By John Bryan Holds, MD

Emphasizing a realistic method of prognosis and remedy, this quantity summarizes present details on congenital, infectious, inflammatory, neoplastic, and tense stipulations of the orbit and adnexa. Highlights contain large dialogue of thyroid-associated orbitopathy, lymphoproliferative issues, and eyelid neoplasms. includes up-to-date references and diverse new colour pictures.

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Extra resources for 2008-2009 Basic and Clinical Science Course: Section 7: Orbit, Eyelids, and Lacrimal System (Basic and Clinical Science Course 2008-2009)

Example text

If the involved pathogen is unknown, then broad-spectrum coverage for gram-positive and gram-negative as well as anaerobic organisms is indicated. Clindamycin is of particular value as it is uniquely effective against the toxins produced by group A Streptococcus. To limit the inflammatory damage associated with the toxins, adjunctive corticosteroid therapy after the start of antibiotic therapy has been advocated. Some cases of necrotizing fasciitis limited to the eyelids can be cautiously followed with systemic antibiotic therapy and little or no debridement; this is considered only in cases that rapidly demarcate and show no signs of toxic shock.

Orbital infections rarely spread posteriorly to the cavernous sinus. Cavernous sinus thrombosis is often heralded by the rapid progression of proptosis and by anesthesia in both the first and second divisions of the trigeminal nerve; in rare cases, by contralateral ophthalmoplegia as well. Meningitis and frank brain abscess may develop. A lumbar puncture may reveal acute inflammatory cells and the causative organism on stain and culture. Garcia GH, Harris GJ. Criteria for nonsurgical management of subperiosteal abscess of the orbit.

33 without the expense and discomfort of intravascular catheterization and injection of contrast material, as well as the risks associated with these maneuvers. When determining which test to use, the ophthalmologist should consult with a radiologist to discuss the suspected lesion and to ensure selection of the imaging modality best suited for the patient. Pathology The diagnosis of an orbital lesion usually requires analysis of tissue obtained through an orbitotomy. Appropriate handling of the tissue specimen is necessary to ensure an accurate diagnosis.

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