A 41-year-old man visited our clinic complaining of esodeviation of the right eye. He had been operated on for corneal laceration 3 years before. One month later, exodeviation of the right eye had developed. The result of computed tomography (CT) was reported as orbital abscess and cellulitis. Although antibiotic treatment was administered for 2 weeks, the exodeviation didn't improve. On ocular examinations performed in our hospital in November-2001, his right eye was esotropic and had a relative afferent pupillary defect. Vision of the right eye was decreased to 0.02. Fundus examination showed optic atrophy. A new CT scan disclosed a foreign body introduced into the right medial orbital wall, nasal cavity and ethmoidal sinus. Although foreign body was surgically removed, vision and eye movement were not improved. In the case of a patient who has undergone orbital trauma, complete history taking and physical examinations must be performed. On suspicion of a foreign body, imaging study such as CT or MRI must be performed. However, because CT findings can be variable, careful follow-up is needed.
Adult ; Eye Foreign Bodies/*radiography/surgery ; Eye Injuries, Penetrating/*radiography/surgery ; Human ; Male ; Ophthalmologic Surgical Procedures ; Orbit/*injuries/radiography ; Tomography, X-Ray Computed ; *Wood

In order to describe the demographics, etiologic and clinical factors, and outcomes of orbital fractures in children, we have reviewed a case series of 17 patients under 18 years of age with internal orbital fractures (i.e., without involvement of the orbital rim) presenting to the Ghil hospital between March 2000 and June 2001. For 15 of the patients, we performed orbital wall reconstruction with Medpor (R) barrier sheet implantation (thickness 1mm) through transconjunctival approach under endoscopic guidance, while maintaining mere observation on the other 2 patients. There were 14 male and 3 female patients. The most common cause of fractures was accident (7 cases). Inferior wall involvement was most commonly seen, and the trapdoor type fracture was the most common. Thirteen patients had extraocular muscle restriction, 9 had nausea/vomiting and 5 had bradycardia. Diplopia of 9 patients disappeared after 43+/-23 days. Nausea/vomiting and bradycardia disappeared rapidly after surgical intervention in all cases. These results suggest that trapdoor fractures with soft tissue entrapment are the most common in pediatric orbital wall fractures, and that most of them are associated with nausea/vomiting. We suggest that early diagnosis, and prompt surgical intervention are required for those patients with oculocardiac reflex.
Adolescent ; Adult ; Child ; Child, Preschool ; *Endoscopy ; Female ; Human ; Male ; *Ophthalmologic Surgical Procedures ; Orbit/surgery ; Orbital Fractures/*diagnosis/radiography/*surgery ; Retrospective Studies ; *Surgery, Computer-Assisted ; Tomography, X-Ray Computed

When a patient is presented with a subconjunctival cyst, it is not only hard to reveal its true nature clinically but also easy to rupture during excision. We experienced cases with cysts of the accessory lacrimal gland in two patients with subconjunctival cysts. They had lid swelling at initial presentation and underwent surgical excision of subconjunctival cysts located in superior portion of the upper tarsal plate. The lining of these cysts composed of ductal epithelia. Biochemical analyses for serum and cystic fluid were performed in one case, in which was found high Ig A titer in the cystic fluid. These cysts seemed to originate from the duct of Wolfring's accessory lacrimal gland, considering their anatomic locations and pathologic findings. Complete removal of the cyst is important, because recurrences have been reported in cases of incomplete removal or simple aspiration.
Adult ; Conjunctival Diseases/pathology/surgery ; Cysts/*pathology/surgery ; Female ; Humans ; Lacrimal Apparatus Diseases/*pathology/surgery ; Orbit/radiography ; Tomography, X-Ray Computed

Transcutaneous and transconjunctival approaches are still frequently used to repair orbital wall fractures. However, medial orbital wall fracture remains a challenging area for plastic surgeons due to technical difficulties and postoperative scars. The transcaruncular approach is described and we present our experience with this approach to access the medial orbital wall in 10 patients with blowout fracture in the medial orbital region. All patients were corrected satisfactorily without cutaneous scar. The transcaruncular approach is a useful technique to repair medial orbital wall fractures.
Adolescent ; Adult ; Female ; Human ; Male ; Middle Aged ; *Ophthalmologic Surgical Procedures ; Orbit/radiography/*surgery ; Orbital Fractures/diagnosis/*surgery ; Postoperative Period ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To evaluate the surgical method and intraorbital foreign body extraction. METHODS: Individualized plan was made based on radiology and foreign body extraction was performed in 27 cases (27 eyes). The outcome of extraction was analyzed. Visual acuity, eye movement, and ptosis were recorded before and after the operation. RESULTS: Intraorbital foreign bodies in the 27 eyes were extracted successfully, 24 eyes (88.9%) extracted once and the other 3 eyes (11.1%) twice. The follow-up was 3-24(9.39±6.25) months. Visual acuity increased in 13 eyes (48.1%), and invariable in 13 eyes (48.1%) at the last follow-up. Disturbance of eye movement was found in 18 (66.7%) and 15 (55.5%) eyes before and after the extraction, respectively. Ptosis was found in 2 eyes (7.4%) and 1 eye (3.7%) before and after the extraction, respectively. CONCLUSION Individualized plan is helpful for the intraorbital foreign body extraction and eye recovery.
Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Foreign Bodies ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Orbit ; diagnostic imaging ; surgery ; Radiography ; Visual Acuity ; Young Adult

OBJECTIVETo evaluate the application of digital surgical technology in reconstruction of orbital frame and assess the treatment outcomes.

METHODSSeven patients with post-traumatic orbital defect were included in this study. Images of the orbit were obtained for each individual through computed tomography (CT). Preoperative design was finished according to rapid prototyping, computer-aided design and computer-aided manufacturing (CAD-CAM) and other digital surgical techniques. Surgical fracture reductions with internal fixation and implant of Medpor were used in operation to reconstruct orbit as well as correct enophthalmos and diplopia.

RESULTSAccurate realignment of the displaced orbital rim was obtained in all the 7 patients, and enophthalmos and diplopia were corrected in 4 and 2 patients, respectively.

CONCLUSIONSDigital techniques provide a precise means for preoperative design and operation implementation during orbital reconstruction. As a result, complications can be reduced, and the patient's facial appearance can be maximally improved.

Adult ; Computer-Aided Design ; Diplopia ; etiology ; surgery ; Enophthalmos ; etiology ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Orbit ; diagnostic imaging ; surgery ; Orbital Fractures ; complications ; diagnostic imaging ; surgery ; Radiography ; Reconstructive Surgical Procedures ; methods ; Surgery, Computer-Assisted ; Treatment Outcome ; Young Adult