PURPOSE: To investigate the normal exophthalmometric values in children and facilitate the exophthalmic evaluation in pediatric patients with orbital disease. METHODS: We measured 516 eyes in 258 children aged 3 to 9 years without any orbital disease such as thyroid ophthamopathy, orbital pseudotumor and orbital wall fracture. We considered the association of age, sex, binocular variance, inter rim distance and axial length with the exophthalmometric values. Axial length was measured in only 120 eyes of60 patients who underwent operation for strabismus. RESULTS: The mean exophthalmometric values in the patients was 12.43+/-1.55 mm. The exophthalmos had a significant positive correlation with the age, axial length and inter rim distance. There were significant differences in exophthalmometric values by sex in children aged from 8 to 9 years but no significant difference by binocular variance. There were significant differences in the inter-rim distance related to sex. CONCLUSIONS: The exophthalmometric values in children had significant correlation with age, sex, axial length, and inter-rim distance. There was a significant increase of inter-rim distance in males compared to females. Knowing the mean exophthalmometric values in children would be useful with the exophthalmometric reference in pediatric patients with orbital disease.
Aged ; Child ; Exophthalmos ; Eye ; Female ; Humans ; Male ; Orbit ; Orbital Diseases ; Orbital Pseudotumor ; Strabismus ; Telescopes ; Thyroid Gland

PURPOSE: To determine the side effects of short-term high-dose methylprednisolone therapy (pulse methylprednisolone therapy), which was used to treat patients with optic neuritis, traumatic optic neuropathy, orbital pseudotumor, and orbital myositis. METHODS: All 27 patients treated with pulse methylprednisolone therapy from June 2005 to June 2006 were included in this study. Each patient was injected with 1 g per day of methylprednisolone intravenously, administered in 250 mg doses every 6 hours, for 3 days. We measured body mass index (BMI), fasting glucose, HbA1c, blood pressure, and intraocular pressure. In addition, we performed slit lamp examination and chest X-ray. RESULTS: The average age of the 27 patients was 35.8 years, including 16 males and 11 females. Thirteen patients had optic neuritis, 10 patients had traumatic optic neuropathy, 3 patients had orbital pseudotumors, and 1 patient had orbital myositis. Before treatment, the average of body mass index (BMI) was 23.09 (kg/m2), but at 3 months after treatment it was 23.73 (kg/m2). All patients had fasting glucose levels higher than the normal range during the treatment. However, all fasting glucose levels returned to within the normal range at 3 months after treatment, except in 1 patient. In addition, a major complaint among patients was an increase in body weight. CONCLUSIONS: We performed a close observation of controlled diet and exercise on patients who were treated with pulse methylprednisolone therapy because we knew it would have a hyperglycemic effect. An increase in body weight is the most common complaint of steroid therapy. Even after treatment is completed, it is important to monitor glucose level and weight.
Blood Pressure ; Body Mass Index ; Body Weight ; Diet ; Eye ; Eye Diseases ; Fasting ; Female ; Glucose ; Humans ; Intraocular Pressure ; Male ; Methylprednisolone ; Optic Nerve Injuries ; Optic Neuritis ; Orbit ; Orbital Myositis ; Orbital Pseudotumor ; Organothiophosphorus Compounds ; Reference Values ; Thorax

Acute visual loss may occur in association with sinusitis either as a complication of orbital cellulitis or, less frequently, as a part of the orbital apex syndrome. Originally, an orbital apex syndrome is associated with an affection of the vessels and nerves passing through the superior orbital fissure and the optic foramen. A classical feature of orbital apex syndrome is presented with visual loss and ophthalmoplegia, but with minimal or no signs of orbital inflammation such as proptosis, chemosis, or lid edema. We present a case of male patient with alternating bilateral visual loss with ophthalmoplegia secondary to paranasal sinusitis.
Edema ; Exophthalmos ; Humans ; Inflammation ; Male ; Ophthalmoplegia ; Orbit* ; Orbital Cellulitis ; Orbital Diseases ; Sinusitis*

Orbital complications of sinus disease continue to appear in clinical practice. Acute visual loss may occur in association with sinusitis either as a complication of orbital cellulitis or, less frequently, as a part of the orbital apex syndrome. The classification which defines the degree of orbital extension is valuable, therapeutically and prognostically. The orbital apex syndrome is associated with an affection of the vessels and nerves passing through the superior orbital fissure and the optic foramen and characterized by visual loss and ophthalmoplegia. But it has minimal or no signs of orbital inflammation such as proptosis, chemosis, or lid edema. We experienced a case of temporary monocular visual loss and ophthalmoplegia caused by mucocele in the sphenoid sinus. Thus, we report, with a review of literature, a case of orbital apex syndrome caused by mucocele in the sphenoid sinus in a 53 year-old male patient.
Classification ; Edema ; Exophthalmos ; Humans ; Inflammation ; Male ; Middle Aged ; Mucocele* ; Ophthalmoplegia ; Orbit* ; Orbital Cellulitis ; Orbital Diseases ; Sinusitis ; Sphenoid Sinus* ; Vision Disorders

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.
Male ; Female ; Child ; Humans ; Abscess/therapy* ; Retrospective Studies ; Sinusitis/therapy* ; Orbital Cellulitis ; Acute Disease ; Exophthalmos ; Orbital Diseases/therapy*

