Introduction to Orbital Disease



Introduction to Orbital Disease


John T. Harvey



This chapter provides the reader with a guide to history taking and examination in the patient presenting with orbital disease. In addition, the demographics of orbital disorders are presented to give an overview of the territory. Specific disease entities are not covered in any great detail because these are discussed in subsequent chapters. Similarly, specific orbital investigative techniques and imaging modalities are not dealt with in an extensive manner because these are covered in more detail in separate chapters. It is assumed that the reader has a good grasp of orbital anatomy and is familiar with basic history taking and general physical examination techniques.


DEMOGRAPHICS OF ORBITAL DISEASE

All the major reports on the incidence of orbital disease have been consolidated into two tables: Table 1 covers orbital disease as a whole, and Table 2 deals with pediatric orbital disorders. Together they include the major studies of the past 40 years.








Table 22-1 Review of 4,635 Orbital Cases (1960–2001)















































































































































































































































































































































  Shields et al1 Reese2 Moss3 Henderson4 Silva5 Kennedy6 Rootman7 Harvey8 Total
Lesion No. % No. % No. % No. % No. % No. % No. % No. % No. %
Inflammatory 87 13 91 18 57 25 40 9 49 16 181 22 808 57 55 21 1368 30%
Cystic 193 30 46 9 13 6 25 5 50 17 89 11 83 6 33 13 532 11%
Secondary/metastatic 86 13 33 7 8 3 136 29 66 22 79 10 61 4 10 4 479 10%
Vasculogenic 40 6 112 22 48 21 57 12 19 6 72 9 96 7 28 11 472 10%
Lymphoid/leukemic 61 9 48 10 22 10 39 8 21 7 102 12 54 4 28 11 375 8
Lacrimal 83 13 27 5 17 7 29 6 14 5 45 5 14 1 21 8 250 5
Optic nerve/meningeal 10 2 29 6 19 8 46 10 19 6 11 1 50 4 18 7 202 4
Peripheral nerve 14 2 23 5 7 3 21 5 13 4 53 6 24 2 2 1 157 3
Osseous, fibrous, cartilaginous 20 3 11 2 2 1 26 6 28 9 33 4 26 2 12 5 158 3
Rhabdomyosarcoma 8 1 37 7 5 2 10 2 5 2 8 1 5 0 1 0 79 2
Melanocytic 1 0 24 5 0 0 22 5 10 3 3 0 12 1 3 1 75 2
Adipose 23 4 4 1 0 0 5 1 0 0 0 0 8 1 5 2 45 1
Histiocytic 1 0 0 0 2 1 7 2 0 0 4 0 8 1 3 1 25 1
Other 18 3 19 4 30 13 2 0 6 2 140 17 160 11 43 16 418 9%
TOTAL 645   504   230   465   300   820   1409   262   4635  
The “Inflammatory” row in the reports of Moss, Silva, and Kennedy & Rootman include Graves’ disease.
All percentages are rounded to the nearest whole number.








Table 22-2 Review of 1,370 Cases of Orbital Tumors in Children (1953–1987)

















































































































































































































































































































































































































  Ingalls9 Porterfield10 MacCarty and Brown11 Yousefi12 Templeton13 Eldrup-Jorgenson and Fledelius14 Iliff and Green15 Crawford16 Shields17 et al. Bullock18 et al. Total
Lesion No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % No. %
Cystic 15 29 25 12 4 2 31 50 0 0 38 48 60 34 6 4 130 52 59 42 368 27
Vasculogenic 14 27 28 13 36 19 9 15 1 2 6 8 27 16 24 16 17 7 23 16 185 14
Optic nerve/meningeal 3 6 39 18 51 27 2 3 0 0 9 11 14 8 17 11 6 2 7 5 148 11
Rhabdomyosarcoma 4 8 56 26 0 0 2 3 1 2 10 13 15 9 14 9 10 4 3 2 115 8
Inflammatory 2 4 10 5 17 9 2 3 9 15 1 1 9 5 13 9 41 16 5 4 109 8
Lymphoid/leukemic 3 6 12 6 1 1 0 0 36 60 4 5 2 1 23 15 6 2 5 4 92 7
Secondary/metastatic 3 6 3 1 11 6 7 11 1 2 2 3 10 6 14 9 9 4 4 3 64 5
Peripheral nerve 6 12 6 3 6 3 0 0 1 2 3 4 11 6 14 9 4 2 9 6 60 4
Osseous, fibrous, cartilaginous 0 0 2 1 21 11 1 2 7 12 1 1 4 2 6 4 3 1 7 5 52 4
Adipose 0 0 3 1 1 1 2 3 0 0 3 4 5 3 0 0 17 7 11 8 42 3
Histiocytic 0 0 2 1 0 0 0 0 0 0 0 0 1 1 20 13 1 0 3 2 27 2
Lacrimal 0 0 4 2 2 1 1 2 0 0 2 3 5 3 1 1 6 2 3 2 24 2
Melanocytic 0 0 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0
Other 1 2 24 11 34 18 5 8 4 7 1 1 11 6 0 0 0 0 2 1 82 6
TOTAL 51   214   186   62   60   80   174   152   250   141   1370  
All percentages are rounded to the nearest whole number.
Modified from Bullock JD, Goldberg SH, Rakes SM: Orbital tumors in children. Ophthalmic Plast Reconstr Surg 5:13–16, 1989

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Jul 10, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Introduction to Orbital Disease

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