PURPOSE: To investigate periorbital lipogranuloma cases that developed after autologous fat injection and to determine various treatment outcomes from these cases. METHODS: This retrospective study involved 27 patients who presented with periocular mass (final diagnosis of lipogranuloma) and had history of facial autologous fat injection. The collected data included information on patient sex, age, clinical presentation, number and site of fat injections, interval between injections, duration from injection to symptom onset, fat harvesting site, use of cryopreservation, and treatment outcome. RESULTS: The most common presenting symptom was palpable mass (92.6%), followed by blepharoptosis and eyelid edema. The mean time from injection to symptom onset was 13.6 +/- 29.2 months (range, 2 to 153 months). Patients were managed by intralesional triamcinolone injection (six patients) and surgical excision (three patients); 18 patients were followed without treatment. Among the six patients who underwent intralesional triamcinolone injection, five showed complete resolution, and one showed partial resolution. Among the 18 patients who were followed without management, three showed spontaneous resolution over a 5-month follow-up period. CONCLUSIONS: Lipogranuloma can develop in the eyelid after autologous fat injection into the face. Both surgical excision and intralesional triamcinolone injection yield relatively good outcomes. Simple observation can be a good option because spontaneous resolution can occur in a subset of patients.
Adipose Tissue/*transplantation ; Adult ; Autografts ; Cosmetic Techniques/*adverse effects ; Eyelid Diseases/diagnostic imaging/*etiology/therapy ; Female ; Granuloma, Foreign-Body/diagnostic imaging/*etiology/therapy ; Humans ; Injections ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Orbital Diseases/diagnostic imaging/*etiology/therapy ; Retrospective Studies ; Rhytidoplasty/*adverse effects ; Young Adult

Acute and chronic infection of sinus could expand to orbital cavity. As the technique and equipment of endoscopic surgery are getting popular and renewal, endoscopic sinus surgery is being used widely and profoundly, which improves the surgical effect of nose and sinus diseases greatly. However, the complications are not decreased rather than traditional surgery. The rate of orbital complication is the highest of all endoscopic sinus surgery. This paper present a case report about orbital complication due to sinusitis or endoscopic sinus surgery and related literature were reviewed.
Endoscopy ; adverse effects ; Humans ; Male ; Middle Aged ; Nasal Surgical Procedures ; adverse effects ; Orbital Diseases ; etiology ; Paranasal Sinuses ; surgery ; Postoperative Complications ; Sinusitis ; complications

The author reports a case of orbital Sarcoidosis in a 70-year-old female that initially presented as diffuse swelling of the lower eyelid. The patient complained of painless swelling of the left lower lid without palpable mass, and a computerized tomography (CT) scan of the orbit was unremarkable. A serum angiotensin converting enzyme level was elevated, and hilar lymphadenopathy was noted on the chest CT. The patient underwent surgical debulking for histologic confirmation, which led to a final diagnosis of sarcoidosis involving the orbital fat. Unexplained chronic eyelid swelling without a mass should be considered a possible ophthalmic manifestation of orbital sarcoidosis.
Aged ; Biopsy ; Diagnosis, Differential ; Edema/diagnosis/*etiology ; Eyelid Diseases/diagnosis/*etiology ; Eyelids/*pathology ; Female ; Humans ; Orbital Diseases/*complications/diagnosis ; Sarcoidosis/*complications/diagnosis ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the diagnostic and therapeutic methods of orbital apex syndrome caused by sinus diseases and to achieve earlier diagnosis and timely treatment. METHOD: Clinical data of 6 cases in our department from January 2008 to March 2012 were retrospectively analyzed. RESULT: All cases had surgical treatment. All cases were preoperatively diagnosed by CT, MRI or intranasal endoscopy. The postoperative pathology showed 2 cases with fungal sphenoiditis, 2 cases with ethmoid mucocele and 2 cases with sphenoid mucocele. CONCLUSION Orbital apex syndrome caused by sinus diseases is very rare. The possible causes of misdiagnosis are low incidence of the disease, nonspecific eye symptoms, and unawareness of the doctor, especially ophthalmologist. CT, MRI or intranasal endoscopy can greatly improve the diagnosis of the disease. Endoscopic sinus surgery is a safe and effective method for orbital apex syndrome caused by sinus diseases,which is the primary therapy for the disease.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Orbital Diseases ; diagnosis ; etiology ; therapy ; Paranasal Sinus Diseases ; complications ; diagnosis ; therapy ; Retrospective Studies ; Syndrome

OBJECTIVE: To investigate the clinical characters and therapeutic methods of orbital apex syndrome caused by sinus diseases. METHOD: Six cases of orbital apex syndrome originated from sinus diseases were retrospective analyzed in our hospital from August 2003 to February 2009. Different therapeutic methods were taken according to different causes of disease. RESULT: Four cases of sinus infection,one cases of sphenoethmoidal mucocele, one cases of sinus squamous cell carcinoma. The results of patients with orbital apex syndrome included cure and effectiveness in 2 cases respectively, death from myocardial infarction in one case, and one case is still following up. CONCLUSION Orbital apex syndrome originated from sinus diseases was rare, which was mainly caused by sinus infection. The key point is the correct etiology diagnosis in early phase. Treatment with endoscopic sinus surgery early is a good effective method for orbital apex syndrome caused by sinus diseases, in the same time with enough dosage of antibiotic and glucocorticoid therapy intravenously.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Nose Diseases ; complications ; Optic Nerve Diseases ; etiology ; Orbital Diseases ; etiology ; Retrospective Studies ; Syndrome

