imaging the eye and orbit - ucsdspinwarp.ucsd.edu/neuroweb/ppt/orbit-45.pdfimaging the eye and orbit...
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Department of Radiology
University of California
San Diego
John R. Hesselink, M.D.
Imaging the Eye
and Orbit
Anterior compartment
Bony orbit
- Extraconal
- Intraconal
Optic nerve
Globe
Retrobulbar space
Orbital Inflammation
Orbital cellulitis
Grave's disease
Orbital pseudotumor
Sarcoidosis
Mucormycosis
Wegener's granulomatosis
History: 5 month old girl
with a swollen eye
168
History: 4 y.o. boy with a
swollen eye
80
Orbital Infection
Extension from sinus or eyelid
Predisposing factors:
Proximity to paranasal sinuses
Thin lamina papyracea
Valveless facial veins
Preseptal cellulitis Orbital cellulitis
Orbital abscess
History: 35 y/o HIV+
male
with diabetes developed
fever & left orbital
swelling
290
Dx: Aspergillosis left
ethmoid sinus & orbit
Orbital swelling
{Page 2}
History: 76 y/o diabetic woman with headache
& acute right eye blindness
598
Dx: Aspergillus sinusitis
{Page 2}
Dx: Grave’s ophthalmopathy
History: 72 y/o woman with bilateral proptosis
795 - 30076929
Graves' Ophthalmopathy
Most common cause of
bilateral proptosis
70% are bilateral & symmetrical
4:1 female preponderance
Medial & inferior rectus muscles
most often involved
Dx: Grave's disease
History: 43 y.o. man with proptosis
42
Grave's Disease
OC 7,8
Enlarged Extraocular Muscles
Graves' disease
Pseudotumor
Orbital cellulitis
AV malformation
Carotid-cavernous fistula
Infiltration by tumor
Spontaneous or traumatic
hematoma
Differential Diagnosis
History: 25 y.o. man with proptosis,
orbital pain & itching
75
Dx: Orbital pseudotumor
Orbital Pseudotumor
Tends to be unilateral
25% of all cases of unilateral
exophthalmos
Diffuse infiltration of orbital tissues
Remitting or chronic and progressive
May regress spontaneously or
responds to steroids
Similar to lymphoma clinically,
radiographically & pathologically
History: 53 y/o man
with intermittent proptosis
for 1 year
312
Dx: Orbital pseudotumor
Proptosis {Page 2}
History: 32 y/o man with facial
swelling & exophthalmos
329
{Page 2}
Dx: Sarcoidosis
Exophthalmos {Page 3}
History: 45 y/o woman with arm & leg weakness,
sensory changes, & bilateral visual loss
441
Dx: Neuromyelitis optica (Devic's disease)
Bilateral visual loss
{Page 2}
Tumors of the Orbit
Optic nerve / sheath tumors
Veno-lymphatic malformations
Lymphoma
Dermoid cyst
Lacrimal tumors
Metastases
Secondary (45%)
Sinus carcinoma
Mucoceles
History: 6 y/o boy with visual problems
294
Dx: NF 1 - vacuolar myelin
& optic nerve glioma
Visual loss
{Page 2}
History: 66 y/o woman with left
eye proptosis & blindness
Dx: Meningioma – optic sheath 660
Optic Nerve / Sheath Enlargement
Optic neuritis
Optic nerve glioma
Optic sheath meningioma
Intracranial hypertension
Lymphomatous &
leukemic infiltration
Differential Diagnosis
Sarcoidosis
Advanced Grave's disease
Central retinal vein occlusion
Hemangioblastoma
Hemorrhage
History: 66 y/o woman with a right 6th
nerve palsy & visual loss
237
Dx: Lymphoma of optic
nerve sheath &
cavernous sinus
Visual loss {Page 2}
History: 33 y/o woman with decreased vision in left
eye
791 - 26144402
Dx: Cavernous hemangioma
Page 2
1 hour later
History: 4 y/o boy with right globe ptosis
770 - 52363508
Dx: Veno-lymphatic malformation
{Page 2}
History: 82 y/o woman
with left eye proptosis
489
Dx: Non-Hodgkin's lymphoma (B cell)
{Page 2}
History: 10 y/o boy with proptosis
319
Dx: Lymphangioma
{Page 2}
History: 92 y/o man with a right eye mass
519
Dx: Basal cell carcinoma
{Page 2}
Lacrimal Gland Masses
50% - Lymphoid-Inflammatory disease
Benign hyperplasia Lymphoma
50% - Epithelial tumors
1/2 - Pleomorphic adenomas
1/2 - Malignant carcinomas
Adenocystic, Pleomorphic
Mucoepidermoid, Squamous cell
Undifferentiated, Adenocarcinoma
Pleomorphic Adenoma
OD 99-100
Pleomorphic Carcinoma
OD 107-8
Dx: Orbital dermoid
History: 57 y/o man with right eye droop
527
Metastatic Breast Carcinoma
od 39-40
Orbital Tumors in Children
Retinoblastoma
Rhabdomyosarcoma
Optic nerve glioma
Lymphangioma
Teratoma
History: Young girl with nasal
obstruction and proptosis
793 - 26971184
Dx: Rhabdomyosarcoma
{Page 2}
DWI
History: 32 y/o woman with right eye swelling & pain
461
Dx: Orbital varix
Carotid-Cavernous
Fistula
oh 5-8
Ocular Lesions
Retinoblastoma
Congenital Lesions
PHPV, Coats' disease, Anophthalmos
Uveal Melanoma
Choroidal Metastases
Benign Lesions
Scleral calcification, Choroidal osteoma
Drusen, Coloboma, Staphyloma
History: 7 month old male
with exophoria & blindness
in the right eye
287
Dx: Bilateral retinoblastomas
Right eye blindness
{Page 2}
Retinoblastoma
Intraocular malignant tumor
Presents in first two years of life
Only 10% of cases are inherited
Mutation of chromosome 13
Bilateral in 30%
Calcification is common
Must be distinguished from benign
causes of leukocoria
Retinoblastoma
OD 33-4
Dx: Coat's disease with retinal detachment
History: 6 month old boy with leukocoria
& markedly decreased vision in left eye
277
Persistent Hyperplastic
Primary Vitreous (PHPV)
Courtesy of Mahmood Mafee, MD
History: 38 y/o man s/p biopsy
for eye pain & mass
736 - 2276964
Dx: Choroidal melanoma
{Page 2}
Dx: Leiomyoma ciliary body
History: 25 y/o male with progressive loss
of vision in the left eye the past year
686
History: 43 y/o man
with visual deficits
428
Dx: CMV retinitis with optic
pathway involvement
{Page 2}
History: 33 HIV+ man with painful
swelling & proptosis of left eye
756 - 1569195
Dx: Orbital cellulitis &
endophthalmitis - Staph
{Page 2}
Dx: Bilateral staphylomas
History: 48 y/o man with visual
problems for many years
579
Ocular
Calcifications
Choroidal osteoma
Drusen
Scleral calcifications