ANATOMY OF THE ORBIT
1.- ORBITAL WALLS
(Figures 4 & 5)
- Frontal bone (Orbital process) (3)
- Lesser wing of sphenoid (9)
Supraorbital incisure (10)
- Orbital plate of maxillary bone (1)
- Maxillary process of zygomatic bone (2b)
- Orbital process of palatinal bone (11)
Infraorbital foramen (7).
Inferior orbital fissure (8)
- Frontal process of maxillary bone (Anterior) (5)
- Lacrimal bone (Posterior)(6)
- Lamina papyracea of Ethmoid bone (4)
- Lateral aspect of spheniod body (9)
- Orbital surface of zygomatic bone (2a)
- Frontal bone (3)
- Greater wing of sphenoid (9)
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384932?maxheight=300&maxwidth=300)
Fig. 4: Fig.4
Frontal bone (Orbital process)(3)
Supraorbital incisure (10)
Orbital plate of maxillary bone (1)
Zygomatic bone (2)
Infraorbital foramen (7)
Frontal process of maxillary bone (Anterior) (5)
Lacrimal bone (Posterior)(6)
Lamina papyracea of Ethmoid bone (4)
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384933?maxheight=300&maxwidth=300)
Fig. 5: Fig 5.
Frontal bone (Orbital process) (3)
Lesser wing of sphenoid (9)
Supraorbital incisure (10)
Orbital plate of maxillary bone (1)
Maxillary process of zygomatic bone (2b)
Orbital process of palatinal bone (11)
Infraorbital foramen (7).
Inferior orbital fissure (8)
Frontal process of maxillary bone (Anterior) (5)
Lacrimal bone (Posterior)(6)
Lamina papyracea of Ethmoid bone (4)
Lateral aspect of spheniod body (9)
LATERAL WALL
- Orbital surface of zygomatic bone (2a)
- Frontal bone (3)
- Greater wing of sphenoid (9)
2.- ORBITAL CONTENT
- FORAMINA AND FISSURES (Figures 6-7)
- Supraorbital incisure (1):Supraorbital artery and nerve
- Infraorbital foramen (5): Infraorbital artery and nerve
Inside the orbit:
- Optic canal (2): CN II and ophtalmic artery
- Superior orbital fissure (3): CN III,
IV,V1,
VI and superior ophtalmic vein.
- Inferior orbital fissure (4): CN V2 and inferior ophtalmic vein.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384414?maxheight=300&maxwidth=300)
Fig. 6: Fig. 6.
- Supraorbital incisure (1): Supraorbital artery and nerve
- Infraorbital foramen (5): Infraorbital artery and nerve
Inside the orbit:
- Optic canal (2): CN II and ophtalmic artery
- Superior orbital fissure (3): CN III, IV,V1, VI and superior ophtalmic vein.
- Inferior orbital fissure (4): CN V2 and inferior ophtalmic vein.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384575?maxheight=300&maxwidth=300)
Fig. 7: Fig. 7
Foramina and fissures of orbit. Relationships.
- GLOBE AND OPTIC NERVE (includes ophtalmic artery)
- INTRACONAL SPACE: Intraconic fat and superior ophtalmic vein
- EXTRAOCULAR MUSCLES: Recti (superior,
inferior,
medial and lateral),
superior and inferior oblique muscles.
- EXTRACONAL SPACE: Extraconic fat and lacrimal gland
FACIAL BONES AND ORBITAL WALLS: (figures 8-9)
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384934?maxheight=300&maxwidth=300)
Fig. 8: Fig.8.
Frontal projection (Caldwell view)
1. Zygomaticofrontal suture
2. Orbital process of frontal bone
3. Anterior orbital roof
4. Upper rim of orbit
5. Frontal sinus
6. Lamina papyracea
7. Posterior orbital floor
8. Posterior lacrimal crest
9. Anterior orbital wall
10. Frontal process of maxilla
11. Lateral nasal wall
12. Lateral maxillary wall
13. Hard palate
14. Perpendicular ethmoid plate and vomer
15. Superior orbital fissure
16. Oblique orbital line
17. Orbital process of zygoma
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384935?maxheight=300&maxwidth=300)
Fig. 9: Fig.9.
Orbital walls in a case of Lefort II fracture.
