Orbital Cavity Research Articles

Comparison of orbital volume measured using computed tomography and fluid displacement: A comparative study using dry skull

Objectives: The purpose of the study was as follows: (1) To compare orbital volume calculated using computed tomography (CT) scans with real-time measurements. (2) To evaluate if the orbital volume of the adjacent orbit can be taken as a tool of comparison for orbital volume correction in orbital fractures. Materials and Methods: A prospective study was conducted on 30 orbital cavities with intact orbital walls. The foramina and fissures were sealed using molding wax. Alginate impressions of the orbital cavity were taken to determine the orbital volume using the Archimedes principle. GE light speed 64 slices CT scanner was used to scan the orbits with 0.8 mm sections. Orbital volume was calculated using the CT software GE ADW 4.5 workstation. Results: The comparison of CT measurement and Archimedes principle measurement shows a mean and standard error of 0.2333 mm and 0.09794, respectively, on the right orbits and a mean and standard error of 0.10011 mm and 0.0981, respectively, on the left orbits. The comparison of the right and left orbits shows a mean and standard error of 0.4067 mm and 0.2771 mm, respectively, using the Archimedes principle and a mean and standard error of 0.3300 mm and 0.2775, respectively, using CT scans. Conclusion: It was found that the difference in orbital volume between CT and real-time measurement is very negligible. The study shows that CT is a reliable tool for the orbital volume measurement and the adjacent orbit can be taken as a comparative tool for the orbital volume corrections.

Morphometric Analysis of Infraorbital Foramen in Human Dry Skulls

Background and aim: The infraorbital foramen morphometric and anatomical variations is the critical factor for avoiding iatrogenic nerve injuries during surgery on the middle third of the face with safe regional anesthesia. The present study aimed to carry out the morphometric analysis of infra orbital foramen in human dry skull. Material and Methods: This morphometric study was carried out on 72 dry human skulls in the Department of Anatomy, Surayya Azeem Teaching Hospital, Lahore from January 2022 to June 2022. Research and ethical committee approved the study protocol. Skulls of identified age and gender with no apparent pathology, traumatic lesions, and deformity were enrolled. Skulls (>18 years) with bone resorption in the alveolar region and had orbital and nasal cavities damaged were excluded. Vernier caliper was used for the measurement of infra orbital foramen exact location on both sides. Transverse and sagittal diameter were measured. Infraorbital foramen and inferior margins of infraorbital margin were measured in order to determine the sagittal diameter. Infraorbital foramen medial margin to lateral margin of pyriform aperture was measured transversely. This study examined the relationship between the infraorbital foramen and the 1st premolar as well as its shape. There was also an indication of accessory foramen. SPSS version 26 was used for descriptive statistics. Results: Of the total 72 dry human skulls, there were 58 (80.6%) male and 14 (19.4%) females. The incidence of oval, triangular, semilunar, and round shape infra orbital foramen (left versus right) was (38.4% vs. 40.3%), (17.8% vs. 16.9%), (26.7% vs. 28.6%), and (17.1% vs. 14.2%) respectively. The occurrence of single and accessory intra orbital foramen was 91.8% and 8.2% respectively. The intra orbital foramen opening was directed medially downward, medially in, and downward was 34 (47.2%), 32 (44.4%), and 6 (8.3%) respectively. In association with upper teeth, the intra orbital foramen on the right and left side was 38.4% and 54.9% respectively; the buccal cusps of the maxillary second premolar teeth were located on the same vertical axis. Conclusion: The present study concluded that accurate localization of the IOF is essential to prevent infraorbital nerve injury. Additionally, foramen oval shape was the most prevalent shape followed by round shape. Knowledge regarding IOF location is critical in maxillofacial region during numerous surgery procedures which might lead to infraorbital vessels and nerve. Thus careful approach should be followed to avoid damage to foramen. Keywords: Infra orbital foramen, human skulls, morphometric analysis

