|Year : 1979 | Volume
| Issue : 4 | Page : 222-223
Orbital lesions-exploration and eradication
Y Dayal, SM Betharia
R.P. Centre for Ophthalmic Sciences, New Delhi, India
R.P. Centre for Ophthalmic Sciences, Ansari Nagar, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dayal Y, Betharia S M. Orbital lesions-exploration and eradication. Indian J Ophthalmol 1979;27:222-3
Orbit is well known to be a pandora's box and as such all sorts of prophecies are made as to the anticipated lesion as the cause of proptosis. These lesions form a very heterogenous group. The clinical presentations are quite varied. In order to arrive at some conclusion, a number of quite sophisticated investigations have to be done to localize the disease at least topographically.
The investigations include:
(1) Orbitotonometry, (2) Plain X-rays of the orbital walls and the optic foramina, (3) Contrast studies like Pneumo-orbitography, venography, (4) Ultrasonography.
All these prove very helpful to locate the lesion. It is needless to mention that X-rays of the optic foramina as well as the contrast studies are very significant. These may indicate, besides the location, the extent of the lesion as well. It may be worthwhile to mention that Pneumo-orbitography by itself is of doubtful value. Ultrasonography whether A or B scan has its own limitations. However, the aetiological. diagnosis is only possible through exploration, biopsy/excision and histopathology.
Based on the experience in tackling this area for over a decade, covering 214 cases [Table - 1] and [Table - 2] an effort has been made to analyse and critically evaluate the scope and results of the variety of techniques (explorations) employed. It is quite evident that a large number of cases (135 out of 214) are well tackled by the anterior approach only. Lesions situated anterior to the equator of the globe are well suited for this simple approach.
As evident from this study, the lateral approach was limited to cases where the clinical examination indicated the lesion posterior to the equator of the globe. During this procedure one has to be very careful not to damage any of the extraocular muscles particularly the lateral rectos. If the lesion is seen posteriorly in the peripheral space, there is not much difficulty in isolating and excising the growth. But if it is confined to the muscle cone, it should be carefully located by palpatation. An encapsulated tumor can often be removed by blunt finger dissection without causing any injury to the retrocular tissues. In case the tumor is found to be infiltrating diffusely its removal demands utmost caution. However, under no circumstances one should attempt to excise the growth blindly, in the interest of the safety of optic nerve, and the extraocular muscles. It is not advisable to attempt a sharp dissection either.
In dealing with pseudo-tumors or diffusely infiltrating lesions, it is better to remove small bits with nontoothed dissection forceps so as not to injure important structures. It is wiser to leave some tumour tissue behind rather than to attempt complete removal and cause irreparable damage.
If one is dealing with the cysts (blood or otherwise), care is taken that it does not rupture during removal. To avoid this it may be worthwhile to guardedly aspirate the contents and thereafter the covering/lining be removed. Likewise the dermoid cysts are cauterized with carbolic acid particularly so if not completely removed.
While tackling the vascular lesions, it is better to ligate any feeder vessels before excising. This precaution will control the bleeding during the entire procedure. While tackling a glioma or even neurofibroma it is better to excise it five to ten milimeters anterior to the optic foramen, and care taken to avoid any damage to any of the nerves (third, fifth or sixth) which lie quite close to the optic nerve on the lateral side.
There are circumstances when no tumor could be localized, then one should get the extraocular muscles examined to determine whether they are hypertrophied or not. This is quite possible by palpation using fingers. In cases where there is a suggestion of a malignancy, frozen section should be undertaken while operating. The management is altered accordingly.
Q. (Dr. K.R. Murthy, Bangalore) How do you manage cases of frontal mucocoel?
A. (Dr. Y. Dayal) I always refer them to the E.N.T. surgeon.
Q. (Dr. B.K. Mitra, Calcutta) What anaesthesia do you use?
A. (Dr. Y. Dayal) Mostly general (anaesthesia).
Q. (Dr. Asutosh Sarkar, Calcutta) Have you come across cases who lost vision following orbitotomies?
A. (Dr. Y. Dayal) Yes. Some times.
[Table - 1], [Table - 2]