The document discusses the anatomy of the orbital apex, superior orbital fissure, optic foramen and canal. It describes the structures that pass through each location and clinical presentations of orbital apex syndrome which involves damage to cranial nerves II-VI with optic nerve dysfunction. Common causes include trauma, infection, inflammation and tumors. Examination focuses on visual acuity, eye movements, pupil response and assessment for complications like optic neuropathy.
Anatomy of cavernous sinus, structures passing through the caveernous sinus, spread of infections, clinical features of cavernous sinus thrombosis, investigations and management of cavernous sinus thrombosis.
Anatomy of cavernous sinus, structures passing through the caveernous sinus, spread of infections, clinical features of cavernous sinus thrombosis, investigations and management of cavernous sinus thrombosis.
Ischemic optic neuropathy constitutes one of the major causes of blindness or seriously impaired vision among the middle-aged and elderly population.
Ischemic optic neuropathy is due to acute ischemia of the optic nerve. it can be classified into two, depending upon the part of the optic nerve involved:
1.Anterior ischemic optic neuropathy (AION)
-AION is due to acute ischemia of the front (anterior) part of the optic nerve (also called optic nerve head), which is supplied mainly by the posterior ciliary arteries.
-AION is divided into two types, depending on what causes it:
1.Arteritic AION: This is the most serious type and is due to a disease called giant cell arteritis or temporal arteritis.
2. Non-arteritic AION: This is the usual, most common type, with many different causes but not associated with giant cell arteritis.
2.Posterior ischemic optic neuropathy (PION). -
-PION is a much less common type. It is due to acute ischemia of the back (posterior) part of the optic nerve, located some distance behind the eyeball; this part of the optic nerve is NOT supplied by the posterior ciliary arteries
(Hayreh, 2009)
A complete unit of the various diseases involving the orbit and the surrounding structures. It involves the unilateral and bilateral proptosis conditions. Also, the various proptosis etiologies involved in adults and children along with various tumors involving the orbit is also dealt with.
Ischemic optic neuropathy constitutes one of the major causes of blindness or seriously impaired vision among the middle-aged and elderly population.
Ischemic optic neuropathy is due to acute ischemia of the optic nerve. it can be classified into two, depending upon the part of the optic nerve involved:
1.Anterior ischemic optic neuropathy (AION)
-AION is due to acute ischemia of the front (anterior) part of the optic nerve (also called optic nerve head), which is supplied mainly by the posterior ciliary arteries.
-AION is divided into two types, depending on what causes it:
1.Arteritic AION: This is the most serious type and is due to a disease called giant cell arteritis or temporal arteritis.
2. Non-arteritic AION: This is the usual, most common type, with many different causes but not associated with giant cell arteritis.
2.Posterior ischemic optic neuropathy (PION). -
-PION is a much less common type. It is due to acute ischemia of the back (posterior) part of the optic nerve, located some distance behind the eyeball; this part of the optic nerve is NOT supplied by the posterior ciliary arteries
(Hayreh, 2009)
A complete unit of the various diseases involving the orbit and the surrounding structures. It involves the unilateral and bilateral proptosis conditions. Also, the various proptosis etiologies involved in adults and children along with various tumors involving the orbit is also dealt with.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. APEX OF ORBIT
• Posterior most end of pyramid shaped orbit
• 4 orbital walls converge here at craniofacial junction
• Complex association b/w bony, neural, and vascular elements
• Has 2 orifices situated in the sphenoid bone
Optic foramen
Superior orbital fissure
3. SOF
• bony cleft at orbital apex
•Lies b/w lateral wall and the roof of the orbit with optic strut at its
superomedial margin
•bounded by greater and lesser wing of sphenoid
•the largest communication between orbit and middle cranial
cavity
•It is situated lateral to optic foramen
4. •pear-shaped with a broad base
•long axis extends upward at an angle of 45° from the base
medially to the apex directed superotemporally.
•SOF is divided at the spina recti lateralis by the annulus of
Zinn, the common tendinous origin of the recti muscles.