A Case of Carcinosarcoma Originating From Maxillary Sinus

Carcinosarcoma is a highly malignant tumor characterized by dual malignant histologic differentiation of epithelial and mesenchymal components, which rarely occurs in the maxillary sinus. We experienced a case of carcinosarcoma mixed with a keratinizing squamous cell carcinoma and an osteosarcoma arising from the right maxillary sinus recently. A 55-year-old male patient presented with right nasal obstruction and epistaxis. The initial punch biopsy revealed a high-grade sarcoma, favoring an osteosarcoma. After general evaluation, the patient was staged as cT4aN0M0. The patient was treated by right total maxillectomy, radiotherapy, and chemotherapy. We present with a review of the literature a case of a carcinosarcoma originating from the right maxillary sinus that had invaded into the orbital cavity and protruded into the nasal cavity.

Limited eye movement caused by clumping of fibrin glue used in blowout fracture surgery: a care report

Fibrin glue is a topical agent widely used for hemostasis, wound healing, and surgical adhesion. Complications of fibrin glue itself are extremely rare because it is absorbed over time, but can occur as a result of inappropriate application. We report a case of a postoperative complication caused by inappropriate application of fibrin glue in blow-out fracture surgery. A 65-year-old male patient presented with periorbital swelling and an open wound on the right infraorbital area. Computed tomography showed a right orbital floor fracture. After reduction of the herniated tissue into the orbit, an implant was inserted and fibrin glue was applied to stabilize the implant. This procedure was performed without difficulty, but the patient complained of persistent diplopia and limited eyeball movement after surgery. An imaging study showed a mass-like lesion, which was not a hematoma, in the orbital cavity. In a second operation, the mass was identified as clotted fibrin glue that had not been applied properly. After removal, the patient's symptoms were relieved without further complications. Appropriate and careful application of fibrin glue is necessary to avoid unnecessary complications.

Suprahyoid Neck: Anatomy and Principle of Pathology

The suprahyoid neck extends from the hyoid bone inferiorly to the skull base, excluding the orbit, sinonasal and oral cavity. The suprahyoid neck is anatomically complex but can be organized into different spaces based on the fascial planes. Multiple systems with slightly different namings are adapted. As a consensus, 5 principal spaces and 2 posterior midline spaces can be recognized. Each space contains unique contents which are subject to a predictable set of disease processes. Localization of lesions to a particular space allows the generation of a limited radiologic differential diagnosis. This is termed a “space-specific diagnosis”. The anatomy and related pathology of the pharyngeal mucosal, the parapharyngeal, the carotid space, the masticator space, the parotid space, the retropharyngeal space, and the perivertebral space will be discussed. After the presentation, participants will be able to comprehend the anatomy of the suprahyoid neck, understand the concept of a space- specific diagnosis and formulate a (differential) diagnosis when encountering pathology in the suprahyoid neck region.

A man with proptosis of the left eye

A 50-year–old man without systemic disease presented to the emergency department with progressive proptosis of the left eye (Figure 1) after a motor vehicle accident 4 weeks ago. On ophthalmic examination, his visual acuity was 20/40 in the left eye and 20/20 in the right eye. The ocular motility test revealed limited medial gaze of the left eye. Point-of-care ultrasound demonstrated an engorged vessel with a pulsatile flow directed toward the probe at the medial side of the left orbital cavity (Figure 2 and Video 1).

The Pterygopalatine Fossa: Skeletal Framework, Communications and Content

The pterygopalatine fossa, located on both sides of the skull, is a neurovascular crossroad between the middle cranial fossa, the orbit, the nasopharynx, the nasal and oral cavities, and the infratemporal fossa. It is considered a strategically complex region given its small size and the numerous structures that pass through it. This review aims to describe its skeletal framework, content, and communications with other regions.

