ORBIT

Anatomy
- quadrangular pyramid a) roof, medial, lateral sides b) floor c) apex d) base forming the bony margin on the face - entire cavity lined with periosteum - 4 compartments a) subperiosteal space potential space between the periorbita and the bone b) muscle cone - space formed by the recti muscles and their intermuscular membranes Tenons capsule - also called central surgical space - tumors here will proptose the eyes forward

c) Peripheral Surgical Space - between the periorbita and the muscle cone - contains orbital fat d) Episcleral space - space between the sclera and Tenons capsule

Orbital Relationships
- common interest to the eye mds/neurologist, neurosurgeon, ENT doctors, plastic surgeon and internist

Diagnostic Procedures
a) Ophthalmoscopy - retinal folds indicate localized orbital pressure on the eyeball b) Exophthalmometry - in proptesis - average reading 13.5 mm c) Orbitonometry - assessment of compressibility of the orbital contents d) X-rays - 5 views in x-rays - CT scan - orbital arteriography ( in vascular lesions ) - orbital venography

Symptomatology
a) Proptosis - passive forward displacement of the eyeball - blow-out fx/vascular lesions/carotid-cavenous fistula b) Exophthalmos - active or dynamic protrusion of the globe - in graves disease c) congestion and edema of the lids and conjunctiva - in inflammatory conditions of the orbits d) bruit and pulsation - in aneurysms

Inflammatory Conditions
a) Orbital edema - severe allergic reaction/ renal disease b) Orbital hemorrhage - black eye syndrome - due to trauma/ retrobulbar injection c) Orbitsl varices d) Carotico cavernous fistula or aneurysms - history of skull injury/fx - carotid angiography - neurosurgical clipping and embolization e) Acute Orbital Inflammation - extension of infection from neighboring structures like the lids, sinuses, lacrimal sac, teeth and the ears - large doses of antibiotics/incision and drainage in orbital abscess - Cavernous sinus thrombosis lethal complication massive antibiotics

Specific Chronic Infection

- granulomatous conditions e.g. tuberculosis, syphilis

Inflammatory Pseudo-tumor
- difficult to differentiate from orbital tumors - anti-inflammatory drugs used

Non-inflammatory conditions
a) Thyrotoxic exophthalmos - slight exolphthalmos, lid retraction, lid lag - improve with treatment of the thyroid problem b) Neoplasm

Orbital Surgery
- biopsy/excision - exenteration entire orbital contents down to the periosteum including the optic nerve as near as possible to its foramine are removed - decompression of the orbit done to relieve vascular glaucoma