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Of 457 patients with facial fractures admitted by the plastic surgery service from 1986 to 1988 at Wayne State University, there were seven displaced orbital roof fractures in five patients. All presented with supraorbital rim fractures, inferior dystopia, limitation of supraduction, upper eyelid ptosis, and diplopia. Proptosis was present in four orbits in three patients. One of these patients had an orbital floor fracture. However, enophthalmos was present in three orbits in two patients with associated zygoma and floor fractures. Two patients had intracranial neurologic injuries, but no ocular injuries were seen. Patients underwent frontal craniotomy and removal of the supraorbital rim for exposure. The orbital roof was reconstructed with outer-table cranial bone grafts. Associated fractures were repaired. Mean follow-up was 21.4 months. In all patients, the inferior dystopia, proptosis or enophthalmos, limitation of supraduction, and diplopia were corrected. In one patient, residual mild eyelid ptosis was seen. No residual neurologic or ocular injury was seen.
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PMID:Displaced orbital roof fractures: presentation and treatment. 200 63

A 44 year old diabetic woman presented with diplopia and bilateral ptosis and mild exophthalmos. The patient was clinically euthyroid, the baseline thyroid function tests were normal, but the thyroid stimulating hormone response to thyrotrophin releasing hormone was flat. Computed tomographic scan and magnetic resonance imaging of the orbits showed left medial and inferior rectus muscle thickening, more prominent on the left side, consistent with Graves' disease. The tensilon stimulation test resulted in resolution of the ptosis and partial improvement of the ophthalmoplegia. The single fibre electromyography was consistent with a defect in neuromuscular transmission. However, forced duction test was normal and anti-acetylcholine receptor antibodies were undetectable. Significant improvement of the extraocular muscle function and resolution of the right ptosis had resulted from anticholinesterase therapy. These findings and the clinical response to therapy were consistent with concomitant euthyroid Graves' ophthalmopathy and ocular myasthenia gravis. Coexistent isolated ocular myasthenia gravis and Graves' ophthalmopathy is rare and should be considered in patients with findings of ocular myasthenia and extraocular muscle dysfunction.
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PMID:Concomitant euthyroid Graves' ophthalmopathy and isolated ocular myasthenia gravis. 209 29

Rhinocerebral mucormycosis developed in two poorly controlled diabetic patients with clinical manifestations of frontal headache, ophthalmoplegia, ptosis, proptosis, epistaxis and facial numbness. Early computed tomography (CT) of the head revealed fluid accumulation in paranasal sinuses. The diagnosis of this disease relied upon CT of the head, and biopsy or culture of the mucosa of sinuses. Remarkable improvement was noted following prompt surgical debridement and amphotericin-B therapy. We conclude that early diagnosis and aggressive treatment is the only way to save patient's life.
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PMID:Rhinocerebral mucormycosis: report of two cases. 217 26

Antineutrophil cytoplasmic antibodies are seen in patients with systemic vasculitides, especially Wegener's granulomatosis. Antineutrophil cytoplasmic antibodies are helpful laboratory markers for these disease. We report on the ocular findings of six patients with systemic vasculitis who had antineutrophil cytoplasmic antibodies. Four patients had systemic Wegener's granulomatosis, one had microscopic polyarteritis, and in one a specific histopathologic diagnosis could not be made. Two patients were first evaluated for systemic vasculitis because of their ocular manifestations. Ocular findings included ptosis, bilateral lacrimal gland masses, proptosis, choroidal folds, episcleritis, phlebitis, retinal and vitreous hemorrhage, keratitis sicca, and bilateral central scotomas. It was difficult to make a systemic diagnosis in all cases. If systemic vasculitis is in the differential diagnosis of a patient with suggestive ocular findings, antineutrophil cytoplasmic antibody testing should be considered. A prospective study of antineutrophil cytoplasmic antibody testing should be considered in patients with ocular findings that suggest the possibility of vasculitis.
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PMID:Ocular manifestations of patients with circulating antineutrophil cytoplasmic antibodies. 235 Feb 86

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 49-year-old woman presented with a left eye abduction-elevation defect and a bilateral internal rectus palsy of peripheral origin. Thyroid function, cranial computed tomographic scan, and cerebrospinal fluid examination were normal, as were the prostigmine test for myasthenia gravis and the guanidine hydrochloride test for myasthenic syndrome. Skull radiography showed osteosclerotic and osteolytic areas, with slight orbital distortion, and there was hyperactivity in an isotopic scan. A skill biopsy showed fibrous dysplasia. This case is an unusual example of fibrous dysplasia of the skull with neuro-ophthalmological symptoms but without ptosis, exophthalmos, or visual loss.
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PMID:Peripheral ophthalmoplegia as the only sign of late-onset fibrous dysplasia of the skull. 294 66

The orbital apex syndrome is a very rare complication of fractures of the facial skeleton, as well as other conditions and is characterized by blindness, fixed dilated pupils, proptosis, ptosis of the eye and ophthalmoplegia. We are reporting such a case we had the opportunity of treating.
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PMID:Orbital apex syndrome. 311 66

A 58-year-old white man with chronic progressive external ophthalmoplegia developed proptosis and an improvement in his ptosis from a mass in the superior orbit. A biopsy showed the mass to consist of an inflammatory mass of the levator palpebrae superioris muscle. As the inflammatory mass responded to periorbital and systemic steroids, the ptosis recurred. Inflammatory pseudotumor of the levator muscle is extremely unusual and has not been reported previously in patients with chronic progressive external ophthalmoplegia.
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PMID:Orbital pseudotumor of the levator muscle. 315 53

A 70-year-old man presented with proptosis and ptosis of the right eye. An orbital mass was palpable and computed tomography scanning and magnetic resonance imaging scanning confirmed its superior orbital position, with extension back to the orbital apex. Definitive biopsy, undertaken via an anterior orbitotomy, demonstrated the lesion to be Kimura's disease. The patient was managed conservatively, and most of his symptoms resolved. Kimura's disease involving the orbit is briefly reviewed in this paper.
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PMID:Kimura's disease of the orbit. 315 45

Symptomatic maxillary sinus cysts are diagnosed less frequently than similar cysts of the frontal and ethmoidal sinuses and are rarely reported in the ophthalmic literature. Patients with cysts of the maxillary sinus may present to the ophthalmologist with proptosis, enophthalmos, diplopia, ptosis, epiphora, and, rarely, decreased visual acuity. Four patients with maxillary sinus mucoceles are presented; one of these patients had a concurrent retention cyst in the orbit. Clinical history, radiologic findings, and histopathologic mechanisms are discussed. Mucocele is a recognized complication of the Caldwell-Luc procedure and midface trauma. Blockage of the sinus ostia was the cause previously proposed to explain antral mucocele development. Clinical and histopathologic features may support more than one single mechanism for the pathogenesis of maxillary sinus cysts. Maxillary sinus mucocele or retention cysts should be considered in the differential diagnosis of exophthalmos or enophthalmos following blowout fracture of the orbital floor.
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PMID:Destructive cysts of the maxillary sinus affecting the orbit. 317 50


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