Idiopathic orbital myositis, a subgroup of previously so called inflammatory orbital pseudotumor, occurred with acute onset periorbital pain, eyelid swelling, proptosis, and ophthalmoplegia. Currently many pathologist and ophthalmologist agreed the term pseudotumor or Tolosa-Hunt syndrome and They classified some cases as characterized histologic and computerized tomographic evidence of inflammation of extraocular muscles, good responsiveness to prednisone, remission and exacerbation, with recurrence, but generally benign condition. The possibility of idiopathic orbital myositis being an immune-mediated process has been discussed. Some believe many of such cases have been grouped under the term Tolosa-Hunt syndrome. It is onloy in the last decade that computerized tomographic scanning has allowed precise localization of the alterations to orbital and retro-orbital strcutures. The term idopathic orbital myositis is precise insofar as it indicates the structures primarily involved ocular muscles. We report a case of idiopathic orbital myositis withr review of literatures.
Exophthalmos ; Eyelids ; Inflammation ; Muscles ; Ophthalmoplegia ; Orbit* ; Orbital Myositis* ; Orbital Pseudotumor ; Prednisone ; Recurrence ; Tolosa-Hunt Syndrome

Idiopathic orbital myositis, a subgroup of inflammatory orbital pseudotumor may occur with acute-onset periorbital pain, diplopia, and, in most cases, eyelid swelling. Proptosis, extraocular muscle motility restrictions, and response to oral prednisolone administration were characteristic. Although the CT appearance of orbital myositis is often helpful, the findings are not pathognomonic: correlation with history, clinical finding, and therapeutic response must be considered in making the diagnosis. The results of corticosteroid therapy on the orbital pseudotumor caused by orbital myositis were as follows: 1. The effect of corticosteroid was more effective in single extraocular muscle involvement than in that of a multiple extraocular muscle. 2. Early age of onset and early treatment after symptom increased the effectiveness of corticosteroid therapy.
Age of Onset ; Diagnosis ; Diplopia ; Exophthalmos ; Eyelids ; Orbit* ; Orbital Myositis* ; Orbital Pseudotumor* ; Prednisolone

No abstract available.
Blepharoptosis ; Myositis* ; Orbital Myositis ; Orbital Pseudotumor

Orbital pseudotumor, also known as idiopathic orbital inflammatory syndrome(IOIS), may have protean clinical manifestations. IOIS should be determined with a diagnosis of exclusion, with evaluation directed toward eliminating other causes of orbital disease. Orbital MRI and CT are the important diagnostic tests, but serologic studies are necessary to exclude a systemic causes. Biopsy is usually not performed currently, as the risk of producing damage to vital structures within the orbital outweighs the benefits. Patients with multiple recurrences, or those unresponsive to therapy, should be treated of biopsy sample extraction. Corticosteroids are the mainstay of therapy and administered for several months to ensure remission. Radiotherapy may be used in patients who fail to respond to steroids or who have a rapidly progressive course. We analysed the data of two patients. There were no specific complications related to this treatment. We discussed the radiologic findings, treatment procedures, and other orbital diseases.
Adrenal Cortex Hormones ; Biopsy ; Diagnosis ; Diagnostic Tests, Routine ; Humans ; Magnetic Resonance Imaging ; Orbit* ; Orbital Diseases ; Orbital Pseudotumor* ; Radiotherapy ; Recurrence ; Steroids

PURPOSE: To perform and compare differential diagnosis of patients with thyroid-associated myopathy, idiopathic orbital myositis and normal controls based on orbital computed tomography. Orbital fat and extraocular muscle densities were quantified using Hounsfield Unit (HU) and their characteristics were compared and analyzed. METHODS: From February 2005 to January 2013, orbital computed tomography was performed on 90 eyes of 47 thyroid-associated myopathy patients, 18 eyes of 14 idiopathic orbital myositis patients and 280 eyes of 140 normal subjects. The average values of orbital fat and extraocular muscle densities were measured and compared using HU. The density differences between the patients with thyroid-associated myopathy and the normal group were analyzed by age, clinical activity score, ocular protrusion and disease duration. RESULTS: In the thyroid-associated myopathy group, orbital fat and extraocular muscle densities were -87.8 +/- 12.5 HU and 48.7 +/- 7.1 HU, respectively. In the idiopathic orbital myositis group, the orbital fat and extraocular muscle densities were 79.9 +/- 9.9 HU and 49.2 +/- 9.1 HU, respectively. There was a statistically significant lower result of orbital fat in the thyroid-associated myopathy group (p = 0.002), however, the extraocular muscle density did not show a statistically significant difference (p = 0.775). The orbital fat and extraocular muscle densities of the normal group were -79.0 +/- 11.2 HU and 54.3 +/- 6.3 HU, respectively. There were significantly lower results in both orbital fat and extraocular muscle densities in the thyroid-associated myopathy group than normal group (p = 0.000). In active cases and those accompanied by ocular protrusion, there was no significant difference in orbital fat density (p = 0.345 and p = 0.952, respectively), while extraocular muscle density significantly decreased (p = 0.007 and p = 0.003, respectively). CONCLUSIONS: A difference between the orbital fat and extraocular muscle densities in thyroid-associated myopathy and idiopathic orbital myositis could be quantitatively found using HU and orbital computed tomography.
Diagnosis, Differential ; Humans ; Muscles* ; Muscular Diseases* ; Orbit* ; Orbital Myositis*