Department of Radiology

University of California

San Diego

John R. Hesselink, M.D.

Imaging the Eye

and Orbit

Anterior compartment

Bony orbit

- Extraconal

- Intraconal

Optic nerve

Globe

Retrobulbar space

Orbital Inflammation

Orbital cellulitis

Grave's disease

Orbital pseudotumor

Sarcoidosis

Mucormycosis

Wegener's granulomatosis

History: 5 month old girl

with a swollen eye

168

History: 4 y.o. boy with a

swollen eye

80

Orbital Infection

Extension from sinus or eyelid

Predisposing factors:

Proximity to paranasal sinuses

Thin lamina papyracea

Valveless facial veins

Preseptal cellulitis Orbital cellulitis

Orbital abscess

History: 35 y/o HIV+

male

with diabetes developed

fever & left orbital

swelling

290

Dx: Aspergillosis left

ethmoid sinus & orbit

Orbital swelling

{Page 2}

History: 76 y/o diabetic woman with headache

& acute right eye blindness

598

Dx: Aspergillus sinusitis

{Page 2}

Dx: Grave’s ophthalmopathy

History: 72 y/o woman with bilateral proptosis

795 - 30076929

Graves' Ophthalmopathy

Most common cause of

bilateral proptosis

70% are bilateral & symmetrical

4:1 female preponderance

Medial & inferior rectus muscles

most often involved

Dx: Grave's disease

History: 43 y.o. man with proptosis

42

Grave's Disease

OC 7,8

Enlarged Extraocular Muscles

Graves' disease

Pseudotumor

Orbital cellulitis

AV malformation

Carotid-cavernous fistula

Infiltration by tumor

Spontaneous or traumatic

hematoma

Differential Diagnosis

History: 25 y.o. man with proptosis,

orbital pain & itching

75

Dx: Orbital pseudotumor

Orbital Pseudotumor

Tends to be unilateral

25% of all cases of unilateral

exophthalmos

Diffuse infiltration of orbital tissues

Remitting or chronic and progressive

May regress spontaneously or

responds to steroids

Similar to lymphoma clinically,

radiographically & pathologically

History: 53 y/o man

with intermittent proptosis

for 1 year

312

Dx: Orbital pseudotumor

Proptosis {Page 2}

History: 32 y/o man with facial

swelling & exophthalmos

329

{Page 2}

Dx: Sarcoidosis

Exophthalmos {Page 3}

History: 45 y/o woman with arm & leg weakness,

sensory changes, & bilateral visual loss

441

Dx: Neuromyelitis optica (Devic's disease)

Bilateral visual loss

{Page 2}

Tumors of the Orbit

Optic nerve / sheath tumors

Veno-lymphatic malformations

Lymphoma

Dermoid cyst

Lacrimal tumors

Metastases

Secondary (45%)

Sinus carcinoma

Mucoceles

History: 6 y/o boy with visual problems

294

Dx: NF 1 - vacuolar myelin

& optic nerve glioma

Visual loss

{Page 2}

History: 66 y/o woman with left

eye proptosis & blindness

Dx: Meningioma – optic sheath 660

Optic Nerve / Sheath Enlargement

Optic neuritis

Optic nerve glioma

Optic sheath meningioma

Intracranial hypertension

Lymphomatous &

leukemic infiltration

Differential Diagnosis

Sarcoidosis

Advanced Grave's disease

Central retinal vein occlusion

Hemangioblastoma

Hemorrhage

History: 66 y/o woman with a right 6th

nerve palsy & visual loss

237

Dx: Lymphoma of optic

nerve sheath &

cavernous sinus

Visual loss {Page 2}

History: 33 y/o woman with decreased vision in left

eye

791 - 26144402

Dx: Cavernous hemangioma

Page 2

1 hour later

History: 4 y/o boy with right globe ptosis

770 - 52363508

Dx: Veno-lymphatic malformation

{Page 2}

History: 82 y/o woman

with left eye proptosis

489

Dx: Non-Hodgkin's lymphoma (B cell)

{Page 2}

History: 10 y/o boy with proptosis

319

Dx: Lymphangioma

{Page 2}

History: 92 y/o man with a right eye mass

519

Dx: Basal cell carcinoma

{Page 2}

Lacrimal Gland Masses

50% - Lymphoid-Inflammatory disease

Benign hyperplasia Lymphoma

50% - Epithelial tumors

1/2 - Pleomorphic adenomas

1/2 - Malignant carcinomas

Adenocystic, Pleomorphic

Mucoepidermoid, Squamous cell

Undifferentiated, Adenocarcinoma

Pleomorphic Adenoma

OD 99-100

Pleomorphic Carcinoma

OD 107-8

Dx: Orbital dermoid

History: 57 y/o man with right eye droop

527

Metastatic Breast Carcinoma

od 39-40

Orbital Tumors in Children

Retinoblastoma

Rhabdomyosarcoma

Optic nerve glioma

Lymphangioma

Teratoma

History: Young girl with nasal

obstruction and proptosis

793 - 26971184

Dx: Rhabdomyosarcoma

{Page 2}

DWI

History: 32 y/o woman with right eye swelling & pain

461

Dx: Orbital varix

Carotid-Cavernous

Fistula

oh 5-8

Ocular Lesions

Retinoblastoma

Congenital Lesions

PHPV, Coats' disease, Anophthalmos

Uveal Melanoma

Choroidal Metastases

Benign Lesions

Scleral calcification, Choroidal osteoma

Drusen, Coloboma, Staphyloma

History: 7 month old male

with exophoria & blindness

in the right eye

287

Dx: Bilateral retinoblastomas

Right eye blindness

{Page 2}

Retinoblastoma

Intraocular malignant tumor

Presents in first two years of life

Only 10% of cases are inherited

Mutation of chromosome 13

Bilateral in 30%

Calcification is common

Must be distinguished from benign

causes of leukocoria

Retinoblastoma

OD 33-4

Dx: Coat's disease with retinal detachment

History: 6 month old boy with leukocoria

& markedly decreased vision in left eye

277

Persistent Hyperplastic

Primary Vitreous (PHPV)

Courtesy of Mahmood Mafee, MD

History: 38 y/o man s/p biopsy

for eye pain & mass

736 - 2276964

Dx: Choroidal melanoma

{Page 2}

Dx: Leiomyoma ciliary body

History: 25 y/o male with progressive loss

of vision in the left eye the past year

686

History: 43 y/o man

with visual deficits

428

Dx: CMV retinitis with optic

pathway involvement

{Page 2}

History: 33 HIV+ man with painful

swelling & proptosis of left eye

756 - 1569195

Dx: Orbital cellulitis &

endophthalmitis - Staph

{Page 2}

Dx: Bilateral staphylomas

History: 48 y/o man with visual

problems for many years

579

Ocular

Calcifications

Choroidal osteoma

Drusen

Scleral calcifications