Transcript Orbit and lids and lacrimal disorders (1 hours) DR. SHEHAH

Orbit and lids and lacrimal
disorders
By
Dr. ABDULMAJID ALSHEHAH
Ophthalmology consultant
Anterior 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
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Proptosis
Enophthalmos
Pain
Eyelid and conjunctival changes
Diplopia
Reduced visual acuity
The orbit
The orbit
Proptosis (exopthalmos)
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protrusion of the eye caused by a spaceoccupying 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 steroid
2- radiotherapy
3- orbital decompression
4- heavy lubrication
• Long term treatment
Only 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
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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