orbit medical students kafrelsheikh university delta university new mansoura university

1. Mohamed Ahmed El –Shafie
Lecturer in ophthalmology department KafrELShiekh
University

2. Frontal Ethmoid Sphenoid
Lacrimal Palatine
Maxillary Zygomatic
 pyramidal or conical in shape
 consists of an apex, a base and
4 sides: roof, floor, medial wall and lateral wall

3.  Roof of the Orbit:
Contains fossa for the lacrimal gland
 frontal bone
 lesser wing of the sphenoid
Defect:
 Pulsatile proptosis

4. MENINGO-
ENCEPHALOCELE

5.  Lateral wall of the Orbit
 zygomatic bone
 greater wing of the sphenoid
Inferiorly – inf orbital fissure
Medially – sup orbital fissure
• Only orbital wall not related to paranasal sinus.

6.  Medial Wall:
The thinnest orbital wall.
ethmoid,
lacrimal,
maxillary and
sphenoid bones
• Related to :
Sphenoid and ethmoid sinus
 The commonest cause of orbital cellulits is ethmoiditis
sinusitis.

7.  Floor of the Orbit:
Forms the roof of the maxillary sinus.
 maxillary,
 zygomatic bones
 palatine
• Relatively weak, so Site of blow out fracture
• Roof of maxillary sinus below, so maxillary carcinoma
invade orbit and displace globe upward.

8. FRACTURES OF THE
ORBITAL FLOOR
• Clinical features
• Periocular changes:
ecchymosis, edema,
subcutaneous
emphysema
• Enophthalmos
• Infraorbital nerve
anesthesia
• Diplopia

11. Contents of orbit
 Eye ball
 Orbital fat
 Connective tissue system:
Periorbita
Orbital septum
Tenon’s capsule
 Blood vessels
 Nerves
 Extraocular muscles

12.  Orbital septum:
Interconnecting / circumferential radial webs of fascial
system
support and transmit forces in trauma
Compressive optic neuropathy following trauma

13. ORBITA
L
DISEASE
S
Inflammatory:
Thyroid eye disease
Idiopathic orbital
inflammatory disease
Tumors and cysts
Infection
trauma

15. Main Clinical Manifestation
1. Eyelid retraction
2. Soft Tissue involvement
3. Proptosis
4. Optic Neuropathy
5. Restrictive Myopathy
General manifestations
- Raised basal metabolic rate.
- Tachycardia.
- Tremors.
- Loss of weight

16. 1-Eyelid Retraction:
Muller's muscle overaction (sympathetic overstimulation).
Darlymple's Sign: Staring look with upper lid retraction
Von Grefe's Sign: Upper lid lag behind the globe on looking
down.
Stellwage's sign: Infrequent blinking and imperfect closure of
lid during the act.

17. • 2-Soft Tissue Involvement
(infiltration)
• 1. Conjunctival Injection
• 2. Chemosis
• 3. Eyelid swelling
• 4. Kerato-conjunctival Sicca

18. •
•
•
•

19. 4-OPTIC NEUROPATHY
• DIRECT COMPRESSION BY RECTI
5-Restrictive Myopathy
IR>MR>SR>LR

20. CT SCAN
• EOM HYPERTROPHY
WITH TENDON SPARING

22. PRESEPTAL
CELLULITIS
Infection confined to the eyelids and periorbital
tissues anterior to the orbital septum
Globe is uninvolved:
Pupillary reflexes, visual acuity, EOM’s are
NORMAL
No chemosis
no pain
No proptosis

23. ORBITAL CELLULITIS
• Commonest cause is ethmoiditis

26. Investigation:
Radiology of
paranasal sinuses.
• Treatment
1- Medical
- Systemic broad spectrum antibiotics , and
non steroidal anti-inflammatories.
- Warm compresses.
- Treatment of the cause.
2- Surgical: Drainage of any suppuration (
pointing ).

27. Dermoid Cyst
 Benign cystic teratoma
 well-encapsulated lined by stratified squamous & contain
dermal appendages

30. • The most common cause of
proptosis in adults is:
A- Dysthyroid orbitopathy
B-Orbital cellulitis
C-Orbital tumors
D-None of the above

31. Unilateral proptosis may be seen in all of
the following except :
a. Cavernous sinus thrombosis
b. Oribital tumors
c. Retrobulbar hemorrtage following tramua
d. Hyphema

32. • The commonest sign of Graves’
disease:
A- Lid retraction
B-Conjunctival chemosis
C-Diplopia
D-Exophthalmos

33. Evisceration is:
A. Excision of the entire eyeball.
B. Excision of all the inner contents of the eyeball including the uveal tissue.
C. Photocoagulation of the retina.
D. Removal of orbit contents.

34. Lagophthalmos can occur in all of the following except;
a. 7th cranial nerve paralysis
b. 5th cranial nerve paralysis
c. Thyrotoxic exophthalmos
d. Symblepharon

35. THANK YOU
THANK YOU