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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between January 1982 and March 1987, 23 patients (26 orbits) were treated for orbital pseudotumor with radiation therapy at the Department of Radiation Oncology, Hospital of the University of Pennsylvania. The patients were referred for clinical relapse after steroid taper in 70%, no response to steroids in 17%, and no steroid treatment (refused or contraindicated) in 13%. Presenting symptoms/signs included soft tissue swelling in 92% of orbits, pain in 92%, proptosis in 85%, and extraocular muscle dysfunction or ptosis in 69%. Decreased visual acuity was seen in only 19% of orbits. Biopsy was performed in nine patients. Treatment consisted of 2000 cGy in 2 weeks in 10 fractions for all patients. Median follow-up was 41 months, with a mean of 53 months, and a range of 21-92 months. Complete response was documented in 87% of orbits with soft tissue swelling, 82% with proptosis, 78% with extraocular muscle dysfunction, and 75% with pain. Of the five patients with visual acuity defects, three experienced complete recovery. There was no difference in complete response in patients biopsied versus those not biopsied. Overall, 17 orbits have remained in complete orbital response with no further steroid requirement (66%). Three orbits suffered local relapse at some point following radiation therapy and were retreated with steroids. These three orbits had durable local control off steroids at last follow-up (11%). Therefore, 77% of orbits attained durable local control and were steroid independent with radiation therapy alone or radiation therapy followed by steroids for relapse. Only one patient developed systemic lymphoma with follow-up. No pretreatment clinical factor reached statistical significance with respect to prognosis following radiation therapy at the less than or equal to .05 level. There were no significant acute or chronic side effects secondary to treatment. Steroids should continue to be first line treatment for orbital pseudotumor, but radiation therapy has a well-defined role in cases of steroid failure or in patients unable to tolerate steroid therapy.
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PMID:The results of radiotherapy for orbital pseudotumor. 240 29

A case of painful ophthalmoplegia due to idiopathic granulomatous involvement of the superior orbital fissure (Tolosa-Hunt syndrome) is described. The clinical features of recurrent pain, ocular motor nerve palsies and proptosis correlated well with the eventual demonstration of an enhancing mass in the region of the cavernous sinus. Removal of the lesion led to a resolution of the clinical picture and demonstration of a non-caseating granuloma with no other detectable cause. The original observation of Tolosa was thus re-affirmed.
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PMID:Clinicopathological correlation in a case of painful ophthalmoplegia: Tolosa-Hunt syndrome. 259 72

21 patients, who fulfilled the clinical and angiographic criteria of a spontaneous carotid cavernous fistula (CCF), were studied at the Alfried Krupp Hospital, Essen, Germany, between 1980 and 1988. Of these patients, 4 had direct shunts between the internal carotid artery and the cavernous sinus and 17 patients had unilateral or bilateral dural shunts between meningeal branches of the internal and/or external carotid artery and the cavernous sinus. The most common initial symptoms were eye redness, bruit and headache. 6 of 12 patients with double vision had mechanical disorders of eye movement. A rapid irreversible loss of vision occurred in 2 patients. In 9 of 21 patients either progressive visual deterioration, proptosis or severe orbital pain necessitated prompt institution of treatment. All direct fistulas could be occluded by the use of the detachable balloon technique. 5 patients with dural CCF were successfully treated with particle embolization of the external carotid artery blood supply. In dural CCF not requiring emergent treatment, combined carotid artery and jugular vein compression was preferred and resulted in complete cure or sufficient improvement in all but one patient. We recommend this method as the first stage of treatment in dural CCF with uncomplicated course.
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PMID:[Clinical aspects and treatment of spontaneous carotid artery-cavernous sinus fistula]. 261 55

A set of coronal CT images obtained by 118 side (109 cases) of post-operative cysts of maxilla, seen from 1982 to 1988, was analyzed as to the orbital wall affections. Coronal images were grouped into five consecutive planes, i.e. the first plane being the one which is 5mm posterior to the nasion, and the other planes in successive orders each being 5mm apart. The orbital walls were classified into inferior, medial, and transition of these two. The orbital wall affections were classified into dehiscence, thinned-out (less than 1mm), and normal. The orbital signs and symptoms (epiphora, pain, asthenopia, visual loss, diplopia, and exophthalmos) were analyzed based upon the questionnaires by patients. The inferior wall affections (dehiscence and thinned-out) were seen most often (57%) at the third plane (2cm posterior to the nasion). The orbital signs and symptoms in general were seen in half of the cases of which 20% were of grave (visual loss, diplopia and exophthalmos). These signs and symptoms were the more often, the more anterior the site of affections located. Grave signs and symptoms were seen at 2 to 2.5cm posterior to the nasion when the orbital floor was affected and the inferior rectus were either pushed up or in direct contact with the cysts.
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PMID:[Post-operative cyst and orbital walls: a CT image analysis]. 280 73

