MUDr. Veronika Matušková, Ph.D., FEBO ®Anatomy ® ®Canalis opticus ®Fissura orbitalis superior ®Fissura orbitalis inferior v ® ® http://image.slidesharecdn.com/anatomyandphysiologyoftheeyelid-131004105340-phpapp02/95/anatomy-and -physiology-of-the-eyelid-22-638.jpg?cb=1380884116 vRoof - frontobasal, orbitofrontal vLateral wall – orbitozygomatic vMedial wall – orbitoetmoideal vFloor – retromarginal, „blow out fracture“ ® vCause – failing on a sharp object, blow to the ®Forehead (head in bend) ®Signs: hematoma of the upper eyelid, disturbance of craniofacial bones ® ®Small fractures require no treatment Fractures extending into the anterior cranial fossa - competence NCH Damage visual functions - ischemic neuropathy n. II ® Therapy ischemic neuropathy: decompression optical channel or megadoses of methylprednisolone Výsledek obrázku pro swordplay Související obrázek ®Cause - blunt trauma on cheekbones ®Usually part of zygomatikomaxilárního complex (ZMK) ® Symptoms: pain, hematoma of eyelids, conjunctiva chemosis, visual disturbances and eyeball displacement (diplopia, enophthalmos) ®Dg. - CT, NMR ®Treatment - Indications for surgery is persistent diplopia, limited mouth opening and flattening of the facial region ® ® ® ® ® ® Výsledek obrázku pro fracture zygomatic complex Výsledek obrázku pro car accident Výsledek obrázku pro Le fort fracture ®Fractura of ZMK ®Isolated fracture of lateral wall ®Cause - blunt trauma ® Symptoms - hematoma eyelid , subcutaneosu emphysema develops on blowing nose ® Dg. - CT ® Treatment – conservative ® ® Výsledek obrázku pro emphysem eyelids ®Cause – sudden increase in the orbital pressure by a striking object ( larger than 5 cm) ® ®The symptoms - swelling, hematoma of eyelids pseudoptóza, diplopia, inability to move the eyeball upwards (seriously elevation). ® Paresthesia, hypoesthesia in n.infraorbitalis. Výsledek obrázku pro blow out fracture ®Dg. - X-ray orbit, CT ® ®Symptom - hammlock - wide breaking orbital floor. Significant enophthalmos, without incarceration of m.r. inf. Symptom - hanging drop - fisure fracture with soft tissue entrappment ®Double diplopia Test passive duction Treatment - Surgery – in case of entrappemnt (in 3-5 days -resolved orbital hematoma). ® ® ® ® ® Acute dacryadenitis – rare, in isolation ®S: swelling of the lateral aspect of the eyelid – charakteristic „S“ shaped ptosis ®T: usually is not required ® ®Tumors: Lacrimal gland carcinoma - high mortality and morbidity ®T: surgery and radiotherapy vDacryadenitis v v v v v v v v ® v vPleomorfic adenoma ® D:\Foto\Dacryoadenitis acuta children.jpg D:\Foto\Dacryoadenitis acuta.jpg D:\Foto\Pleomorfní adenom slzné žlázy.jpg ®Measurement of the position of the eye Hertel exoftalmometr measures the distance corneal apex - the external edge of the bony orbit (diameter 17 mm, above 20 - pathology) ®Side difference to 2 mm - physiological ®Always should be recorded the distance of the outer edges of the orbits v ® ®Pulsatile proptosis - the carotid cavernous fistula – abnormal communication btw vein and artery ( carotid artery and orbital cavernous sinus vein ) ® http://2.bp.blogspot.com/-bMcjpLgnolI/UmIn5lAx_eI/AAAAAAAAAmE/XNl2EdcY2r8/s1600/Medusa.jpg Výsledek obrázku pro caput medusae conjunctiva Výsledek obrázku pro carotid cavernous fistula ® ®Intermittent proptosis - a symptom of vascular malformations in orbit (varix) - Valsalva maneuver ® Pseudoproptosis - high axial myopia enophthalmos v Výsledek obrázku pro proptosis Výsledek obrázku pro high myopia vAxial proptosis - only in the sagittal plane (Graves' disease, orbitocellulitis ) vParaaxial proptosis - lesions of peripheral lateral space (lacrimal gland