DIMENSIONS
Length: around 22 mm
Width : 2-3 mm at the apex
7-8 mm at the base
5. • Annulus of zinn encircles the optic foramen and central part of
SOF,dividing it into upper,middle and lower part
• The superior part contains
Trochlear nerve (IV)
Frontal and lacrimal branches
Of the ophthalmic division
Of the trigeminal nerve (V1)
Superior branch of ophthalmic vein
Recurrent branch of the lacrimal
artery(occasionally)
6. The middle part
confined within the tendinous ring
more susceptible to shearing injury during craniofacial trauma
contains
Superior and inferior branches
of the oculomotor nerve (III)
Nasociliary nerves (V1)
Abducens nerve (VI)
Inferior branch of ophthalmic
vein
Fibers from the internal carotid
sympathetic plexus
7. Lower part:
• Inferior ophthalmic vein
The inferior venous compartment is given by the confluence
of the SOV and IOV which drain into the cavernous sinus
8. Radiographic enlargement of the superior orbital fissure
may accompany pathologic processes such as
Aneurysms, Meningioma, Choroidoma,pituitary
adenoma and Tumors of the orbital apex
9. •Located within the lesser wing of sphenoid
• It connects the orbit to the middle cranial fossa
•From an anterior view, the entrance to the optic canal is the
most superior and medial structure in the apex.
• Attains adult dimensions by age 3 and is symmetric in most
persons
Optic Foramen
10. • 2 bony roots that connect the lesser wing of the sphenoid
with the body of the sphenoid form the optic canal.
• The inferior root separates the optic canal from SOF and
also is referred to as the optic strut.
• The superior root forms the roof of the optic canal and
separates it from the anterior cranial fossa.
• The body of the sphenoid forms the medial wall of the canal.
11. Optic canal
Optic foramen:
Vertically : 6-6.5mm
horizontally: 4.5-5mm
>7mm : Abnormal
(enlarges in optic nerve
gliomas, Meningiomas)
Optic canal:
length : 8 to 10 mm
width : 5 to 7 mm
lateral wall is shortest
medial wall is longest
Structures passing through it
•Optic nerve and its meningeal
covering
•Ophthalmic artery
•Sympathetic nerves
12. • Each optic canal passes posteromedially at an angle of
approximately 35° to the sagittal
• opens posteriorly into the chiasmatic groove (which
terminates posteriorly at the tuberculum sellae).
• The canal has an intimate relationship to the sphenoid
sinus, and with extensive sinus pneumatization, the optic
canal may become completely surrounded by a posterior
ethmoidal Onodi air cell, the sphenoid sinus, or an aerated
anterior clinoid process.
13. •Throughout its intraorbital and intracanalicular course, the optic
nerve is surrounded by pia mater, arachnoid, and dura mater,
giving the nerve a sheath.
•Thus, optic nerve is a white matter tract of the brain and carries
with it meningeal coverings.
•Within the orbit, the optic nerve is quite mobile however, within
the canal, the optic nerve sheath remains adherent to the
sphenoid periosteum and thus is fixed.
•Optic nerve glioma or Meningioma may lead to unilateral
enlargement of Optic canal, seen on Xrays
14. Inferior orbital fissure
20-mm bony defect
Lies between lateral wall and floor of the orbit
bounded by the :
• sphenoid
• zygomatic
• maxillary
• palatine bones
Communicates orbit with inf temporal fossa and pterygopalatine
fossa
15. Structures passing through it:
Zygomatic nerve (V2)
Infraorbital nerve (V2)
Infraorbital artery
Infraorbital vein
br from Inferior ophthalmic vein
leading to pterygoid plexus
Max division of trigeminal Nerve
Parasympathetics to lacrimal gland
Orbital Br from pterygopalatine
ganglion
16. Superior orbital fissure syndrome applies to lesions located
immediately anterior to the orbital apex, including the structures
exiting the annulus of Zinn and often those external to the annulus
as multiple cranial nerve palsies may be seen in the absence of
optic nerve pathology.
Features
• ophthalmoplegia,
• upper eyelid ptosis
• nonreactive dilated pupil
• anesthesia over the ipsilateral forehead,
• loss of corneal sensation (and hence loss of corneal reflex
• orbital pain
• Axial proptosis.
• neurotrophic keratopathy]
17. Syndrome Definition
Orbital apex syndrome involves damage to
oculomotor nerve (III)
trochlear nerve (IV)
abducens nerve (VI)
ophthalmic branch of the trigeminal nerve (V1)
with optic nerve (II) dysfunction
The orbital apex syndrome is a SOF syndrome with loss of
vision.
