is a high clinical suspicion of OCS, treatment should not be delayed for further diagnostic workup. Orbital imaging may be performed after decompression. [4]

Referencestoggle arrow icon

  1. Douglas RS et al. Teprotumumab for the Treatment of Active Thyroid Eye Disease. N Engl J Med. 2020; 382 (4): p.341-352.doi: 10.1056/nejmoa1910434 . | Open in Read by QxMD
  2. Preseptal and Orbital Cellulitis. Updated: October 1, 2017. Accessed: December 7, 2017.
  3. Murali S, Davis C, McCrea MJ, Plewa MC. Orbital compartment syndrome: Pearls and pitfalls for the emergency physician.. Journal of the American College of Emergency Physicians open. 2021; 2 (2): p.e12372.doi: 10.1002/emp2.12372 . | Open in Read by QxMD
  4. McCallum E, Keren S, Lapira M, Norris JH. Orbital Compartment Syndrome: An Update With Review Of The Literature.. Clinical ophthalmology (Auckland, N.Z.). 2019; 13: p.2189-2194.doi: 10.2147/OPTH.S180058 . | Open in Read by QxMD

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