Orbits

Tolosa-Hunt Syndrome

Painful ophthalmoplegia

Granulomatous inflammation

• cavernous sinus

• Superior orbital fissures

• Orbital apex

MR- T1/T2 isointense to grey matter, vivid enhancement

Tx: high dose steroid

Extraconal orbital lesion

Dermoid cyst - most common in paeds

Lacrimal gland lesion - dacryocystocoele, dacryoadenitis

Haemangioma

Nerve sheath tumour- schwannoma, neurofibroma

Rhabdomyosarcoma

Lymphoma/leukemia

Extra orbital lesion extending into extraconal

• orbital cellulitis

• Mets

• Sinonasal tumour

• Meningioma

Intraconal orbital lesion

Optic nerve glioma

Optic nerve meningioma

Optic neuritis

Vascular malformation

Lymphatic malformation

Mets

Lymphoma/leukemia

Conal orbital lesion

Painless

• thyroid ophthalmopathy (no tendon)

• Lymphoma

Painful

• orbital pseudotumour

Intraocular lesion

Painful

• ocular trauma

• Uveitis

• Glaucoma

Painless

• staphyloma

• Coloboma

• Retinoblastoma

• Mets

Retinoblastoma

USS

• echogenic mass with variable shadowing

CT

• contrast enhance retrolental mass

• calcification

• haemorrhage-dense vitreous

MR

• T1 hyperintense compared to vitreous

• T2 hypointense to vitreous

• diffusion restriction

Leukocoria ddx

1. Retinoblastoma

2. Persistent Hyperplastic Primary Vitreous

3. Coats Disease

4. Larval granulomatosis

Coats Disease aka exudative retinitis

Leukocoria, 3-9yo

telangiectasias and aneurysms of retinal blood vessels

→ subretinal exudative fluid collections

→ RETINAL DETACHMENT

Tx:

• ophthalmology ref

• photocoagulation/cryotherapy/surgical repair