Reconstruction in the coronal plane.
C=crista galli
E=ethmoidal sinus roof-fovea ethmoidalis
1. Posterior lacrimal crest
2. Anterior orbital floor
3. Lateral nasal wall
4. Anterior orbital roof
5. Perpendicular ethmoid plate and vomer
1.- LE FORT FRACTURES
Le Fort fractures involve a separation of all or a portion of the maxilla from the skull base.
Invariably entail a pterygomaxillary disjunction.
All Le Fort fractures require disruption of the pterygoids from the posterior maxilla.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384936?maxheight=300&maxwidth=300)
Fig. 10: Fig.10.
Le Fort fractures
- Le Fort I pattern (fig 11) involves fractures through the inferior portions of the medial and lateral maxillary buttresses.
The Le Fort I fracture is the only one that involves the anterolateral margin of the nasal fossa just above the maxillary alveolar process.
If the anterolateral margin of the nasal fossa is intact,
a Le Fort I fracture is excluded.
Transverse injury that crosses the floor of the nose,
pyriform aperture,
canine fossa,
and lateral wall from the maxilla,
resulting in separation of the palate from the maxilla.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384580?maxheight=300&maxwidth=300)
Fig. 11: Fig.11.
Le Fort I Fracture, of Guerin or transverse fracture of the maxilla
- Le Fort II fracture (fig 12.
Graphic) (also can see in fig 9.
CT) involves fractures through the zygomaticomaxillary and frontomaxillary sutures.
The Le Fort II fracture is the only one that involves the inferior orbital rim.
If the inferior orbital rim is intact,
a Le Fort II fracture is excluded.
It crosses the nasal bones on the ascending process of the maxilla and lacrimal bone and crosses the orbital rim.
Figure 25.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384750?maxheight=300&maxwidth=300)
Fig. 25: Fig.25.
Nasal bone fracture and vertical lamina of maxillar-vomer: extending stroke to lower aspect of the medial orbital wall. Lefort II fracture.
Only the Le Fort II fracture violates the orbital rim (fig 18).
Le Fort II fracture extends posteriorly to the pterygoid plates at the base of the skull.
A Le Fort I fracture is characterized by a low septal fracture,
whereas a Le Fort II fracture results in a high septal fracture.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384581?maxheight=300&maxwidth=300)
Fig. 12: Fig.12.
Le Fort II or Pyramidal fracture
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384588?maxheight=300&maxwidth=300)
Fig. 18: Fig.18.
LeFort II fracture: comminuted fracture of maxillary sinus walls, with a trace that runs through the nasal root, lacrimal bone, infraorbital rim and the wall of the maxilla to the pterygoid process
- Le Fort III pattern (fig 13.
Graphic) involves complete craniofacial dissociation (fig 19).
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384760?maxheight=300&maxwidth=300)
Fig. 29: Fig.29.
Orbitozygomatic comminuted fracture. Nasal bone, maxillary sinus walls, and malar injury. Lefort III fracture.
Le Fort III fracture is the only one that involves the zygomatic arch (fig 29).
Crosses the frontal process of the maxilla,
the lacrimal bone,
the lamina papyracea,
and the orbital floor.
This fracture often involves the posterior plate of the ethmoid.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384582?maxheight=300&maxwidth=300)
Fig. 13: Fig.13.
Le Fort III or craniofacial disjunction
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384589?maxheight=300&maxwidth=300)
Fig. 19: Fig.19.
LeFort III fracture or craniofacial disjunction:
The fracture line goes to the root nasal, lacrimal bone, frontal process of malar bone, lateral and posterior wall of the maxilla to pterygoid process.
Another classification system is the Wassmund system.
This system classifies fractures into grades I-V.
A Wassmund II fracture is equivalent to a Le Fort II fracture.
A Wassmund IV fracture is equivalent to a Le Fort III fracture.
Wassmund I and III fractures (Fig 14 & 15) are similar as a Le Fort II and III fractures without inclusion of the nasal bones (comparison-Fig 16 & 17).
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384583?maxheight=300&maxwidth=300)
Fig. 14: Fig.14.
Wassmund I fracture
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384584?maxheight=300&maxwidth=300)
Fig. 15: Fig.15.
