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Anaesthesia and Intensive Care Nov 2020Thyroid eye disease is an autoimmune inflammatory disorder of the orbit in adults. It causes inflammation, expansion and fibrosis of orbital fat, muscles and the... (Review)
Review
Thyroid eye disease is an autoimmune inflammatory disorder of the orbit in adults. It causes inflammation, expansion and fibrosis of orbital fat, muscles and the lacrimal gland, leading to facial disfigurement, functional disability and, in severe cases, blindness. Overall, approximately 20% of affected patients need some form of surgical intervention requiring anaesthesia. This narrative review explores the background of thyroid eye disease, surgical procedures performed and their implications for anaesthesia. General anaesthesia is used for orbital decompression procedures, strabismus correction surgery and complex oculoplastic procedures. Local anaesthetic infiltration or regional anaesthesia under monitored anaesthesia care are the techniques most commonly employed for eyelid retraction surgery. It is important to limit the volume of local anaesthetic agent used during infiltration and continuously monitor the orbital volume and ocular pressure with a ballottement technique. In addition, the contralateral eye should be checked and, if necessary, protected against corneal exposure. Retrobulbar, peribulbar and sub-Tenon's blocks are best avoided. Topical anaesthesia has been used for some strabismus correction surgery but its use is limited to motivated and cooperative patients only.
Topics: Adult; Female; Graves Ophthalmopathy; Humans; Ophthalmologic Surgical Procedures; Orbit; Pregnancy
PubMed: 33198476
DOI: 10.1177/0310057X20957018 -
Neuroimaging Clinics of North America May 2022This article discusses mimics, anatomic variants, and pitfalls of imaging of the sinonasal cavity, orbit, and jaw. The authors discuss clinical findings and imaging... (Review)
Review
This article discusses mimics, anatomic variants, and pitfalls of imaging of the sinonasal cavity, orbit, and jaw. The authors discuss clinical findings and imaging pearls, which help in differentiating these from one another.
Topics: Humans; Orbit
PubMed: 35526962
DOI: 10.1016/j.nic.2022.01.008 -
Acta Otorhinolaryngologica Italica :... Apr 2021
Review
Topics: Decompression, Surgical; Graves Ophthalmopathy; Humans; Orbit; Retrospective Studies
PubMed: 34060524
DOI: 10.14639/0392-100X-suppl.1-41-2021-09 -
The New England Journal of Medicine Apr 2020
Topics: Adult; Animals; Echinococcosis; Echinococcus granulosus; Exophthalmos; Female; Humans; Orbit; Orbital Diseases
PubMed: 32242360
DOI: 10.1056/NEJMicm1911903 -
Seminars in Ophthalmology Jul 2023Orbital decompression is mainly performed in thyroid eye disease to reduce proptosis and retrobulbar pressure, to improve venous congestion, and to relieve optic nerve... (Review)
Review
PURPOSE
Orbital decompression is mainly performed in thyroid eye disease to reduce proptosis and retrobulbar pressure, to improve venous congestion, and to relieve optic nerve compression. Secondary effects of orbital decompression are also occasionally encountered. The aim of this study was to review the secondary effects of orbital decompression.
METHODS
This is a comprehensive literature review that summarizes the secondary effects of orbital decompression.
RESULTS
Decreased intraocular pressure, inter-pupillary distance, and eyelid pressure, and improvement of eyelid retraction, lateral flare, orbital discomfort, and psychosocial condition after orbital decompression are favorable changes for patients. In contrast, refractive changes in some patients and decreased Bell's phenomenon and nasal function worsen patients' condition.
CONCLUSION
These favorable changes may reduce the patients' burden for treatment of thyroid eye disease. In contrast, as some of the adverse effects significantly worsen the patients' disease condition, we should carefully monitor these changes.
Topics: Humans; Graves Ophthalmopathy; Decompression, Surgical; Retrospective Studies; Orbit; Treatment Outcome
PubMed: 36631972
DOI: 10.1080/08820538.2023.2166354 -
Die Ophthalmologie Feb 2023The possible complications of anophthalmic eye sockets can occur due to many different pathomechanisms. A differentiation is made between allergic, infectious,... (Review)
Review
The possible complications of anophthalmic eye sockets can occur due to many different pathomechanisms. A differentiation is made between allergic, infectious, inflammatory or mechanical causes. This article gives an overview on the different etiologies of socket complications with their pathophysiology and treatment options.
Topics: Humans; Orbit; Aftercare; Eye Enucleation; Orbital Implants; Anophthalmos; Inflammation
PubMed: 36705680
DOI: 10.1007/s00347-022-01800-6 -
Arquivos Brasileiros de Oftalmologia 2024Vascular anomalies comprise a wide spectrum of clinical manifestations related to disturbances in the blood or lymph vessels. They correspond to mainly tumors... (Review)
Review
Vascular anomalies comprise a wide spectrum of clinical manifestations related to disturbances in the blood or lymph vessels. They correspond to mainly tumors (especially hemangiomas), characterized by high mitotic activity and proliferation of the vascular endothelium, and malformations, endowed with normal mitotic activity and no hypercellularity or changes in the rate of cell turnover. However, the classifications of these lesions go beyond this dichotomy and consist various systems adapted for and by different clinical subgroups. Thus, the classifications have not reached a consensus and have historically caused confusion regarding the nomenclatures and definitions. Cavernous venous malformations of the orbit, previously called cavernous hemangiomas, are the most common benign vascular orbital lesions in adults. Herein, we have compiled and discussed the various evidences, including clinical, radiological, morphological, and molecular evidence that indicate the non-neoplastic nature of these lesions.