Abstract B030: Induction chemotherapy plus concurrent chemoradiotherapy led to clinical complete response in locally advanced sinonasal rhabdosarcomas

Abstract Background: Sinonasal rhabdosarcoma is a rare but aggressive malignancy. In cases where locally advanced diseases involve critical structures such as the orbital and cranial cavities, surgery may not guarantee safety margin. Therefore, we evaluated the effect of induction chemotherapy plus concurrent chemoradiotherapy in locally advanced sinonasal rhabdosarcoma. Methods: During January 2013 to January 2019, 4 patients (2 males and 2 females, 22 to 33 years old) with locally advanced sinonasal rhabdosarcoma (3 alveolar and 1 poorly differentiated rhabdosarcoma) were treated with induction chemotherapy followed by concurrent radiochemotherapy. The patients were staged as cT4N0M0, cT4N0M0, cT4N1M0, and cT3N1M0 respectively. The patients were treated with induction chemotherapy composed of 2 to 4 cycles of EI regimen (epirubicin 60mg/m2, day 1-day 2; Ifosfamide 1.8g/m2, day 1-day 5; every 21 days) based on their tolerance. Thereafter, all patients received concurrent radiochemotherapy with 70Gy in 30 fractions given to the primary tumors and 63Gy in 30 fractions to the lymph nodes in N1 patients. Concurrent chemotherapy with cisplatin (100mg/m2, day 1 and day 22) was delivered during the course of radiotherapy. The follow-up time was 29, 28, 7 and 4 months, respectively. Results: Induction chemotherapy yielded partial response and concurrent radiochemotherapy led to clinical complete response. No sign of local recurrence was detected until the last follow-up. Only one patient had vertebral metastasis 6 months post-treatment in T10 and received vertebral irradiation. Others were free of distant metastasis. During the induction chemotherapy, all patients were presented with grade IV leucopenia, 3 of whom developed febrile neutropenia that required dose reduction in the consecutive chemotherapies. Concurrent radiochemotherapy was well tolerated, 3 patients developed grade II leucopenia and 1 grade IV leucopenia. All patients experienced grade II gastrointestinal side effects, dermatitis, and stomatitis. Conclusions: Induction chemotherapy plus concurrent chemoradiotherapy could lead to clinical complete response in locally advanced sinonasal rhabdosarcoma. Hematological toxicities were the most common toxicities and should be monitored and treated carefully. Longer follow-up and larger scale of study are needed to confirm these results. Citation Format: Qiuji Wu, Shaojie Li, Juan Wang, Jia Liu, Yahua Zhong. Induction chemotherapy plus concurrent chemoradiotherapy led to clinical complete response in locally advanced sinonasal rhabdosarcomas [abstract]. In: Proceedings of the AACR Special Conference: Sarcomas; 2022 May 9-12; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2022;28(18_Suppl):Abstract nr B030.

Essential fatty acids in farmed tambaqui (Colossoma macropomum) from the Brazilian Amazon Area

The goal of this study was to determine the essential fatty acids of the total lipids of the fillet, head and orbital cavity tissue from farmed tambaqui (Colossoma macropomum) fish from a Brazilian Amazon area. The tambaqui were acquired from different fish farms in the Roraima state, located at Western Brazilian Amazon. The meat, the head and the fatty tissue from orbital cavity were dissected for lipid extraction and analysis of fatty acids by gas chromatography. The fatty acids were quantified in mg g-1 of total lipids using C23:0 as an internal standard. The nutritional quality of the lipids was determined by using the atherogenicity and thrombogenicity indices, and also by the ratio between hypocholesterolemic / hypercholesterolemic fatty acids. The orbital cavity tissue had the higher concentration amount of linoleic and α-linolenic acid, whereas the fillet had higher docosahexaenoic acid (DHA). The eicosapentaenoic acid (EPA) concentration was: 1.28, 0.97, 1.71 mg g-1 of total lipids, in the filet, in head, and in orbital cavity tissue, respectively. All essential fatty acids were detected in the three parts analyzed. The nutritional quality of the total lipids from the head and from the orbital cavity tissue was similar to the fillet.