Wassmund III fracture
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384585?maxheight=300&maxwidth=300)
Fig. 16: Fig.16.
Wassmund I and Le Fort II fractures comparison
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384586?maxheight=300&maxwidth=300)
Fig. 17: Fig.17.
Wassmund III and Le Fort III fractures comparison
2.- ORBITAL FLOOR FRACTURES
It may occur isolated or associated with Le Fort II fracture. Should be given special attention to the existence of collapse of the floor (fig 20) and the position and shape of the inferior rectus; it may require surgical approach (figs 21-22).
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384745?maxheight=300&maxwidth=300)
Fig. 20: Fig.20.
Orbital floor fracture with mild collapse, herniation of extraconic fat and hemosinus
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384746?maxheight=300&maxwidth=300)
Fig. 21: Fig.21.
Orbital floor collapse: CT Reconstructions in sagittal and coronal planes. Hemosinus occupation is appreciated. Striation extraconal fat with herniation of inferior rectus muscle.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384747?maxheight=300&maxwidth=300)
Fig. 22: Fig.22.
Diplopia. Orbital floor fracture: Axial and Coronal CT images. Herniation of fat and inferior rectus muscle due collapse and floor disruption.
3.- MEDIAL ORBITAL WALL FRACTURES (figs 23- 25)
They may determine entrapment of the medial rectus muscle and diplopia (fig 24).
If the posterior-medial orbital bulge is lost,
blow-out fractures of medial wall cause enophtalmos.
(Fig 25: view also Le Fort fracture II).
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384748?maxheight=300&maxwidth=300)
Fig. 23: Fig.23.
Fracture-collapse of medial wall of the orbit: Lamina papyracea of ethmoid is fractured. Occupation of ethmoidal cells.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384749?maxheight=300&maxwidth=300)
Fig. 24: Fig.24.
Diplopia. There is dislocation of the left medial rectus muscle in a case of fracture of the medial orbital wall.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384750?maxheight=300&maxwidth=300)
Fig. 25: Fig.25.
Nasal bone fracture and vertical lamina of maxillar-vomer: extending stroke to lower aspect of the medial orbital wall. Lefort II fracture.
4.- ORBITAL ROOF-APEX FRACTURES (figs 26-27)
These fractures are rare,
but can produce dural affectation and optic nerve impingement.
They may requiere surgical intervention if ocurr loss of vision due to optic nerve compresion secondary to the existence of retrobulbar hematoma or bony fragments detached.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384755?maxheight=300&maxwidth=300)
Fig. 26: Fig.26.
Frontonasal and orbital collapse: Fracture of the anterior wall of the frontal sinus with occupation. Note the existence of comminuted fracture of the orbital roof and medial wall. Left exophthalmos.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384756?maxheight=300&maxwidth=300)
Fig. 27: Fig.27.
Orbital apex fracture, and foreign bodies in soft tissues of the roof. Frontal sinus and medial wall fracture with collapse, with metallic foreign body in left orbit.
5.- LATERAL ORBITAL WALL FRACTURES
The lateral orbital wall is strongest than the other orbital walls.
However,
it is commonly fractured in the setting of severe facial trauma (figs 28-29).
The fracture usually occurs at the sphenozygomatic suture line.
Isolated lateral orbital wall fractures are rare and only occur after isolated trauma to this anatomical structure.
Much more common is a lateral orbital wall fracture together with a zygoma fracture.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384759?maxheight=300&maxwidth=300)
Fig. 28: Fig.28.
Orbital "blow-out". Malar, lateral wall, medial wall and orbital floor fractures. Glass foreign body. Lefort III fracture.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384760?maxheight=300&maxwidth=300)
Fig. 29: Fig.29.
Orbitozygomatic comminuted fracture. Nasal bone, maxillary sinus walls, and malar injury. Lefort III fracture.
ORBITAL CONTENT
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384937?maxheight=300&maxwidth=300)
Fig. 30: Fig.30.
Illustration of the section; Eyeball and optic nerve.
Modified scheme of W. S. Müller and Forell. Imaging of orbital and visual pathway pathology. Germany 2006. Pg 48.
MRI Anatomy: A brief reminder (Figs 31,
32 and 33)
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384901?maxheight=300&maxwidth=300)
Fig. 31: Fig.31.