Cavernous sinus syndrome (CSS) may include the features of an
OAS with added involvement of the
maxillary branch of the trigeminal nerve (V2)
oculo-sympathetic fibers
more commonly bilateral
18. Cavernous sinus syndrome
(involvement of cranial nerves III, IV, V1, V2, VI, and periarterial
sympathetic plexus)
•sensory deficits in the maxillary branch of the trigeminal nerve orbital
sympathetic innervation involvement
•Traumatic carotid-cavernous fistula may be present.
•vascular congestion
• proptosis
•Chemosis
•Ophthalmoplegia
•elevated intraocular pressure (IOP)
•vascular bruit
CSF rhinorrhea in fracture involving the sphenoid sinus, fovea
ethmoidalis, or cribriform plate.
19. • Traumatic optic neuropathy (involvement of cranial
nerve II): The intracanalicular optic nerve may be
damaged by sphenoid fractures
• The firm attachment of the dural sheath to the optic
nerve may make the intracanalicular nerve particularly
susceptible to acceleration or deceleration injuries.
20. • The superior orbital fissure, orbital apex, and cavernous
sinus are all contiguous, and although these terms
define the precise anatomic locations of a disease
process, the etiologies of these syndromes are similar.
• In some instances, patients who have features of a SOFS
may subsequently develop orbital apex and cavernous
sinus pathology.
25. Iatrogenic
1. Sinonasal surgery
2. Orbital/facial surgery
Neoplastic
1. Head and neck tumors: nasopharyngeal carcinoma, adenoid
cystic carcinoma, squamous cell carcinoma
2. Neural tumors: neurofibroma, meningioma, ciliary neurinoma,
schwannoma, gliomas
3. Metastatic lesions: lung, breast, renal cell, malignant
melanoma
4. Hematologic: Burkitt lymphoma, non-Hodgkin lymphoma,
leukemia
5. Perineural invasion of cutaneous malignancy
Etiology of Orbital Apex Syndrome
26. Clinical Presentation
• Vision Loss
• Uniocular Diplopia
• Ophthalmoplegia
• Periorbital/Facial Pain
• Axial Proptosis
• Ptosis
• Ocular Deviation
• Headache
• Loss of sensations over the face
27. History taking
• h/o blunt orbital trauma
• h/o visual loss- whether at the time of injury or subsequently.
Progressive decrease in vision suggests optic neuropathy due to
hemorrhage into the optic nerve sheath, retrobulbar hematoma,
compression by a bony fragment, or possibly arachnoiditis at the site
of fracture.
• h/o diplopia binocular misalignment. Diplopia will be worse in the
field of gaze of the paretic muscle.
• h/o ptosis
• Past ophthalmic history- antecedent spectacles, decreased
vision, amblyopia, strabismus, and previous ocular surgery.
• h/o Sensory disturbances in the distribution of V1 and V2
28. Examination
• Initial management in facial injuries assessing the airway
security,hemodynamic stability, and cervical spine integrity.
• An assessment of neurologic status must be made, and head
injuries must be excluded.
• Additional soft tissue and bony injuries of the head and neck
must be sought.
• In patients with suspected orbital apex fractures, the
examination should focus on an assessment for the presence
of following that may demand acute intervention
an optic neuropathy
an evolving orbital compartment syndrome, or
ruptured globe
29. • Visual acuity :including pinhole vision and colour vision of
Each eye must be recorded.
• Confrontation visual fields may be performed at the bedside
prior to more formal perimetric assessment.
• Assessment of pupil responses:
The direct and consensual light responses
An absolute or relative afferent pupil defect or an efferent pupil
defect (as seen in third nerve palsy, ciliary ganglion injury,
and traumatic mydriasis) is recorded.
30. • Assessment of ocular motility:
• Volitional movements are examined at the bedside
• forced ductions and force generation examinations are
undertaken with appropriate topical anesthesia and patient
cooperation.
These assessments help differentiate between ocular motility
disturbance caused by entrapped muscles, intramuscular
hematoma, and nerve damage.
• Assessment of integrity of cranial nerve V: Sensory
disturbances should be sought in the territories of branches of
V1 and V2.
31. Orbital inspection, palpation, and assessment of globe position
•Periocular ecchymosis, edema, and proptosis in trauma
•Orbital hematoma, intraorbital emphysema, and orbital volume
changes with orbital wall fractures all alter the globe position.
