Year : 1984 | Volume
: 32 | Issue : 5 | Page : 355--358
Orbital venography-(clinical evaluation of orbital lesions)
DB Chandra, Rajiv Kumar, D Srivastava, Dinesh Swarup
State Institute of Ophthalmology, Allahabad, India
D B Chandra
State Institute of Ophthalmology. Allahabad
|How to cite this article:|
Chandra D B, Kumar R, Srivastava D, Swarup D. Orbital venography-(clinical evaluation of orbital lesions).Indian J Ophthalmol 1984;32:355-358
|How to cite this URL:|
Chandra D B, Kumar R, Srivastava D, Swarup D. Orbital venography-(clinical evaluation of orbital lesions). Indian J Ophthalmol [serial online] 1984 [cited 2013 Jun 19 ];32:355-358
Available from: http://www.ijo.in/text.asp?1984/32/5/355/27510
Orbital venography is a technique in which radio-opaque dye is injected in frontal vein or its tributaries and then X-rays are taken to visualize ophthalmic veins. It helps in diagnosing nature, site and size of orbital lesions even when plain X-rays or/and tomography fails. It also helps in visualisation of cavernous sinuses, measurement of sellar width prior to trans-sphenoidal surgery and in diagnosing orbital lesions during Orbitotomy operation.
The normal orbital venogram has been described as a parallelogram in the inner half of the orbit. Any minor and major displacement, obstruction or pathological circulation in ophthalmic veins is diagnostic.
MATERIALS AND METHODS
A clinico-radiological study of normal orbits and orbital lesions of various patients admitted at M.D. Eye Hospital, Allahabad and referred cases from other hospitals was conducted. Orbital venography of 50 cases was done in which 15 cases were normal and 35 cases were of orbital lesions. It was done in the Department of Radiology, S.RN. Hospital, Allahabad by `frontal veins technique' described by Vritsios.
It is a very simple method of performing this investigation as an outdoor procedure by trans-cutaneous puncture of frontal vein and any of its tributaries. Patient is sedated 45 minutes before starting this procedure. In case of children general anaesthesia by open ether method was used. Patient was asked to lie down with head end tilted down by 15 to 20 (Trendlenberg position). Forehead' was cleaned by spirit swab and veins were made prominent by Jugular vein compression in the direction of orbit. Its patency was maintained by slowly running saline drip. Table was made horizontal, jugular compression loosened and a rubber band was tied on the forehead around the hair line to check back flow of eye in skull veins.
When frontal vein was thin prominent anterior temporal branch was punctured. If both frontal and temporal vein were thin then cut open at the site of frontal vein was performed.
Sensitivity to conray 280 was done before injecting. Emergency drugs with oxygen were kept ready. The patient was asked to put his two fingers hardly pressed against maxilla so that drug remained in the orbit. Then 10 cc of conray 280 was injected each time before taking A.P. and lateral exposure- of skull.
Observation is shown in tabulated form.
This series comprised 50 cases subjected to orbital venography consisting of 15 cases used as controls and 35 cases of orbital lesions.
Orbital venogram showing superior ophthalmic vein and its three segments forming a parallelogram in the inner half of the orbit was seen as reported by different authors.,,, The angles between first and second segment and between second and third segment varied from 50 to 60 degrees and 110 to 120 degrees respectively.
Out of 15 normal cases subjected to orbital venography 14 cases (93.4%) showed good venograms while one case (6.6%) failed due to thin vein. Lloyd achieved success in 97% cases by a scalp vein needle puncture of frontal veins in a series of 611 consecutive venogram while in this series frontal vein was punctured in 12 cases (85.72%) and one case (7.14%) each was done by temporal veins punctures and cut open method. Inferior ophthalmic vein and cavernous sinus were visualized in 2 cases (14.28%) out of 14 successful cases. Anterior collateral veins were seen in 2 cases (14.28%) while medial, lateral and posterior collateral veins were not seen.
Variation in normal pattern of superior Ophthalmic veins was seen in 2 cases (14.28%). In one case first segment was absent and a connecting vein was present in its place.
This type of variation is reported, in literature. In other case a loop of vein was connecting first segment with second segment although first segment was present. This type of variation was not reported in the literature.
35 cases of orbital lesions subjected to orbital venography showed good venogram in 30 cases (85.75%) while in 5 cases (14.25%) it failed. Out of these 30 successful cases 3 cases (9.99%) were done by puncturing temporal vein and 2 cases (6.66%) by cut open.
Plain X-ray changes were found in 8 cases (26.64%). Out of these 4 cases (13.32%) each showed soft tissue shadow and haziness in maxillary antrum, while 26 cases (86.68%) showed changes in venographic pattern. Xray of optic foramina was normal in all cases.
Normal venogram was observed in 2 cases each of post traumatic proptosis and pseudo proptosis (Myopia). Extraconal displacement in the form of closing of parallelogram was observed due to pressure from outside muscle cone in cases of carcinoma maxilla and pseudotumour. Intraconal displacement was seen in only one case of pseudotumours. Preconal obstruction, i.e., obstruction in the 1st segment of superior ophthalmic vein was seen in 3 cases of carcinoma maxilla, and one case each of thyrotoxic and thyrotropic exophthalmos, and orbital cellulitis.
Intraconal obstruction, i.e., obstruction in the 2nd and 3rd segment of superior ophthalmic vein was seen in inflammatory and post inflammatory orbital lesions, e.g., pseudotumour and orbital cellulitis. One case of pseudotumour showed extraconal displacement alongwith intraconal obstruction.
In one case of orbital varices dilated superior ophthalmic veins were seen. In this series postconal obstruction and pathological circulation was not seen.
Orbital venography was done in 50 cases
Results were compiled, analysed and compared with other series. They were found to be diagnostic in most of the cases.
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