MRI anatomy I
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384902?maxheight=300&maxwidth=300)
Fig. 32: Fig.32.
MRI Anatomy II
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384931?maxheight=300&maxwidth=300)
Fig. 33: Eyeball anatomy
References: virtualmedicalcentre.com/anatomy/the-eye-and-vision
- EYEBALL AND OPTIC NERVE PATHOLOGY
1.- EVALUATION OF THE EYEBALL POSITION
The position of the eyeball should lie in the range of 9.9 +/- 1.7 mm behind the interzygomatic line in axial CT section through the lens (fig 34).
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384895?maxheight=300&maxwidth=300)
Fig. 34: Fig.34.
Axial CT scan. Normal eyeball position
The orbits are often involved in craniofacial malformations,
which include orbital clefts and orbital hypotelorism and hypertelorism.
Measurement of the bony interorbital distance (BID) is useful in
estilblishing the severity of them.
Orbital hypertelorism describes the anatomical situation in
which the medial walls of the orbits are farther apart than normal.
Orbital hypotelorism refers to a decrease in the BID.
Exophthalmos (fig 35) describes abnormal prominence of the globe
and proptosis emphatizes the abnormal protrusion of the
globe: however,
exophthalmos and proptosis are commonly used
as synonyms.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384896?maxheight=300&maxwidth=300)
Fig. 35: Fig.35.
Great right unilateral exophthalmos due to nasal and intraorbital invasion of squamous cell carcinoma of maxilla.
CT orbital measurements in 400 adults. From Mafee MF.
Pruzansky S.
Corrales MM.
et at a in the evaluation of the orbit and the bony intraorbital distancc.
AJNR 1986:7:265-269.
Modified outline in axial CT scan (fig 36)
Table (fig 37) from Mafee.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384897?maxheight=300&maxwidth=300)
Fig. 36: Fig.36.
Modified outline in axial CT scan from Mafee et Al
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384898?maxheight=300&maxwidth=300)
Fig. 37: Fig.37.
Table from Mafee MF. Pruzansky S. Corrales MM. et at. Evaluation of the orbit and the bony intraorbital distance. AJNR 1986:7:265-269.
References: Mafee MF. Pruzansky S. Corrales MM. et at. Evaluation of the orbit and the bony intraorbital distance. AJNR 1986:7:265-269.
Measures to remember
• Eyeball: diameter 23.5 x 23 x 25 mm T-CC-AP
• Orbital volume: 23.5 cc 3.33
• Eyeball position 9.9 + - 1.7 mm posterior to the interzygomatic line
• Optic Nerve: Retrobulbar 5.5 + - 0.8 mm
Waist: 4.2 + - 0.6 mm
2.- TRAUMATIC PATHOLOGY AND OCULAR FOREIGN BODIES
Figures 38-54
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384938?maxheight=300&maxwidth=300)
Fig. 38: Fig.38.
Intralenticular foreign body: Metal shrapnel
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384939?maxheight=300&maxwidth=300)
Fig. 39: Fig.39.
Left eyeball deformity produced by vegetable foreign body not visible on CT scan.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384940?maxheight=300&maxwidth=300)
Fig. 40: Fig.40.
Intraocular foreign body: Splinter of wood. Intraconic, extraconic and in episcleral space of Tenon air presence.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384941?maxheight=300&maxwidth=300)
Fig. 41: Fig.41.
Axial CT scan. Ocular perforation. Metallic foreign body. Ocular deformity with air presence in anterior and posterior chamber. Vitreous hemorrhage (asterisk).
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/395995?maxheight=300&maxwidth=300)
Fig. 42: Fig.42.
Ocular trauma caused by the bursting of a tire. Rubber fragments are observed impacted on the cornea and sclera (white arrows) and metal from the rim in the periorbital soft tissues (black arrows).
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384942?maxheight=300&maxwidth=300)
Fig. 43: Fig.43.
Facial trauma. Perforation of the left eye. Loss of volume. Vitreous hemorrhage. Air in anterior chamber and in extraconic space.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384943?maxheight=300&maxwidth=300)
Fig. 44: Fig.44.
Traumatic injury of right orbit. Blow-out of the eyeball with extraconic preseptal hematoma. Deformity of the eye with vitreous hemorrhage.
