LECTURE No. 9. Diagnosis, clinic and treatment of pathologies of the orbit

The main symptom of most diseases of the orbit, both inflammatory and non-inflammatory, is exophthalmos, along with which other symptoms can be noted. The eyeball, depending on the localization of the process in the orbit, can be displaced in one direction or another, its mobility can be limited, diplopia occurs. Sometimes there are changes in the condition of the edges and walls of the orbit. In the presence of dense tissue in the retrobulbar space, the reposition of the eyeball is difficult. In inflammatory diseases of the orbit, eyelids are often involved in the process, possibly a serious general condition of the patient.

1. Phlegmon of the orbit (Phlegmona orbitae)

In children of any age, but more often in the first year of life and at school age, among full health, eyelid edema suddenly and quickly appears, sometimes significant, chemosis is possible. Exophthalmos develops rapidly, but there may also be a shift of the eyeball to the side (with ethmoiditis, periostitis). The mobility of the eyeball, as a rule, is limited due to a mechanical obstacle, damage to the muscles and motor nerves. There is a severe general condition, high fever, headaches and pain in the orbit.

In infants, general symptoms of the disease often prevail over local ones. In children of the first months of life, except for exophthalmos, it is not possible to identify other signs of the disease. A carefully collected history, consultations of an otolaryngologist, a dentist, and radiography of the paranasal sinuses contribute to the establishment of its cause. In infants, orbital phlegmon is more often associated with inflammatory processes in the upper jaw, umbilical sepsis and dacryocystitis, in schoolchildren with orbital injuries and sinusitis.

Treatment. Loading doses of broad-spectrum antibiotics intramuscularly, periorbitally and retrobulbarno.

If necessary, the cells of the ethmoid labyrinth are opened, the maxillary sinus is punctured. At the same time, the phlegmon of the orbit is opened with drainage of the wound cavity with turunda soaked in antibiotics.

2. Sarcoma of the orbit

On examination, the patient is found to have exophthalmos, displacement of the eyeball, limitation of its mobility, diplopia, a painless tumor-like elastic formation, sometimes soldered to the underlying tissues and skin, is palpated. More often the tumor is localized in the upper half of the orbit. The diagnosis becomes even more likely when indicating the rapid growth (weeks and months) of the tumor.

Orbital sarcoma should be differentiated from eosinophilic granuloma, tumor-like forms of leukemia. To clarify the diagnosis, additional research methods are needed: radiography of the orbits, sternal puncture (study of the myelogram), often puncture biopsy.

Treatment consists of orbital exenteration followed by x-ray and chemotherapy.

3. Lymphomas of the orbit

In some types of leukemia (hemocytoblastosis, etc.), tumor-like infiltration nodes appear on the upper or, less commonly, lower edge of the orbit, developing from the hematopoietic tissue of the flat bones of the orbit. Exophthalmos, displacement of the eyeball are noted. The process is often two-way. To clarify the diagnosis, blood tests and a myelogram are necessary.

Treatment is carried out in the hematology department. With the appointment of cytostatic agents, infiltrates may disappear without a trace.

Author: Shilnikov L.V.

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