Indian Journal of Ophthalmology

ARTICLES
Year
: 1983  |  Volume : 31  |  Issue : 7  |  Page : 975--977

Ultrasonography in cystic lesions of the orbit


IM Bhatia, N Verma, Y Dayal, SM Betharia 
 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Correspondence Address:
I M Bhatia
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi-119 029
India




How to cite this article:
Bhatia I M, Verma N, Dayal Y, Betharia S M. Ultrasonography in cystic lesions of the orbit.Indian J Ophthalmol 1983;31:975-977


How to cite this URL:
Bhatia I M, Verma N, Dayal Y, Betharia S M. Ultrasonography in cystic lesions of the orbit. Indian J Ophthalmol [serial online] 1983 [cited 2021 Aug 6 ];31:975-977
Available from: https://www.ijo.in/text.asp?1983/31/7/975/29721


Full Text

Unilateral exophthalmos is an important ophthalmic diagnostic problem. The relia­bility of echography in orbital diagnosis varies from 98% in detecting mass lesions to 80% in their correct characterization (Ossoinig 1973). However, the science has advanced and today an aetiological diagnosis is possible in upto 90% of patients (personal series).

The present study is aimed at characteriz­ing various types of cysts of the orbit and cor­relating echographic pattern with the histo­pathological characteristics of the lesions.

 MATERIALS AND METHODS



Thirteen cases of proptosis were selected from a documented series of seventy patients with orbital disease examined in the ultra­sonography service of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi:

Each patient underwent the routine pro­potosis workup, laboratory investigations, radiological evaluation (both conventional and CT Scanning) - a presumptive diagnosis being made at each step and then echography was done.

All patients were operated - orbitotomy being performed by the anterior or lateral route as indicated. The final diagnosis was made at the ocular pathology laboratory.

The Kretztechnik 7200 MA and the ophthalmoscan 200 were used for high resolu­tion orbital scanning. Compound linear, arc and sector scanning patterns were used.

 RESULTS AND DISCUSSION



The patients studied were in the 3-24 year age group (average age 20.8 years) and the sex incidence was equal. They formed 18.6% of all patients studied.

The accuracy of the various forms of diagnosis was

This group of abnormal orbit exhibited the following common features :

1. Well rounded anterior and posterior borders.

2. High starting and terminal spikes.

3. No intrinsic mobility.

4. Compressibility (seen in 38.5%) indicated by a narrowing of tumor echofree interval on contact A scanning.

5. Low to medium amplitude spikes among from within the tumor.

6. Sound attenuation (angle Kappa 0-15%). 7. Compression of the surrounding orbital structures.

Dermoid cysts (3) Had the following features in addition

1. Extremely thick walls.

2. Low to medium amplitude spikes arising from within the tumor.

3. Location in superior orbit.

4. Identification of intracranial extension (bony ostium) in one patient (vide infra).

Parasitic cysts and lymphangiomas (5) were specially characterized by

1. Thin wall

2. Presence of surrounding inflammatory changes in the form of orbital fat oedema. accentuation of muscle and optic nerve shadows.

3. Present in the inferior orbit.

4. Frequent occurrence of papoloedema and indentation of the globe.

Mucocoeles (3 1. Present in the superonasal quadrant of the orbit.

Pneuromat- 2. Thin walled. ocoeles (1)

3. Usually clear (echo free) intracystic contents.

4. Presence of a bony ostium (see saw pat­tern)-communication with the parent sinus. This is the diagnostic feature of a mucocoele.

Encephalocoele Was seen to have:

(1) (i) posterior location (ii) high amplitude

spikes form contained brain tissue - associated with a rapid attenuation of sound.

 COMMENTS



The indications for an orbital echographic evaluations are

1. Proptosis

2. Unexplained papilloedema, opticatrophy

3. Unexplained loss of vision

4. Orbital apex syndrome

5. Presence of a visible mass anteriorly

The cystic lesions studied his­topathologically were seen to consist of a wall of varying thickness with intracystic contents of different consistency. The abrupt accoustic discontinuity between orbital fat and cyst wall (with and without pericystitis) causes a high starting echo to arise from this interface. The posterior spike however arises -from the intracystic fluid - wall interface, the corres­ponding wall-fat interface being in a sense a negative one.

The mucocoeles contain mucus with very little cellular debris and consequently are almost echo free. The dermoid cysts on the contrary have large amounts of cellular deb­ris, hair and the like. They therefore give rise to low to medium. amplitude spikes on A­scanning.

The see saw pattern arising from the bony ostium on A scan is due to the beam alter­nately striking the orbital wall and the interior of the sinus with changing trarisuducer positions.

The avantages of echography over CT scan­ning and conventional radiology are by now evident, CAT has a lower resoulution and fails to distinguish solid from cystic lesions. However, intracranial and periorbital exten sion are by this techniqe of orbital imaging.

Ultrasonography provides data as to the loca­tion,'size, nature of orbital lesions as well as offers a tissue diagnosis and forms an impro­tant procedure in the preoperative evaluation of cystic lesions.

 SUMMARY



The value of ultrasonography in orbital cysts is presented.[2]

References

1Ossoinig KK.C., Till P. : A 10 year study of clinical echography in orbital disease. in, Ultrasonography in Ophthalmology (J Francois). Basel S. Karger 1975 (200­216).
2Reese A.B. : Tumors of the Eye. New York Haper and Row, 1963.