The authors reviewed 35 cases of orbital hydatid cysts, which represented 5% of orbital surgical cases seen from 1944 to 1985. The average age was 16 years (range, 2-57 years). Slowly progressive unilateral exophthalmos, with or without pain, was the most frequent clinical manifestation. Computed tomography (CT) of the orbit demonstrated a well-circumscribed mass. Ultrasonography showed an anechoic cystic mass. The parasitic membrane and contents were surgically removed through an orbital approach. Hydatid cysts should be included in the differential diagnosis of unilateral exophthalmos in patients from countries where echinococcosis is endemic. Preoperative recognition is important for planning an appropriate surgical treatment in avoiding complications.
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PMID:Hydatid cysts of the orbit. A review of 35 cases. 306 5

Over the past seven years we have treated three cases of drug abusers in whom endogenous Bacillus cereus endophthalmitis rapidly progressed to panophthalmitis. Ocular features of infection with this organism include severe pain, chemosis, proptosis, corneal infiltration and ring abscess, subretinal exudation, retinal hemorrhages, and perivasculitis. The process becomes fulminant in an explosive manner and may be accompanied by fever and leukocytosis. Ophthalmologists should be cognizant of the apparent susceptibility of drug abusers to Bacillus cereus infections and should consider this organism in any severe, rapidly evolving intraocular infectious process.
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PMID:Endogenous Bacillus cereus panophthalmitis. 310 7

Prostate carcinoma was previously thought to be a rare source of orbital metastasis. We studied a clinical series of eight cases of orbital metastases from prostate carcinoma. Presenting symptoms included proptosis, pain, diplopia, eyelid swelling, decreased vision, ptosis, and red eye. The mean age at onset was 72.1 years. In three of the eight patients, evaluation of the orbital masses led to the diagnosis of prostate carcinoma. Of the six patients in whom computed tomography was performed, four had predominantly osteoblastic lesions. In our experience, the rapid development of an osteoblastic orbital lesion in an elderly man is highly suggestive of metastatic prostate carcinoma.
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PMID:Orbital metastases from prostate carcinoma. 317 51

Traumatic carotid-cavernous sinus fistula is an uncommon situation resulting from severe trauma, with less than 40 cases having been reported. It is usually associated with a skull base, frontal or mid-facial fracture, but it may also be a spontaneous phenomenon of congenital, infective or degenerative origin. The blood shunts from the internal carotid to the cavernous sinus resulting in pulsating exophthalmos, orbital headache, pain, orbital or frontal bruit, loss of visual acuity, diplopia, ophthalmoplegia and the differential diagnosis should include superior orbital fissure syndrome, orbital apex syndrome and cavernous sinus thrombosis. Several modes of treatment have been proposed. We were recently faced with such a case, who had sustained fractures of the facial skeleton and developed the fistula despite an initial non-contributory angiogram. The patient remained in a permanent coma.
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PMID:Traumatic carotid-cavernous sinus fistula. 320 64

Evidence of ocular involvement was found in seven of eleven patients with histologically confirmed Wegener's granulomatosis. Pain (7/7), redness (6/7), scleritis (5/7), reduced visual acuity (5/7), episcleritis (5/7), uveitis (3/7), proptosis, sclerokeratitis and conjunctivitis (2/7) each were the major ophthalmological features. One patient each had bilateral corneoscleral ulcers, eyelid infiltration, scleromalacia perforans and epiphora. Corneal, scleral and uveal tract involvement was observed more frequently than has been described in the literature. These complications responded favourably to treatment with cyclophosphamide and corticosteroids. Treatment was delayed as most of these patients were diagnosed, initially, to be suffering from tuberculosis.
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PMID:Ocular manifestations of Wegener's granulomatosis in north India. 322 86

We examined two women with orbital hematomas that occurred during labor. Both women developed sudden diplopia, proptosis, and orbital pain. The location of the hematoma was confirmed by orbital echography and computed tomography. The patients were observed without surgical intervention. Neither patient developed clinical or echographic signs of compressive optic neuropathy. Clinical resolution occurred during the following two weeks. Serial standardized orbital echographic examinations documented resolution of the hematomas.
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PMID:Maternal orbital hematoma associated with labor. 328 95


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