OBJECTIVE: Although rare, invasive rhino-orbital-skull base aspergillosis usually is fatal and necessitates prompt diagnosis, surgical intervention and antifungal treatment. METHOD: A case series of 5 patients, with review of treatments and outcomes. RESULT: Five patients initially presented with orbital apex syndrome without apparent rhino-sinus disease. Histologic examination revealed invasive aspergillosis. Four patients underwent transnasal endoscopic surgical exploration of rhino-orbital-skull base, and three of them simultaneously underwent optic nerve decompression. One patient underwent the rhinopharyngeal biopsy. Following surgical debridement and antifungal drug, Two patients achieved various degree of recovery, 1 patient (case 5) showed vision improvement, from counting fingers to 0.1 and symptom-free during 65 months follow-up. One patient (case 1) showed no recovery of vision from no light perception, but symptom-free during 43 months follow-up. Other three patients respectively died of massive intracranial spread (case 3), postoperative brainstem hemorrhage (case 2) and sepsis (case 4). CONCLUSION Invasive sino-orbital-skull base aspergillosis often may resemble inflammatory conditions. Early diagnosis and surgical intervention are required to improve vision and survival. The endoscopic surgical exploration and biopsy often are necessary to rule out fungal sinus infection before considering steroid use, especially in immunocompromised individuals. The patients with invasive rhino-orbital-skull base aspergillosis usually have a poor prognosis.
Adult ; Aged ; Aspergillosis ; pathology ; Female ; Humans ; Male ; Middle Aged ; Orbit ; microbiology ; Orbital Diseases ; etiology ; metabolism ; Retrospective Studies ; Sinusitis ; microbiology ; Skull Base ; microbiology

Child ; Edema ; diagnostic imaging ; etiology ; Emphysema ; diagnostic imaging ; etiology ; Ethmoid Bone ; diagnostic imaging ; injuries ; Eyelid Diseases ; diagnostic imaging ; etiology ; Humans ; Male ; Orbit ; diagnostic imaging ; Orbital Diseases ; diagnosis ; diagnostic imaging ; pathology ; Radiography ; Skull ; diagnostic imaging ; pathology ; Skull Fractures ; complications ; diagnostic imaging

A 51-year old man presented with vertical and torsional diplopia after reduction of a blowout fracture at another hospital one year ago. He had no anormalies of head position and 14 prism diopters (PD) right hypertropia (RHT) in the primary position. In upgaze no vertical deviation was found, and hyperdeviation on downgaze was 35PD. Bielschowsky head tilt test showed a negative response. Distinct superior oblique (SO) and inferior rectus (IR) underaction of the right eye was noted but IO overaction was mild on the ocular version test. Double Maddox rod test (DMRT) revealed 10-degree extorsion, but fundus extorsion was minimal in the right eye.Thin-section coronal CT scan showed that there was no fracture line on the anterior orbital floor, but a fracture remained on the posterior orbital floor. Also, the anterior part of the right inferior oblique muscle was vertically reoriented and the medial portion of the inferior oblique muscle was not traced on the coronal CT scan. The patient underwent 14 mm right IO recession and 3 mm right IR resection. One month after the surgery, his vertical and torsional diplopia were eliminated in the primary position.
Constriction, Pathologic/complications/etiology/physiopathology/radiography ; Diplopia/etiology ; Humans ; Male ; Middle Aged ; Muscular Diseases/complications/etiology/*physiopathology/*radiography ; Oculomotor Muscles/*physiopathology/*radiography/surgery ; Orbital Fractures/*complications ; *Tomography, X-Ray Computed

Female ; Hemorrhage ; etiology ; Humans ; Middle Aged ; Orbital Diseases ; etiology ; Orbital Fractures ; surgery ; Prostheses and Implants ; adverse effects ; Silicones ; adverse effects ; Staphylococcal Infections ; etiology

OBJECTIVETo distinguish trochlear calcification and intraorbital foreign body after eye injury in order to avoid misdiagnosis as well as mistreatment.

METHODSThe orbital CT images of 403 patients, who visited the Eye Hospital or the Second Affiliated Hospital of Wenzhou Medical College during May 2005-April 2007, were reviewed. The diagnosis of trochlear calcification and intraorbital foreign body was made together by a skilled radiologist as well as an ophthalmologist. General information and CT characteristics in the patients with trochlear calcification were collected.

RESULTSUsing CT scan images, 27 among 403 patients (6.69%) were identified with trochlear calcification. Three patients (3/27, 11.11%) were misdiagnosed by radiologists as intraorbital foreign body. Among the 27 patients with trochlear calcification, 23 (85.19%) were male and 4 (14.81%) were female, with an unilateral calcification in 7 patients (7/27, 25.93%) and bilateral in 20 (74.07%) . The highest occurrence of trochlear calcification was in 31-40 years old group (13/403, 3.23%) which reached to 12.87% (13/101) after age-correction. There were 3 types of trochlear calcification on the basis of CT images: commas, dot and inverted "U".

CONCLUSIONSThe trochlear calcification is not an uncommon phenomenon and should not be diagnosed as intraorbital foreign body, especially when it co-exists with eye injury in 31-40 years old group. Injury history and our classification method on the basis of CT images could help to avoid misdiagnosis.

Adolescent ; Adult ; Aged ; Calcinosis ; diagnostic imaging ; etiology ; Child ; Child, Preschool ; Eye Foreign Bodies ; diagnostic imaging ; etiology ; Eye Injuries ; complications ; diagnostic imaging ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Orbit ; diagnostic imaging ; Orbital Diseases ; diagnostic imaging ; etiology ; Tomography, X-Ray Computed