Lens luxation.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384944?maxheight=300&maxwidth=300)
Fig. 45: Fig.45.
Eyeball disruption (arrow). Trauma against a doorknob. Haematoma and extraconic air
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384945?maxheight=300&maxwidth=300)
Fig. 46: Fig.46.
Ocular fracture due to a golfball impact. Vitreous hemorrhage and lens dislocation. Extraconic haematoma.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384946?maxheight=300&maxwidth=300)
Fig. 47: Fig.47.
Ophthalmic ultrasound. Traumatic cataract. Hyperechogenic foci related lens opacity.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384954?maxheight=300&maxwidth=300)
Fig. 48: Fig.48.
Orbital fracture; Both medial walls. Bilateral exophthalmos. Dislocation and migration of lens to vitreous body (arrow). Extraconic haematoma and left medial rectus muscle herniation. Right periconic air.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384955?maxheight=300&maxwidth=300)
Fig. 49: Fig.49.
Preseptal haematoma and traumatic lens luxation.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384956?maxheight=300&maxwidth=300)
Fig. 50: Fig.50.
Barotrauma. Blow-out with ocular emptying. Lack of eyeball.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384960?maxheight=300&maxwidth=300)
Fig. 51: Fig.51.
Anticoagulated patient. Conjunctival hemorrhage in the right eye. Coloboma displaces optic nerve. Calcifications in the optic nerve (arrow). Hemorrhage in the left eyelid and extraconic air presence.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384961?maxheight=300&maxwidth=300)
Fig. 52: Fig.52.
Sintrom treatment. Expulsive hemorrhage in the right eye.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384962?maxheight=300&maxwidth=300)
Fig. 53: Fig.53.
Volume loss and bleeding in left vitreous body after cataract surgery. The next day, expulsive hemorrhage.
Right ocular prosthesis.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384963?maxheight=300&maxwidth=300)
Fig. 54: Metal worker. Retroocular fragment of metal in conic fat. Vitreous hemorrhage.
3.- DEGENERATIVE DISEASES,
POSTOPERATIVE IMAGING AND POSTSURGICAL INJURY
Figures 55-60
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384964?maxheight=300&maxwidth=300)
Fig. 55: Fig.55.
Ophthalmic ultrasound. Cataract. Increased volume of the lens, with hyperechoic foci.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384965?maxheight=300&maxwidth=300)
Fig. 56: Fig.56.
Right eye ocular prosthesis
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384966?maxheight=300&maxwidth=300)
Fig. 57: Fig.57.
T1WI in coronal and axial planes and T2 FLAIR WI. History of left eye enucleation for choroidal melanoma.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384967?maxheight=300&maxwidth=300)
Fig. 58: Fig.58.
Phthisis bulbi.Right eyeball atrophy, with abnormal morphology and calcifications. CT and MRI findings.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384968?maxheight=300&maxwidth=300)
Fig. 59: Fig.59.
Left eyeball prosthesis.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384969?maxheight=300&maxwidth=300)
Fig. 60: Fig.60.
CT without and after intravenous contrast media administration. Endophthalmitis and preseptal cellulitis after surgery. Subhyaloid effusion and scleritis . Enhancing septa in vitreous humor.
4.- OPTIC NERVE INFLAMMATION
Fig.
61
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/384970?maxheight=300&maxwidth=300)
Fig. 61: Fig.61.
MRI T2WI. Optic neuritis. Swollen appearance with foci of hypersignal in the right optic nerve. Lesions of multiple sclerosis in brain.
5.- OPTIC NERVE AND INTRAOCULAR TUMOURS
Figures 62-66
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385011?maxheight=300&maxwidth=300)
Fig. 62: Fig.62.
Choroidal melanoma with episcleral extension. CT and eye fundus image.Homogeneous enhancing mass at the nasal side of left eye. Retinal detachment injury(asterisk).
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385016?maxheight=300&maxwidth=300)
Fig. 63: Fig.63.
Choroidal Melanoma: TC without (1) and after contrast media administration (2). T1WI (3), T2WI (4 and 8) and T1WI after gadolinium administration (5, 6 and 7). High density is observed in the precontrast CT scan and discrete enhancement at MRI. Paucimelanotic lesion. The tumor is typically hyperintense on T1WI by the melanic pigment and moderately hypointense on T2WI.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385019?maxheight=300&maxwidth=300)
Fig. 64: Fig.64.
