Orbit and lids and lacrimal disorders

ByDr. ABDULMAJID ALSHEHAH

Ophthalmology consultantAnterior Segment and Uveitis consultant

The orbit

Anatomy Function• protection to the globe• attachments which stabilize

the ocular movement;• transmission of nerves and

blood vessels.

The orbit

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

The orbit

The orbit

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)

Thyroid ophthalmopathy

Pathogenesis • 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.

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)

Thyroid ophthalmopathy

Thyroid ophthalmopathy

• Treatment of associated ocular emergencies (optic nerve compression and corneal exposure)

1- systemic steroid2- radiotherapy3- orbital decompression4- heavy lubrication

• Long term treatmentOnly after stabilization, muscle and lid surgery

Diplopia (Muscle pathology)

Thyroid ophthalmopathy (Graves’ ophthalmopathy)

Idiopathic Orbital Inflammatory Disease ( orbital pseudotumor)

Enophthalmos

• Congenital (small eye)• After trauma ( blow out

fracture)

Orbital pain

• Infection• Tumors (malignant)• inflammation

Eyelid and conjunctival changes

• Redness• Swelling(orbital cellulitis, preseptal

cellulitis, carotid cavernous fistula)

Reduced visual acuity

• Corneal exposure• Compression or inflammation of optic nerve• Macular distortion

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).

QUSTIONS

The eyelids

ABNORMALITIES OF LID POSITION

• Ptosis • Entropion

• Ectropion

INFLAMMATIONS OF THE EYELIDS

• Blepharitis

BENIGN LID LUMPS AND BUMPS

Chalazion Xanthelasmas

MALIGNANT LID TUMOURS

• Basal cell carcinoma (rodent ulcer)

ABNORMALITIES OF THE LASHES

• Trichiasis

QUSTIONS

The lacrimal system

The lacrimal drainage system

NLD obstruction

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

Adult NLD obstruction

Dacryocystitis

Questions