Topics: Humans; Hemangioma, Cavernous; Orbital Neoplasms; Orbit; Vascular Malformations
PubMed: 38655941
DOI: 10.5935/0004-2749.2023-0338 -
The Journal of Craniofacial Surgery Sep 2022Orbital dysplasia is caused by congenital microphthalmos, anophthalmos, or eye atrophy. Orbital volume growth is known to parallel ocular growth and the absence of an...
PURPOSE
Orbital dysplasia is caused by congenital microphthalmos, anophthalmos, or eye atrophy. Orbital volume growth is known to parallel ocular growth and the absence of an eye results in noticeable hemifacial deformity that affects patients' lives. The aim of this study was to observe the effects of injections of hyaluronic acid gel into the orbit combined with ocular prosthesis to treat orbital dysplasia.
METHODS
Three patients with orbital dysplasia who were 3 to 7 years old treated in our department. Each year, the hyaluronic acid gel was injected into each patient intraconal and extraconal posterior orbit and each wore an ocular prosthesis. The length of the palpebral fissure and orbital volume were measured before and after the injections.
RESULTS
A total of 9 injections were performed on 3 patients ages 7, 5, and 4 years old, respectively. The follow-up periods were 5, 5, and 2 years. The authors observed significant improvements in patient appearance. The length of the palpebral fissure and the volume of the orbit increased linearly with the increasing age, and there were no complications, such as intraorbital hemorrhage or local hyperplastic stimulation.
CONCLUSIONS
Orbital hyaluronic acid gel injection and combined with an ocular prosthesis is a safe, convenient, and effective treatment for orbital dysplasia.
Topics: Anophthalmos; Child; Child, Preschool; Enophthalmos; Eyelids; Humans; Hyaluronic Acid; Orbit
PubMed: 35765127
DOI: 10.1097/SCS.0000000000008393 -
Folia Morphologica 2023The goal of the present study was to provide accurate data on the prevalence and morphometrical aspects of the cranio-orbital foramen (COF), which can surely be of use... (Review)
Review Meta-Analysis
BACKGROUND
The goal of the present study was to provide accurate data on the prevalence and morphometrical aspects of the cranio-orbital foramen (COF), which can surely be of use by surgeons performing procedures on the lateral orbit. Furthermore, the embryology and the clinical significance of this osseous structure were thoroughly discussed.
MATERIALS AND METHODS
Major online medical databases such as PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched to find all relevant studies regarding COF.
RESULTS
Eventually, a total of 25 studies that matched the required criteria and contained complete and relevant data were included in this meta-analysis. The pooled prevalence of COF was found to be 48.37% (95% confidence interval [CI]: 41.67-55.10%). The occurrence of the COF unilaterally was set to be 71.92% (95% CI: 41.87-96.97%). The occurrence of the COF bilaterally was set at 26.08% (95% CI: 3.03-58.13%).
CONCLUSIONS
In conclusion, we believe that this is the most accurate and up-to- -date study regarding the anatomy of the COF. The COF is prevalent in 48.37% of the cases, and it is most frequently unilateral (73.92%). Furthermore, the prevalence of accessory COFs was found to be 16.72%. The presence of these foramina may represent a source of haemorrhage that ophthalmic surgeons should be aware of when performing procedures in the lateral part of the orbit.
Topics: Orbit; Humans
PubMed: 36178278
DOI: 10.5603/FM.a2022.0086 -
Current Opinion in Endocrinology,... Oct 2022We attempt to provide an historical perspective on progress made in understanding the pathogenesis of thyroid-associated ophthalmopathy (TAO), focusing on the roles of... (Review)
Review
PURPOSE OF REVIEW
We attempt to provide an historical perspective on progress made in understanding the pathogenesis of thyroid-associated ophthalmopathy (TAO), focusing on the roles of orbital fibroblasts (OF) in the diseased orbit (termed GD-OF) and how these cells differ from those residing in the healthy orbit. GD-OF comprise both residential OF and those apparently derived from CD34 + fibrocytes.
RECENT FINDINGS
CD34 + fibrocytes of the monocyte lineage putatively traffic to the TAO orbit from bone marrow. We believe that these fibroblastic cell populations dictate the activity and severity of TAO. Their impact on disease may be moderated by Slit2, a neuron axon guidance repellent synthesized by and released from residential CD34 - OF. Approximately 50% of patients with GD develop clinically meaningful TAO. Relatively few require systemic medical and surgical therapies, while milder disease can be managed with conservative, local care. Determining the intrinsic properties of GD-OF and their expression of Slit2 may explain why some patients with GD develop severe, vision-threatening TAO while others virtually escape any of its manifestations. Such insights should allow for improved and better-tolerated therapies.
SUMMARY
Identifying unique characteristics of fibrocytes and GD-OF subsets reveals their apparent roles in tissue activation, inflammation, and remodeling associated with TAO. Better understanding of these cells, their origins, behavior, and factors modulating their activities remains necessary for the development of more targeted, effective, and safe treatments.
Topics: Antigens, CD34; Bone Marrow; Cells, Cultured; Fibroblasts; Graves Ophthalmopathy; Humans; Orbit
PubMed: 35950703
DOI: 10.1097/MED.0000000000000765