We report two patients with unilateral vertical retraction syndrome. Magnetic resonance imaging (MRI) of the orbits of the two cases showed similar size and location of the orbital structure, but with dramatically different strabismus type. MRI sagittal reconstruction of the orbits suggested that abnormal muscle tissue arised from the inferior rectus, which might be associated with retraction and narrowing of the palpebral fissure and atypical strabismus as well.
Child ; Eyelids ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Oculomotor Muscles ; physiopathology ; Orbit ; pathology ; Strabismus ; pathology ; Syndrome

PURPOSE: To evaluate orbital blood flow velocities and optic nerve diameter with Doppler and gray-scale sonography in patients with acute unilateral optic neuritis (ON). METHODS: Orbital Doppler and gray-scale sonography was performed in 46 eyes of 23 patients aged 19- to 47-years with acute unilateral ON. ON was diagnosed by an ophthalmologist on the basis of clinical presentation, presence of decreased visual acuity and assessment of visual evoked potentials. The peak systolic velocity (PSV) and end-diastolic velocity (EDV), as well as the resistance index (RI) and pulsatile index (PI) of the ophthalmic artery (OA), central retinal artery (CRA), posterior ciliary arteries (PCAs) and optic nerve diameter were measured in both eyes. We compared results from affected and unaffected eyes using the paired t-test. The area under the receiver operating characteristic (ROC) curves was used to assess the diagnosis of ON based on measured blood flow parameters of the OA, CRA and PCAs and optic nerve diameter. RESULTS: The mean (standard deviation) optic nerve diameter in eyes with ON was 4.1 (0.8) mm, which was significantly larger than the 3.0 (0.4) mm diameter measured in unaffected control eyes (p < 0.001). There were no differences in average PSV, EDV, RI, or PI of the OA and CRA between affected and unaffected eyes (p > 0.05). The mean RI in the PCAs was slightly lower in the eyes with ON than in the contralateral eyes (0.60 vs. 0.64, p < 0.05). The area under the ROC curves indicated that optic nerve diameter was the best parameter for the diagnosis of ON. CONCLUSIONS: Optic nerve diameter was related to ON, but orbital blood flow parameters were not.
Adult ; Humans ; Middle Aged ; Ophthalmic Artery/*physiology/*ultrasonography ; Optic Nerve/*blood supply/*ultrasonography ; Optic Neuritis/*physiopathology/*ultrasonography ; Orbit/blood supply/ultrasonography ; Pulsatile Flow/physiology ; Regional Blood Flow/physiology ; Ultrasonography, Doppler, Color ; Vascular Resistance/physiology ; Young Adult

We report a very rare case of odontogenic orbital cellulitis causing blindness by severe tension orbit. A 41-yr old male patient had visited the hospital due to severe periorbital swelling and nasal stuffiness while he was treated for a periodontal abscess. He was diagnosed with odontogenic sinusitis and orbital cellulitis, and treated with antibiotics. The symptoms were aggravated and emergency sinus drainage was performed. On the next day, a sudden decrease in vision occurred with findings of ischemic optic neuropathy and central retinal artery occlusion. Deformation of the eyeball posterior pole into a cone shape was found from the orbital CT. A high-dose steroid was administered immediately resulting in improvements of periorbital swelling, but the patient's vision had not recovered. Odontogenic orbital cellulitis is relatively rare, but can cause blindness via rapidly progressing tension orbit. Therefore even the simplest of dental problems requires careful attention.
Adult ; Anti-Bacterial Agents/adverse effects/therapeutic use ; Blindness/*diagnosis/etiology ; Drainage ; Fluorescein Angiography ; Humans ; Male ; Optic Neuropathy, Ischemic/complications ; Orbit/*physiopathology ; Orbital Cellulitis/*diagnosis ; Retinal Artery Occlusion/complications ; Sinusitis/diagnosis/drug therapy ; Tomography, X-Ray Computed ; Tooth Root

INTRODUCTIONAcute retrobulbar haemorrhage is a potentially sight-threatening condition, and can follow retrobulbar anaesthesia or trauma to the orbit. Acute loss of vision can occur with retrobulbar haemorrhage and is reversible if the condition is recognised and treated early.

CLINICAL PICTUREWe report a case of acute retrobulbar haemorrhage following orbital trauma in a 78-year-old Chinese lady.

TREATMENTThe patient was on follow-up for a mature cataract in the right eye and had been scheduled for cataract surgery. The patient presented to the emergency department with acute loss of vision in the right eye, severe proptosis and tense periorbital haematoma after she hit her right face following a fall. Computed tomography scans revealed fractures of the floor, lateral and medial walls of the right orbit as well as retrobulbar and periorbital haematoma. There was marked proptosis and tenting of the globe with stretching of the optic nerve. Emergent lateral canthotomy and cantholysis was performed at the emergency department. The patient subsequently underwent surgical evacuation of the orbital haematoma.

OUTCOMEThe patient's vision in the right eye recovered from no perception of light to light perception over the next few days. After a month of follow-up, the patient underwent right cataract surgery, and her best corrected visual acuity was 6/12 part.

CONCLUSIONIn severe acute retrobulbar haemorrhage, prompt surgical evacuation of the haematoma can reverse visual loss.

