Rose Geoffrey E, Verity David H
Adnexal Service, Moorfields Eye Hospital, London, UK.
Handb Clin Neurol. 2011;102:467-91. doi: 10.1016/B978-0-444-52903-9.00023-6.
In this chapter the presentation and management of common orbital diseases are discussed. An accurate clinical history and assessment are essential, with computed tomography being the imaging of choice. Magnetic resonance imaging provides detail of intrinsic optic nerve disease and orbital apical or intracranial pathology, and ultrasonography is valuable in assessing anterior orbital masses, in particular vascular lesions. Inflammatory lesions require a tissue biopsy before immunosuppression is instituted. Exceptions to this principle are scleritis, myositis, thyroid eye disease, and characteristic orbital apex syndrome, in which delay in immune suppression may jeopardize visual outcome. The term "orbital pseudotumor" is now obsolete. The management of active thyroid eye disease includes immunosuppression and low-dose orbital radiotherapy. Urgent orbital decompression is indicated in the presence of nonresponsive optic neuropathy, and inactive disease is managed by decompression for exophthalmos, and correction of muscle imbalance and lid retraction. Subacute lacrimal gland inflammation, unresponsive to a few weeks of nonsteroidal treatment, may be due to underlying carcinoma and a specialist opinion should be sought without delay. Pleomorphic adenoma, with typical features on imaging, should always be excised intact to avoid subsequent pervasive malignant disease.
本章将讨论常见眼眶疾病的临床表现及治疗。准确的临床病史和评估至关重要，计算机断层扫描是首选的影像学检查方法。磁共振成像可提供视神经内在疾病以及眶尖或颅内病变的详细信息，超声检查在评估眶前部肿块，尤其是血管性病变方面具有重要价值。在开始免疫抑制治疗之前，炎性病变需要进行组织活检。巩膜炎、肌炎、甲状腺眼病和典型的眶尖综合征是该原则的例外情况，在这些疾病中，免疫抑制的延迟可能会危及视力预后。“眼眶假瘤”这一术语现已过时。活动性甲状腺眼病的治疗包括免疫抑制和低剂量眼眶放疗。在出现无反应性视神经病变时，需紧急进行眼眶减压，静止期疾病则通过眼眶减压治疗眼球突出，并矫正肌肉失衡和眼睑退缩。亚急性泪腺炎在经过数周非甾体治疗无反应时，可能是由潜在的癌症引起的，应立即寻求专科意见。具有典型影像学特征的多形性腺瘤应完整切除，以避免随后发生弥漫性恶性疾病。