Endoscopic Management of Malignant Tumors of Paranasal Sinus and Nasal Cavity: An Institutional Experience.

Malignant tumors of sinonasal region are rare and affect less than 1 in 100,000 people per year. They are histologically diverse group and potentially pose significant management problems due to their proximity to the orbit and intracranial cavity. Although squamous cell carcinoma (SCC) is most common malignant tumor of paranasal cavity, tumors like adenocarcinoma, olfactory neuroblastoma, malignant melanoma, adenoid cystic carcinoma, sarcomas, haemoproliferative tumors, e.g. lymphoma may also occur. Retrospectively study was done in a tertiary care institute from January 2008 to December 2018 in India. Inclusion criteria-all biopsy proven PNS malignancy patients operated by endoscopic approach, irrespective of age and gender. Exclusion criteria- patients diagnosed with nasopharyngeal carcinoma, skin involvement, gross orbital involvement (muscle invasion), metastasis, operated by open approaches. 46 patients who underwent endoscopic tumor removal were reviewed. 36 (78.2%) were males and 10 (4.6%) females. Most common tumor in our study was adenoid cystic carcinoma. Recurrence was seen in 6 patients. Palliative therapy was given to all patients with recurrence. Management of malignant PNS tumor involving anterior skull base is multidisciplinary. R0 resection should be main goal in all malignant PNS malignancy. Tumors invading unresectable areas like cavernous sinus, brain parenchyma, carotids can be left in these places followed by palliation except in cases of squamous cell carcinoma. If R0 cannot be achieved surgically in SCC than patient should be considered inoperable and send for palliation. T1-T3 PNS malignant tumors can be managed by endoscopic approach followed by adjuvant therapy after a period of 6weeks. Endoscopic excision should be converted to endoscopic assisted open approach in case of T4 tumors. We have tried to give a management protocol for management of malignant PNS tumors. Level of evidence: II.

Management of Proptosis in a Case of Sphenoid-Orbital Meningioma

Sphenoid-orbital meningiomas (SOMs) are difficult to completely resect because they involve the sphenoid wing, orbit, and cavernous sinus. As the tumor invades the optic canal, SOMs frequently appear with visual deficits. The authors of this case report dealt with the case of a 65-year-old male patient who had right-sided proptosis. We diagnosed the patient, and his MRI revealed of having SOMs. The surgical approach was determined by the tumor’s placement in the orbit and cranial cavity and its connections to the optic canal and optic nerve axis. Surgical excision was used to successfully remove the SOM. The patient maintained a proptosis of less than 4 mm during the follow-up period. The visual acuity, visual field, and ocular fundus were examined during the optical follow-up. SOMs are notoriously difficult to treat surgically. The primary goal of surgery in symptomatic individuals with SOMs is to slow down the tumor’s progression. Longer periods of post-operative observation and follow-up are recommended to observe long-term advantages. Bang. J Neurosurgery 2022; 11(2): 145-149

Components and lipid-lowering effect of total saponins from underground part of Gynostemma pentaphyllum