Accidental Falls ; Aged ; Decompression ; methods ; Facial Injuries ; complications ; Female ; Follow-Up Studies ; Humans ; Orbit ; injuries ; Retrobulbar Hemorrhage ; etiology ; physiopathology ; surgery ; Tomography, X-Ray Computed ; Visual Acuity ; physiology ; Visual Fields ; physiology

Trigeminal neuralgia is a paroxysmal disorder with severely disabling facial pain and thus continues to be a real therapeutic challenge. At present there are few effective drugs for treatment of this pain. The present study was aimed to explore the involvement of BK(Ca) channels and Kv channels in the mechanical allodynia in a rat model of trigeminal neuropathic pain. Here the effectiveness of drug target injection at the trigeminal ganglion through the infraorbital foramen was first evaluated by immunofluorescence and animal behavior test. Trigeminal neuropathic pain model was established by chronic constriction injury of the infraorbital nerve (ION-CCI) in rats. BK(Ca) channel agonist and Kv channel antagonist were administered into the trigeminal ganglion in ION-CCI rats and sham rats by the above target injection method, and the facial mechanical pain threshold was measured. The results showed that the drug could accurately reach the trigeminal ganglion by target injection which was more effective than that by the normal injection around infraorbital foramen. Rats suffered significant mechanical allodynia in the whisker pad of the operated side from 6 d to 42 d after ION-CCI. BK(Ca) channel agonist NS1619 significantly and dose-dependently attenuated the facial mechanical allodynia and increased the facial mechanical pain threshold in ION-CCI rats 15 d after operation. Kv antagonist 4-AP was able to reduce the threshold in ION-CCI rats when facial mechanical threshold was partly recovered and relatively stable on the 35th day after operation. These results suggest that BK(Ca) channel agonist NS1619 and Kv channel antagonist 4-AP can significantly affect the rats' facial mechanical pain threshold after ION-CCI. Activation of BK(Ca) channels may be related to the depression of the primary afferent neurons in trigeminal neuropathic pain pathways. Activation of Kv channels may exert a tonic inhibition on the trigeminal neuropathic pain.
4-Aminopyridine ; administration & dosage ; Animals ; Benzimidazoles ; administration & dosage ; Constriction ; Facial Pain ; physiopathology ; Injections, Intralesional ; Kv1.4 Potassium Channel ; antagonists & inhibitors ; Large-Conductance Calcium-Activated Potassium Channels ; agonists ; Male ; Orbit ; innervation ; Pain Threshold ; physiology ; Rats ; Rats, Sprague-Dawley ; Trigeminal Ganglion ; drug effects ; Trigeminal Neuralgia ; drug therapy ; physiopathology

PURPOSE: To assess the effect of intravitreal and posterior subtenon injections of triamcinolone acetonide (TA) on intraocular pressure (IOP). METHODS: we reviewed 42 consecutive eyes after intravitreal TA injection (IVTA) and 43 eyes following posterior subtenon TA injection (PSTA). All cases had a minimum follow-up time of three months. After injection, the value and time of the maximal IOP, the amount of IOP elevation and the needs of the medication were assessed. RESULTS: The IOP increased significantly (p<0.001) from 16.3+/-2.5 mmHg preoperatively to a mean maximum of 21.7+/-5.3 mmHg in the IVTA group, and from 15.3+/-4.5 mmHg to 20.6+/-3.0 mmHg in the PSTA group. An elevation in the IOP of more than 5 mmHg from the baseline IOP was seen in 52.4% of the IVTA group at a mean time of 3.1 weeks postoperatively, and 44.2% of the PSTA group displayed an IOP elevation at 5.9 weeks. CONCLUSIONS: Both developed significant elevations of IOP, but this appeared at a later date in the PSTA group. Careful follow-up after local injection of steroids is necessary.
Vitreous Body ; Uveitis, Posterior/*drug therapy/pathology ; Triamcinolone Acetonide/administration & dosage/*adverse effects ; Time Factors ; Retrospective Studies ; Orbit ; Ocular Hypertension/*chemically induced/physiopathology ; Middle Aged ; Male ; Macular Edema, Cystoid/*drug therapy/pathology ; Intraocular Pressure/*drug effects ; Injections ; Humans ; Glucocorticoids/administration & dosage/*adverse effects ; Follow-Up Studies ; Female ; Aged, 80 and over ; Aged ; Adult

INTRODUCTIONA case is presented of a patient with severe and chronic pain in the orbital region, which was relieved by retrobulbar injection of absolute alcohol. The management of chronic pain in the orbital region has received little attention and the literature is reviewed.

CLINICAL PICTUREA 52-year-old man with adenoid cystic carcinoma of the maxillary sinus was suffering from severe pain, especially in the left orbital region. There was also pain from ocular exposure and compression caused by the tumour. Magnetic resonance imaging (MRI) revealed spread of tumour to both orbits, particularly on the left. Multiple debulking surgery and various treatment modalities offered no relief from his pain.

TREATMENTA single retrobulbar injection of 2 mL of absolute alcohol, was placed into the putative orbital apex.

OUTCOMEAs a consequence of the injection, he had complete resolution of his pain in the 6 months prior to his death.

DISCUSSIONRetrobulbar injection of alcohol offers effective pain relief in certain specific conditions characterised by chronic orbital pain when other treatments do not help.

CONCLUSIONWe have demonstrated that the retrobulbar technique still has a place in our armamentarium.

Analgesia ; Anti-Infective Agents, Local ; administration & dosage ; therapeutic use ; Carcinoma, Adenoid Cystic ; pathology ; Chronic Disease ; Ethanol ; administration & dosage ; therapeutic use ; Humans ; Injections ; Lidocaine ; administration & dosage ; therapeutic use ; Male ; Maxillary Sinus ; drug effects ; pathology ; Middle Aged ; Orbit ; drug effects ; physiopathology ; Pain ; drug therapy