Optic nerve sheath meningioma-en-plaque.
Right optic nerve with linear calcification areas over the sheath. Signal and thickness changes are noted in MRI.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385022?maxheight=300&maxwidth=300)
Fig. 65: Fig.65.
Choroidal osteoma.
Ophthalmic ultrasound, which shows image of acoustic shadow. TC: choroidal densely calcified-ossified nodule adjacent to the optic disc. Eye fundus image.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385027?maxheight=300&maxwidth=300)
Fig. 66: Fig.66.
Neurofibromatosis type I. Right optic nerve glioma. Coronal MRI: low signal on T2WI (upper left corner) and relatively homogeneous enhancement after gadolinium contrat media administration.
T1WI and after contrast media.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385038?maxheight=300&maxwidth=300)
Fig. 67: Fig.67.
Illustration of intraconal space.
Intraconal Space (Star) limited by the extraocular muscles, medial and lateral rectus muscles(*). Modified scheme of W. S. Müller and Forell. Imaging of orbital and visual pathway pathology. Germany 2006. Pg 48.
1.- ANATOMY
Intraconal space is limited by the extraocular muscles, medial and lateral rectus muscles.
*We exclude optic nerve disease,
treated together with the eyeball.
Measures to remember
- Volume fat: men 11.19 +1.41. women 10.10 + - 1.05 cc
- Superior ophthalmic vein: axial: 1.8 + - 0.5 mm
coronal: 2.7 + - 1 mm
2.- PATHOLOGY
Common causes of pathology
- Cavernous hemangioma
- Granulomatous disease
- Lymphoma
- Inflammatory pseudotumor
- Lymphangioma
- Venous angioma
- Orbital varix
- Arteriovenous malformations
- Carotid-cavernous fistula
- Hemangiopericytoma
- Rhabdomyosarcoma
- Metastasis
- Retroseptal cellulitis
- Capillary hemangioma
- Leukemia
- Hematocele
- Chemodectomas
- Lipoma
- Amyloidosis
- Traumatic injury
3.- TRAUMATIC INJURY AND INFLAMMATION
Figures 68-72
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385045?maxheight=300&maxwidth=300)
Fig. 68: Fig.68.
Trauma. Right orbital floor fracture with eyelid edema and emphysema. Air in extraconal space, and in conal intraorbital fat (*).Crepitus and diplopia.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385043?maxheight=300&maxwidth=300)
Fig. 69: Fig.69.
Idiopathic inflammatory pseudotumor.
“Myositic Pseudotumor” occupying the conal fat. It extends to extraocular muscles and extraconal space.
Proptosis painful.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385046?maxheight=300&maxwidth=300)
Fig. 70: Fig.70.
Lamina papyracea fracture-collapse with conjunctival chemosis, and emphysema. Intra and extraconal air delimiting the conal space between the rectus muscles and optic nerve.
Right proptosis.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385138?maxheight=300&maxwidth=300)
Fig. 71: Fig.71.
Craniofacial trauma.Intraconal and preseptal hematoma. It is noted calcification image-retinal drusen incidentally.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385139?maxheight=300&maxwidth=300)
Fig. 72: Fig.72.
Fibrinolysis for pulmonary embolism. Developments in 6 hours of conal large hematoma, which determines left exophthalmos.
4.- VASCULAR DISEASE
Figures 73-76
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385153?maxheight=300&maxwidth=300)
Fig. 73: Fig.73.
Intraorbital venous angioma: tortuous vessels cluster in conal fat. Note posterior collecting vein.
Left proptosis
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385154?maxheight=300&maxwidth=300)
Fig. 74: Fig.74.
Sudden proptosis and chemosis in right eye. Angiography demonstrates spontaneous nontraumatic dural fistula filled by both internal carotid arteries supply.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385155?maxheight=300&maxwidth=300)
Fig. 75: Fig.75.
Vitreous hemorrhage. Right Carotid cavernous fistula.