The saponins in different parts of Gynostemma pentaphyllum were analyzed via UPLC-Q-TOF-MS~E. A total of 46 saponins were identified, and the underground part had 26 saponins more than the aboveground part, most of which were trisaccharide saponins. The rat model of hyperlipidemia was established with high-fat diet. This study explored the lipid-lowering activity of total saponins in the underground part of G. pentaphyllum, so as to provide a theoretical basis for the comprehensive utilization of the underground part of G. pentaphyllum. A total of 99 healthy SD rats were randomly assigned into a blank group, a model group, a positive drug group, an aboveground total saponins group, and low-, medium-, and high-dose underground total saponins groups. Except the blank group, the other groups were fed with high-fat diet for 6 weeks. Then, the blood was collected from the orbital cavity to determine whether the modeling was successful according to the serum levels of total cholesterol(TC) and triglyceride(TG). After intragastric administration of the corresponding agents for 30 continuous days, the physical state of the rats were observed, and the body weight and liver specific gravity were measured. Furthermore, the levels of TC, TG, low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), alanine transaminase(ALT), aspartate transaminase(AST), bilirubin, and total bile acids in serum, as well as the levels of superoxide dismutase(SOD), malondialdehyde(MDA), peroxidase proliferator-activated receptor(PPAR-γ) in the liver tissue, were determined. The pathological changes of liver was observed via HE staining. The results showed that the aboveground total saponins and medium-and high-dose underground total saponins can treat hepatocyte steatosis, lower TC, TG, LDL-C, ALT, AST, total bilirubin, MDA, and PPAR-γ levels, and increase HDL-C and SOD levels in the model rats. The effect tended to be more obvious with the increase in dosage. Therefore, the total saponins in the underground part of G. pentaphyllum have good pharmacological effect of reducing blood lipid, which provides a theoretical basis for the comprehensive utilization of the underground part of G. pentaphyllum.

Rhino-orbito-cerebral mucormycosis: patient characteristics in pre-COVID-19 and COVID-19 period.

Rhino-orbito-cerebral-mucormycosis (ROCM), a rare and potentially fatal disease was seen in increasing numbers during the COVID-19 pandemic. This study describes and compares the patient characteristics and outcomes in COVID-19 associated mucormycosis (CAM) and non-COVID-19 mucormycosis (non-CAM). CAM patients (24 cases) were recruited from the COVID-19 period and non-CAM (24 controls) from the pre-COVID-19 period. Clinical data of the CAM group was collected retrospectively with 3 month outcomes prospectively. The non-CAM group data was collected retrospectively. Patient characteristics were compared and risk factors for mortality in ROCM were assessed. Orbital symptoms [altered vision, restricted eye movements, ptosis] and intracranial involvement were higher in CAM patients on presentation. Similarly, the radiological involvement of orbit (orbital apex, superior orbital fissure) and intracranial cavity (intracranial thrombosis, cavernous sinus) was also higher in CAM patients. Newly detected diabetes was found only in CAM patients (29.2%). Although univariate analysis suggested an increased mortality risk in ROCM patients with orbital involvement, the multivariate analysis showed no increased risk with any of the parameters assessed, including COVID-19 positivity. Compared to the non-CAM, the disease presentation was severe in CAM with higher frequency of orbital and intracranial involvement. However, with early detection and treatment, the short term survival was comparable in both groups.

Removal of an ectopic canine tooth in the maxillary sinus using bone lid technique

Objective: Ectopic teeth are teeth that are located deep in the jawbone or in other areas outside the alveolar bone, such as nasal cavity, chin, mandibular bone, palate, orbital cavity, and maxillary sinus. The presence of teeth in the maxillary sinus can cause an inflammatory reaction in the sinus and cause local sinonasal symptoms such as nasal obstruction, facial fullness, headache, hyposmia, and recurrent chronic sinusitis, due to obstruction of the sinus ostium and it can also develop into cysts. Replantation of bone fragments after tooth extraction using the Bone Lid technique can maintain sinus volume. The aim of this paper is to report the extraction of ectopic teeth in the maxillary sinus by using Bone Lid technique.
 Methods: A 9-year-old girl was referred from ENT clinic with complaints of pain in the right cheek and sniffles which were diagnosed as maxillary sinusitis. Radiographic examination showed that the canine tooth was located on the right maxillary sinus. The ectopic canine tooth was removed with a modified bone lid technique.
 Results: The panoramic radiograph and Waters’ projection radiograph postoperatively showed there were no ectopic teeth in the sinus and no volumetric changes of maxillary sinus cavity. In the clinical evaluation of 1 month postoperatively, there were no complaints of pain and sniffles.
 Conclusion: The use of the Bone Lid technique is beneficial because it maintains sinus volume, thus it does not disturb the function of the maxillary sinus.

Management of Posttraumatic Enophthalmos Including Complex Secondary Deficits.

