This document summarizes various orbital and intracranial pathologies that can cause vision loss or eye abnormalities. It describes conditions such as ruptured globe, retinal detachment, choroidal detachment, optic neuritis, thyroid orbitopathy, retinoblastoma, optic pathway glioma, and pituitary macroadenomas, among others. Diagnostic imaging findings are provided for many conditions. Orbital cellulitis and inflammatory diseases are distinguished. The document also outlines anatomical details of certain cranial nerves that are susceptible to compression or injury.

1. ORBITAL
PATHOLOGIES
Dr. Mohit Goel
JRIII

2. TRAUMA

3. Ruptured globe - flat tire sign

4. Ocular rupture

5. Ocular trauma and choroidal hematoma

6. Choroidal hematoma following ocular surgery

7. Perforation and collapse of the globe

11. Partially dislocated lens

12. Perforation of the cornea

13. Corneal laceration

14. Corneal ulceration

15. Acute perforation of the lens capsule

16. Retinal hemorrhage

17. Configuration of collection is cresent shaped or V shaped on axial
sections.
Limbs of V represent detached leaves of retina converging towards
optic disc represent the apex of V.
Collection anteriorly extend upto ora serrata represent anterior
limit due to normal anterior attachment of retina.
Retinal detachment

18. Retinal detachment

19. Choroidal detachment
Choroidal detachment is accumulation of blood or fluid in supra
choroidal space between choroid and sclera, so collection extend
circumferentially along the entire supra choroidal space ,
configuration is lentiform shaped along medial as well as lateral wall
of globe, choroid bulging medially on either side giving so called
kissing choroid sign.
Anteriorly extend upto ciliary bodies and posterior limit formed by
anchoring effect of short posterior ciliary arteries and nerves
preventing convergence of detached choroidal leaves to a single
point.

20. Choroidal detachment

21. Posttraumatic hemorrhagic choroidal detachment

22. Vitreous hemorrhage

23. MR imaging may be of value, particularly for detecting
nonmetallic foreign bodies.
However, a metallic foreign body must be definitively ruled
out before MR imaging is performed.
Failure to detect a metallic foreign body before performing
MR imaging may result in blindness.
Fortunately, CT is a very sensitive imaging modality that can
demonstrate metal fragments less than 1 mm in size.
FOREIGN BODY

24. Metallic foreign body inside the globe

26. Non-metallic foreign body

28. Traumatic Carotid cavernous fistula

29. Optic Nerve Injuries

30. ORBITAL INFECTIONS

31. IDIOPATHIC ORBITAL INFLAMMATORY DISEASE
Orbital pseudotumour is an
idiopathic inflammatory
condition that usually involves
the extraocular muscles
although, in some cases there
is inflammatory change involving
the uvea, sclera, lacrimal gland
and retrobulbar soft tissues.

34. Orbital and periorbital cellulitis
It is important to differentiate between orbital and periorbial
cellulitis, as this has theraputic and prognostic implications:
1. peri-orbital cellulitis (pre-septal cellulitis) is limited to the soft
tissues anterior to the orbital septum. This condition is often
managed with oral antibiotics
2. orbital cellulitis refers to a post-septal infection (i.e. is behind or
extends posterior to the orbital septum). This is a more serious
condition requiring hospitalisation and parental antibiotics.
Complications such as intraorbital abscess formation may require
surgical intervention

37. Pre-septal cellulitis

38. Pre-septal cellulitis

39. Post-septal cellulitis

40. SUBPERIOSTEAL ABSCESS
Accumulation of pus between orbital wall (usually medial) and orbital periosteum.

41. OPTIC NEURITIS
Acute inflammation of optic nerve , commonly associated with multiple
sclerosis.
Edema and inflammatory cells infiltrate the nerve resulting in uniform
swelling and focal demyelination.
Imaging : MRI is the modality of choice with hyper intense signal of
T2WI due to fluid and edema. Fat Sat contrast enhanced T1WI will show
areas of demyelination. CT relatively insensitive.
Straightening and thickening
of right optic nerve.

42. Optic Neuritis. CE Fat Sat T1W axial (B) MR images demonstrate subtle
enlargement and enhancement of the left optic nerve (curved arrow).
T2WI (C) demonstrates corresponding increased signal intensity (straight
arrow).

43. Thyroid associated orbitopathy
It is the most common cause of proptosis in adults, and is most
frequently associated with Graves disease.
The extra-ocular muscles are involved in a predictable fashion as
remembered by the I'M SLOW mnemonic.
Involvement of the rectus muscles in decreasing order of frequency:
1. inferior
2. medial
3. superior
4. lateral
5. obliques

46. Neoplastic lesions

47. RETINOBLASTOMA

49. Trilateral RB:
Bilateral ocular tumors plus midline intracranial neuroblastic
tumor, typically pineal
Quadrilateral (tetralateral) RB:
Bilateral disease plus pineal and suprasellar tumor

50. Trilateral RB

51. Quadrilateral RB

53. OCULAR MELANOMA

56. OPTIC PATHWAY GLIOMA

58. INTRACRANIAL
PATHOLOGIES
CAUSING
VISION LOSS

59. Pituitary macroadenoma causing compression on optic chiasm

61. A variety of pathologic conditions can affect cranial nerve III.
Its close association with the posterior cerebral and superior
cerebellar arteries makes cranial nerve III susceptible to
compression by vascular lesions such as posterior communicating
artery aneurysms.

62. Cranial nerve IV is the only cranial nerve to exit the dorsal brainstem, and each
superior oblique muscle is innervated by the contralateral cranial nerve IV
nucleus.

64. The cisternal portion of cranial nerve VI exits the brainstem near
the midline through the space between the pons and the
pyramid of the medulla oblongata.
The nerve courses anteriorly in the prepontine cistern and
penetrates the dura mater to enter the Dorello canal and then
the cavernous sinus, where it is the only nerve to travel within
the venous sinusoids of the cavernous sinus (cranial nerves III, IV,
V1, and V2 all lie within the lateral dural wall of the cavernous
sinus).