Orbit and lids and lacrimal disorders

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Orbit and lids and lacrimal disorders

• By
• Dr. ABDULMAJID ALSHEHAH
• Ophthalmology consultant
• Anterior Segment and Uveitis consultant

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The orbit

• Anatomy

• Function

• protection to the globe
• attachments which stabilize the ocular movement
• transmission of nerves and blood vessels.

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The orbit

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

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The orbit
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The orbit
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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)

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Thyroid ophthalmopathy

• Pathogenesis

• Clinical features

• 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.

• Proptosis (most common cause in adults)
• Lid retraction (characteristic stare)
• Lid lag
• Double vision
• red painful eye (exposure)
• Reduced visual acuity (optic nerve)

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Thyroid ophthalmopathy
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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

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Diplopia (Muscle pathology)

• Thyroid ophthalmopathy (Graves ophthalmopathy)
• Idiopathic Orbital Inflammatory Disease ( orbital
  pseudotumor)

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Enophthalmos

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

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Orbital pain

• Infection
• Tumors (malignant)
• inflammation

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Eyelid and conjunctival changes

• Redness
• Swelling
• (orbital cellulitis, preseptal cellulitis,
  carotid cavernous fistula)

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Reduced visual acuity

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

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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).

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QUSTIONS
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The eyelids
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ABNORMALITIES OF LID POSITION

• Entropion
• Ectropion

• Ptosis

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INFLAMMATIONS OF THE EYELIDS

• Blepharitis

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BENIGN LID LUMPS AND BUMPS

• Chalazion

• Xanthelasmas

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MALIGNANT LID TUMOURS

• Basal cell carcinoma (rodent ulcer)

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ABNORMALITIES OF THE LASHES

• Trichiasis

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QUSTIONS
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The lacrimal system
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The lacrimal drainage system
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NLD obstruction
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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

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Adult NLD obstruction
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Dacryocystitis
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Questions