Posttraumatic enophthalmos (PE) arises when the ocular globe is displaced posteriorly and inferiorly in the orbital cavity due to a mismatch in orbital volume and orbital content. This most commonly happens after orbital fractures. The resulting disruptions to aesthetic form and ocular functions often necessitate surgical correction for reconstruction and restoration. The purpose of surgical management of PE is to reconstruct orbital shape and volume as well as to restore any herniated orbital content. This can be particularly challenging in cases involving large defects that require complex orbital reconstruction. Recent advancements in computer-aided surgery have introduced innovative and important tools to assist surgeons with these difficult cases. The ability to create customized, patient-specific implants can facilitate reconstruction involving complicated anatomy. Additionally, intraoperative imaging and intraoperative navigation can serve as useful guides for surgeons to more accurately place implants, especially in cases with limited visualization, in order to achieve optimal outcomes.

CT anatomy of the head in the Ile de France sheep.

BackgroundCT scan images provide accurate anatomical data from different areas of the body that can be used to diagnose diseases.ObjectivesThe present work aimed to describe the normal anatomical structures of the Ile de France sheep head and its morphometric and volumetric properties using computed tomography (CT) and stereological methods.MethodsFive adult Ile de France sheep heads, which were of mature age (above 10 months), were included in this study. The different cavities of the head, including the nasal cavity, paranasal sinuses, oral cavity, orbital cavity and vestibulocochlear system, were evaluated using CT scans, cross, sagittal and coronal sections.ResultsThe mean length, height and width of the skull were 25.3 ± 1.02, 9.8 ± 0.93 and 12.3 ± 0.91 cm, respectively. The results showed that the nasal cavity is divided into three regions. Vestibular, respiratory and olfactory regions. The paranasal sinuses are composed of maxillary, frontal, palatine, sphenoid, lacrimal and ethmoidal that were identified and named in the CT scan images and their corresponding anatomical cross‐sections. The total volume of the head, nasal cavity and oral cavity was estimated to be 2998 ± 202.00, 303 ± 31.33 and 229.3 ± 10.61 cm3, respectively.ConclusionsThe frontal sinus in the Ile de France sheep was limited to the frontal bone without extending into the parietal, temporal, or occipital bones, similar to Saanen goat. This study provided a comprehensive atlas of Ile de France sheep anatomy to internal medicine veterinarians and surgeons.

Anatomical variations of the maxillary sinus and their relationship with pathologies of surrounding structures: A literature review

IntroductionAnatomically, the maxillary sinus (MS) and maxillary bone is a complex structure to study, due to its walls and its communication with different structures such as the respiratory system, upper teeth and the orbital cavity, specifically the floor of this cavity and the inferomedial region. The MS is a pneumatic cavity housed within the body of the mandible that communicates with the nasal cavity through the ostium at the middle nasal meatus.MethodsThis literature review seeks to describe the characteristics of the anatomical variations of the region of the maxillary sinus, The search process was carried out in the following databases; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS and GOOGLE SCHOLAR, using as search terms; “Maxillary bone”, “Maxillary sinus”, “Paranasal sinus”, “Anatomical variations”, “Sinusitis” and “Clinical anatomy”.ResultsDifferent anatomical variations of the sinus and maxillary bone were found, being mainly the anterior and medial maxillary regions, those that presented the greatest number of variations in their walls or external and internal structures, from the clinical point of view, there are variations that can cause sinusitis, some types of tumors or affect neighboring structures that can be compromised by this variation.ConclusionThe results obtained in this review show that MS is a complex anatomical structure for its study, which is why it is also certainly complex to be able to distinguish the presence of anatomical variations or pathological abnormalities. Therefore, the knowing the different variations and the possible clinical relationship of these can be very useful for the clinical practice of medical personnel who are dedicated to this region.

Subarachnoid space of the optic nerve sheath and intracranial hypertension: a macroscopic, light and electron microscopic study.