•Axial displacement of the globe should be assessed by
exophthalmometry.
•Increased resistance to globe retropulsion is seen with orbital
hemorrhage.
32. • subcutaneous or intraorbital emphysema.-due to Disruption of
the mucosal integrity of the maxillary or ethmoidal sinus
• Orbital rim fractures
• Traumatic telecanthus is seen in naso-orbito-ethmoid (NOE)
fractures and lateral canthal dystopia is seen in displaced
zygomaxillary complex (ZMC) fractures.
• exclude a coexistent globe rupture or injury.
• IOP is recorded.
33. • Anterior segment trauma including corneal injury, hyphema,
iridodialysis, lens dislocation, and posterior segment trauma
including retinal commotio, retinal detachment, choroidal
rupture, and scleral rupture.
• Pharmacologic pupil dilation for fundus examination to
assess optic nerve head perfusion, disc swelling, and
peripapillary hemorrhages.
• In patients with head injuries, pharmacological pupil dilation
should only be undertaken after neurosurgical consultation
34. CT scanning
• In facial trauma and suspected fractures, noncontrast CT
scans - most appropriate initial imaging technique.
• Associated intracranial injury, associated facial fractures, and
intraorbital hematoma may be assessed.
• Axial and coronal views 3-mm cuts review the orbit, and 1-mm
axial cuts may be used to assess the optic canal.
35. • Coexistent cervical injury may preclude direct coronal
projections.
• Reconstructed coronal views may be needed in patients
with neck injury.
• Best images of relationship between the bone and soft
tissues
• Metallic orbital foreign bodies
36. Plain radiography
The orbital apex may be visualized with 2 radiographic projections
AP view for the superior orbital fissure
oblique view for the optic foramen
37. MRI
• The poor resolution of bone on MRI significantly limits its
role in general orbital trauma.
• However, better soft tissue differentiation may be
obtained.
• MRI reveals the abnormal signal indicative of recent
hemorrhage in optic nerve sheath hematoma.
• Associated neurological damage
• Wooden foreign bodies
38. • The best resolution of orbital structures is presently obtained by MRI
using standard T1w or T2w TSE pulse sequences.
• Fat appears hyperintense (bright) on T1w and T2w images, and other
structures, such as vessels, nerves, and muscles, appear darker
(hypointense) than orbital fat.
• Gd-DTPA enhances vascular structures, such as cavernous sinus or
the venous plexus surrounding Meckel’s cave and the hypophysis.
• Fat suppression techniques like STIR with or without contrast
enhancement are especially useful for the diagnosis of retrobulbar
optic neuritis and intraorbital meningiomas.
Townsend ,Clinical application of MRI in ophthalmology., NMR Biomed
39. Newer functional MRI (fMRI) with blood-oxygenation-level-
dependent (BOLD) techniques and fNMR MRI can evaluate retinal
physiology and oxygenation. PET, SPECT, MRS with NAA, DSA
and MRA/MVA with MOTSA can aid in diagnosis.
Although MRI and magnetic resonance angiography may be
helpful in diagnosing intracranial aneurysms or shunts at the
cavernous sinus, the “gold standard” for intracranial vascular
disease is catheter angiography and super selective vessel
exploration.
40. Angiography
Angiography may be considered in patients with
orbital apex fractures
with clinical features consistent with a carotid artery
injury, revealing
carotid artery dissection
carotid artery spasm
carotid-cavernous fistula
41. Visual field assessment
• Automated static threshold perimetry (eg, Humphrey
Visual Field analysis) or
• Kinetic perimetry (eg, Goldmann perimetry)
• used in patients with adequate cooperation and fixation
to document visual field disturbance with optic
neuropathy.
• No specific visual field loss pattern is pathognomonic for
traumatic optic neuropathy.
42. Formal color testing
• Dyschromatopsia is expected in optic neuropathy
• It may be formally documented with use of the
Farnsworth-Munsell 100 hue test or the Farnsworth
panel D-15.
• These tests require patient cooperation and may not be
appropriate in the acute setting.
43. Visual-evoked potentials
(VEP)
• may assess the integrity of the visual pathway
• Able to compare pathways from each eye.
• They are a consideration in patients with altered level of
consciousness or in whom bilateral optic neuropathy is
suspected