• Clinical science

Orbital disorders

Summary

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 learning card.

Graves ophthalmopathy

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

Orbital and preseptal cellulitis

Orbital cellulitis Preseptal cellulitis
Definition
  • An infection of the eyelid and periorbital soft tissues without involvement of the orbital contents
  • Anterior to the orbital septum
  • The eye globe is not affected.
Etiology
  • Complication of upper respiratory tract infection, most commonly due to bacterial rhinosinusitis
  • Other causes include:
    • Acute dacryocystitis
    • Local trauma to the surrounding tissues of the face and eyelids
    • Insect or animal bites
    • Ophthalmic surgery
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
  • Primarily a clinical diagnosis
  • Laboratory tests: leukocytosis; blood cultures are generally unnecessary
  • CT scan: only eyelid swelling apparent
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!

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

Rhabdomyosarcoma

  • 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
    • Open or core needle biopsy for light microscopy to look for rhabdomyoblasts (confirm the presence of rhabdomyosarcoma)
  • 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]