The optic nerve (ON) is an extension of the central nervous system via the optic canal to the orbital cavity. It is accompanied by meninges whose arachnoid layer is in continuity with that of the chiasmatic cistern. This arachnoid layer is extended along the ON, delimiting a subarachnoid space (SAS) around the ON. Not all forms of chronic intracranial hypertension (ICH) present papilledema. The latter is sometimes asymmetric, unilateral, or absent. The radiological signs of optic nerve sheath (ONS) dilation, in magnetic resonance imaging, are inconsistent or difficult to interpret. The objective of this study was to analyze the anatomy, the constitution, and the variability of the SAS around the ON in its intraorbital segment to improve the understanding of the pathophysiologic mechanism of asymmetric or unilateral or absent papilledema in certain ICH. The study was carried out on nine cadaveric specimens. In four embalmed specimens, macroscopic analysis of the SAS of the ONS were performed, with description about density of the arachnoid trabecular meshwork in three distinct areas (bulbar segment, mid-orbital segment and the precanal segment). In three other embalmed specimens, after staining of SAS by methylene blue (MB), we performed macroscopic analysis of MB progression in the SAS of the ONS. Then, in two non-embalmed specimens, light and electron microscopy (EM) analysis were also done. On the macroscopic level, after staining of SAS, we found in all cases that MB progressed on 16mm average throughout the SAS of the ONS without reaching the papilla. In four embalmed specimens, in the SAS of the ONS, the density of the arachnoid trabecular meshwork showed inter-individual variability (100%) and intra-individual variability with bilateral variability (50%) and/or variability within the same ONS (88%). On the microscopic level, the arachnoid trabeculae of the ONS are composed of dense connective tissue. The EM perfectly depicted its composition which is mainly of collagen fibers of parallel orientation. The variability of the SAS around the ONS probably impacts the symmetrical or asymmetrical nature of papilledema in ICH.

Clinical Profile of Proptosis in Dr. M. Djamil General Hospital Padang

Background. Proptosis is a condition that describes a protrusion or forward shift of the eyeball and is commonly used to describe the condition of protrusion of the eyeball. Proptosis generally occurs due to a mismatch between the orbital capacity and the volume of the tissue structure in the orbital cavity. It is a common manifestation of a wide variety of diseases of the structures in and around the orbit and in some systemic diseases. This study aimed to describe the clinical profile of proptosis patients in Dr. M. Djamil General Hospital Padang.
 Methods. We reviewed the medical record of the oncology subdivision of ophthalmology patients associated with proptosis retrospectively, such as inflammatory, infectious, tumors, and vascular, admitted to the M.Djamil General Hospital in Padang from January 2019 to August 2020. The ocular and systemic history and examination details were recorded.
 Results. We found 48 proptosis patients from January 2019 to August 2020, consisting of 30(62.5%) males and 18(37,5%) females. The majority of subjects were in the Adult age group (79,17%). Unilateral and bilateral proptosis were found in 37(77%) and 11(23%), with mostly axial proptosis (83,33%). Inflammatory tumors were found in 17(35,41) and 29(60%) patients.
 Conclusion. Proptosis is a common clinical feature of various local and systemic diseases. Even though proptosis have diverse etiology and pathogenesis, they usually present with similar clinical manifestation. Proptosis may be one of the most important keys to disease guidance from a close structure that requires a multidisciplinary approach.

Rubber tree fruit in the eye

Orbital foreign bodies are seen commonly, but the presence of an unusually large organic foreign body in-toto in the orbital cavity is rare. Here, we are discussing a case of the organic orbital foreign body following a fall. A 22-year-old gentleman with a history of fall presented to us with a large organic foreign body in his right orbit with the collapsed globe. Following thorough history and evaluation, the foreign body was removed and the globe was repaired. The eye became phthisical. A custom-fit prosthesis was applied a month after surgery. We are highlighting the importance of surgical intervention and follow-up to achieve good cosmetic outcomes and the importance of protective gear in the workplace.