By John Bryan Holds MD
Info the anatomy of the orbit and adnexa, and emphasizes a pragmatic method of the overview and administration of orbital and eyelid problems, together with malpositions and involutional adjustments. Updates present details on congenital, inflammatory, infectious, neoplastic and stressful stipulations of the orbit and accent constructions. Covers key features of orbital, eyelid and facial surgical procedure. comprises a variety of new colour photos. significant revision 2011-2012.
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Extra info for 2011-2012 Basic and Clinical Science Course, Section 7: Orbit, Eyelids, and Lacrimal System (Basic & Clinical Science Course)
T he VO rl Graefe sign refers to the delay in the up pe r eyelid's descent ("lid lag") duri ng dow ngaze an d is high ly suggesti ve of a d iagnosis of TED. In fact, such lid lag and the re trac ti o n of the upper and lower eyel ids are the most common phys ical signs of TED. Several eyeUd signs of orbital patho logy are seen in childhood disord ers. Capi llary hemang iomas in the orbit often involve the skin of th e eyelids, producing strawbe rr y birthmarks th at usuall y grow duri ng the fi rs t yea r of life an d th en regress spontaneo usly.
21 22 • Orbit, Eyelids, and Lacrima l System Table 2-1 Periorbital Changes Associated With Orbital Disease Sign Etiology A sa lmon-colored mass in the cul-de-sac Eyel id retraction and eyelid lag Vascu lar congestion over the insertions of the rectus muscles (particularly the lateral rectus) Corkscrew conjunctival vessels Vascular anomaly of eyelid skin Lymphoma (see Fig 5- 14) T hyroid eye disease Thyro id eye disease (see Fig 4-5A) S-s haped eyelid Eczematous lesions of the eyelids Ecchymoses of eyelid skin Prominent temple Edematous swelling of lower eyelid Optocilia ry shunt vessels on disc Frozen globe Black-c rusted les ions in nasopharynx Fac ial asymmetry Arteriovenous fistula (see Fig 4-58) Lymphangioma, varix, or capillary hemangioma Plex iform ne urofibroma or lacrimal gland mass (see Fig 5-7) Mycosis fungo ides (T-cell lymphoma) Metasta tic neuroblastoma, leukemia, or amylo idosis Sphenoid wing meni ngioma, metastatic ne uroblastoma (see Fig 5-9A) Men ingioma, inflammato ry tumor, metastases Men ing ioma Metastases or zygomycosis Ph yeo mycoses Fib rous dysplasia or neurofib romat os is (see Fig 5- 12A) Physical Examination Special attention should be give n to ocu la r motility, globe position, pupillary fun ctio n, and ophthalmoscopy.
Treatment Workup shou ld proceed qui ckl y, particularl y in ch ildren , and include computed tomograph y (CT) of the o rb it and sin uses if th e eyelid swelli ng is profound enough to preclude exa mination of the globe and th ereby exclude orbital celluliti s. The patient should be treated in co nsultati on with a primar y care phys ician. l deco ngesta nts (suc h as oxymetazoline nasal spray). in cases of assoc iated sinusitis, are typically effective therapy; this approach is chose n if th e examin ati o n of the child is reliable a nd fo llow- up exam inations ca n be ensured.