tumors, frontoetmoidal mucocele, tumors of PN sinus) vBilateral proptosis - thyreotoxicosis and EO v Výsledek obrázku pro proptosis v X ray vUltrasound vCT vNMR ®Etiopatogenesis: ® Microbial infection Immune responses hyperergická-allergic-type Endocrine ophthalmopathy (Graves disease) ®Microbial infections: ® orbitocellulitis phlegmone orbit abscess of orbit Tenonitis myositis orbitalis Inflammatory pseudotumor of the orbit ® vOrbitocelulitis v v v v v v v v v vAbscess of orbit v D:\Foto\Orbitální celulitida.jpg vAutoimmune disease with the formation of a binding antibodies on cells of thyroid gland Orbital fat Subcutaneous tissue front of the lower leg vClinical picture: Eyelid symptoms Eye movement disorder Pseudoglaukom Exophtalmus Neuropathy n.II v ® D:\Foto\Maligní exoftalmus.jpg D:\Foto\EO - víčkové příznaky.jpg ®Diagnosis: laboratory findings Imaging (ultrasound B scan, NMR, CT) Test passive duction (muscle fibrosis) ® Complications of EO - the cornea exposure, elevated intraocular pressure, changes in the orbit (neuropathy) ® vTreatment: ® Endokrinologist vOphthalmologist - serious ocular complications - megadoses of steroids, orbital decompression, the treatment of ocular disorders ® vBenign and malignant primary secondary metastatic ®Primary vascular tumors dermoid cyst nerve tumors lacrimal gland tumors meningiomas orbit malignant lymphomas rhabdomyosarcoma ® P1010108 7 ®Secondary tumors of PN sinuses carcinomas of the eyelids Extrabulbar expansion of intraocular tumors metastatic - Adenocarcinomas (breast, lung, prostate, colon, pancreas, testis) ® ®Treatment According to type, location and size of the tumor. Interdisciplinary cooperation ®Anterior, lateral, and transcranial transetmoidální orbitotomy. ®Orbital decompression, exenteration of the orbit. Výsledek obrázku pro optic nerve glioma Výsledek obrázku pro rhabdomyosarcoma orbitae Výsledek obrázku pro hemangioma orbitae https://lh3.googleusercontent.com/9PzM-dmOiLAiKe2yeoOCufgMgwKgFXoU9yJmLi0SiHEe-tbUwL1y9bB9eRK28h7Ik w5uhQ=s85 Výsledek obrázku pro meningioma orbitae ® ®Enucleation of the eyeball – ® Removing the whole globe after ®( transection of eye ocular muscles and optic nerve) ® Indications: malignant intraocular tumors without extrabulbární promotion painful blind bulbus cosmetically unsightly blind bulbus devastating eye injury (primary enucleation) sympathetic ophthalmia ® ® TU 6 PICT0043 TU dítě 2 490927058_002_001 ®Enucleation of the eyeball surgical procedure without orbital implant orbital implant ® 6 5 rovně vpravo 2 ®Evacuating of the contents of the eyeball, leaving its packaging. Indications: Endophthalmitis (panoftalmitida) The devastating trauma of the globe with the evacuation of its contents ® eviscerace-predem eviscerace-zadem ® Without implant ®With implant PICT0027 PICT0029 IM000000 IM000001 eviscerace-zadem medpor nové I nové II ®Benefits of implant: good motility of the globe satisfactory cosmetic effect ® Disadvantages of implant: elimination of implant the possibility of infection ® 8510145204_001_003 8510145204_004_006 ®Removing the entire contents of the orbit and the periosteum without retaining caps, preserving eyelid indications: tumors of the orbit tumors of the eyelids and eyeball with propagation into orbit intractable infectious processes trauma (devastating injuries with extensive tissue necrosis) ® P1010044 Fidlerova_Marie_1 melanom spojivky ®Ways of dealing with the defect: healing granulation tissue free skin graft tissue flap with pedicle (muscle, fat, skin) PICT0093 lalok ivetka PICT0054 ® ® ®Permanent Cosmetic Solutions: Spectacle ectoprotesis (prostheses) ®Fixed implants Obrázek1 Obrázek4 epiteza