Orbital Infarction Syndrome

Borruat, F.–X.; Bogousslavsky, Julien; Uffer, S.; Klainguti, G.; Schatz, Norman J.

doi:10.1016/s0161-6420(93)31606-4

Cited by 85 publications

(55 citation statements)

References 18 publications

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“…In addition to the usual manifestations listed above, rhinoorbito-cerebral zygomycosis sometimes manifests as a painless orbital apex syndrome without any sign of orbital cellulitis or acute systemic disease (23), which may have a good outcome with medical therapy; orbital infarction syndrome (38); bilateral cavernous sinus thrombosis (13); isolated pontine infarction (49); palatal ulcer (292,403); sudden blindness (209); fever with right-sided hemiparesis, and dysarthria (1); and numbness and loss of sensation over the temporal region, with loss of vision and proptosis on one side of the face (21). Other conditions which can mimic these manifestations include sinusitis, viral infections, diabetic ketoacidosis, cavernous sinus thrombosis, bacterial orbital cellulitis, fulminant orbital aspergillosis, and pseudallescheriosis.…”

Section: Clinical Features Predisposing Factors and Management Of Smentioning

confidence: 99%

Current Perspectives on Ophthalmic Mycoses

2003

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Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors

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Section: Clinical Features Predisposing Factors and Management Of Smentioning

confidence: 99%

Current Perspectives on Ophthalmic Mycoses

2003

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“…1 All cases had acharacteristicconstellationofsymptomsincludingseverevisionlossoftenNLP-completeophthalmoplegia,proptosisororbitalcongestion, andafundusexaminationconsistentwithaCRAO.Orbitalinfarctionsyndrome has been reported postoperatively after intracranial aneurysm clipping and spinal surgery as well as due to orbital cellulitis after transcanalicular dacryocystorhinostomy. [2][3][4] The mechanism for postsurgical orbital infarction syndrome is unclear.…”

Section: Discussionmentioning

confidence: 96%

“…1 Orbital infarction results in retinal infarction, choroidal ischemia, and ophthalmoplegia. Ophthalmic artery occlusion alone cannot cause these symptoms because of the extensive anastomoses between the ophthalmic artery and external carotid artery.…”

Section: Discussionmentioning

confidence: 99%

Acute Postoperative Visual Loss

2014

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“…Routes of the central retinal arteries should also be confirmed with cerebral angiography to avoid postoperative retinal ischemia. 4,11,15 To approach intraconal lesions, we advocate a wide opening of the surgical window through the lamina papyracea and periorbita, regardless of lesion size. After opening the periorbita, the tumor capsule is carefully dissected from the surrounding anatomies such as the medial and inferior rectus muscles or the superior oblique muscles.…”

Section: Periorbita (Extraperiosteal Lesions) or Inside (Intraperiostmentioning

confidence: 99%

Endoscopic transnasal approach for resection of locally aggressive tumors in the orbit

Shin¹,

Kondo

Hanakita³

et al. 2015

JNS

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OBJECT In recent years, application of endoscopic transnasal surgery (ETS) has been expanded to orbital lesions, and preliminary results have started to be published for medially located soft mass lesions. However, reports on experience with endoscopic intraorbital surgery aimed at resection of invasive skull base tumors remains quite limited. This report presents the authors’ experience with ETS for locally aggressive tumors involving the orbit. METHODS ETS was performed for 15 cases of aggressive tumors involving the orbit: 5 meningiomas (meningothelial, n = 3; atypical, n = 1; anaplastic, n = 1), 4 chordomas, 2 chondrosarcomas, and 4 others (metastasis from systemic myxofibrosarcoma, schwannoma, inverted papilloma, and acinic cell carcinoma, n = 1 each). Among these, 9 tumors were located outside the periorbita and 6 inside the periorbita. In 6 intraperiosteal tumors, 5 were intraconal lesions, of which 3 arose in the muscle cone (anaplastic meningioma, optic sheath meningioma, and metastatic myxofibrosarcoma), and 2 meningothelial meningioma had invaded from the sphenoid ridge or the cavernous sinus into the muscle cone through the optic canal and the superior orbital fissure. A case of schwannoma originated around the cavernous sinus and pterygopalatine fossa and extended extraconally into the periorbita. Intraoperatively, ethmoid air cells and the lamina papyracea were removed, and extraperiosteal tumors were safely approached. For intraperiosteal tumors, the periorbita was widely opened, and the tumors were approached through the surgical window between the rectus and oblique muscles. RESULTS Gross-total resection was achieved for 12 of the 15 tumors, including 2 intraconal lesions. After surgery, exophthalmos resolved in all 8 patients with this symptom, and diplopia resolved in 5 of 6 patients. Improvement of visual symptoms was reported by 4 of 5 patients with loss of visual acuity or constriction of the visual field. Postoperatively, 1 patient showed mild, transient worsening of existing facial dysesthesia, and another showed transient ptosis and mild hypesthesia of the forehead on the affected side. All those symptoms resolved within 3 months. No patients showed enophthalmos, worsening of diplopia or visual function, or impairment of olfaction after surgery. CONCLUSIONS ETS appears acceptable as a less-invasive alternative for treating aggressive tumors involving the orbit. For extraperiosteal tumors, gross-total removal can generally be achieved without neurological complications. For intraperiosteal tumors, surgical indications should be carefully discussed, considering the relationship between the tumor and normal anatomy. Wide opening of the periorbital window is advocated to create a sufficient surgical pathway between the extraocular muscles, allowing a balance between functional preservation and successful tumor resection.

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Orbital Infarction Syndrome

Cited by 85 publications

References 18 publications

Current Perspectives on Ophthalmic Mycoses

Current Perspectives on Ophthalmic Mycoses

Acute Postoperative Visual Loss

Endoscopic transnasal approach for resection of locally aggressive tumors in the orbit

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