3D TOF MRI and 3D MR Angiography (MIP reconstructions) after gadolinium contrast media administration.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385156?maxheight=300&maxwidth=300)
Fig. 76: Fig.76.
Melanoma. Temporal bleeding.
Left exophthalmos. Ophthalmic veins increased and Carotid-cavernous fistula.
5.- TUMOURS
Figures 77-80
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385160?maxheight=300&maxwidth=300)
Fig. 77: Fig.77.
Cavernous hemangioma. CT after contrast media administration. Conal tumor enhanced displacing slightly medially CN II.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385161?maxheight=300&maxwidth=300)
Fig. 78: Fig.78.
Cavernous hemangioma. T1-weighted MR images (without and after gadolinium administration) and T2WI in axial plane. Rounded homogenous well defined mass in the conal fat. It is isointense to muscle on T1WI and hyperintense on T2WI with homogeneous enhancement.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385162?maxheight=300&maxwidth=300)
Fig. 79: Fig.79.
Orbital lymphoma.
Invasion of conal fat by multiple similar to muscle signal masses, which enlarge intraconal space and displace extraocular muscles. They have slightly enhanced after gadolinium administration(right column); axial and sagittal planes
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385166?maxheight=300&maxwidth=300)
Fig. 80: Fig.80.
Metastases from melanoma.
T1-weighted images, 3DFSPGR after gadolinium (bottom) and T2WI.
Paucimelanotic melanoma.
Slightly hyperintense on T1WI and T2WI compared to muscle lesion. Incomplete hemosiderotic ring and enhancement after gadolinium administration.
- EXTRAOCULAR MUSCLES (CONAL SPACE)
The conal space is formed by the ocular muscles and an envelope of fascia.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385177?maxheight=300&maxwidth=300)
Fig. 81: Fig.81.
Graphic of the section.
Extraocular muscles (asterisk).
1.- ANATOMY
Measures to remember
- Muscular volume : 2.20 + - 0.80 cc
- Muscle thickness:
Medial rectus muscle: 4.1 + - 0.5 mm
Lateral rectus muscle: 2.9 + - 0.6 mm
Superior rectus muscle: 3.8 + - 0.7 mm
Inferior rectus muscle: 4.9 + - 0.8 mm
Superior oblique muscle: 2.4 + - 0.4 mm
Figures 82-88
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/386737?maxheight=300&maxwidth=300)
Fig. 82: Fig.82.
Extraocular muscles. Frontal view.
1.TROCHLEA
2.SUPERIOR OBLIQUE MUSCLE
3.LEVATOR PALPEBRAE SUPERIORIS MUSCLE
4.SUPERIOR RECTUS MUSCLE
5.MEDIAL RECTUS MUSCLE
6.OPHTALMIC ARTERY
7.CN II
8.INFERIOR RECTUS MUSCLE
9.INFERIOR OBLIQUE MUSCLE
10.LATERAL RECTUS MUSCLE
References: Used with permission from Amirsys Publishing, Inc. Harnsberger. [et al.]. Diagnostic and surgical imaging anatomy. Brain, head &neck, spine . Section II pg 91. Amirsys. Salt Lake City, Utah. 2006
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/386738?maxheight=300&maxwidth=300)
Fig. 83: Fig.83.
Extraocular muscles. Coronal section.
1.SUPERIOR OPHTALMIC VEIN
2.SUPERIOR OBLIQUE MUSCLE
3.LEVATOR PALPEBRAE SUPERIORIS MUSCLE
4.SUPERIOR RECTUS MUSCLE
5.MEDIAL RECTUS MUSCLE
6.OPHTALMIC INFERIOR VEIN
7.DURAL SHEATH OPTIC NERVE
8.INFERIOR RECTUS MUSCLE
9.CN V2.INFRAORBITAL NERVE
10.LATERAL RECTUS MUSCLE
11.LACRIMAL ARTERY AND NERVE
12.CENTRAL RETINAL ARTERY AND VEIN
13.NASOCILIARY NERVE
14.OPHTALMIC ARTERY
15.SUPRAORBITAL NERVE
References: Used with permission from Amirsys Publishing, Inc. Harnsberger. [et al.]. Diagnostic and surgical imaging anatomy. Brain, head &neck, spine . Section II pg 91. Amirsys. Salt Lake City, Utah. 2006
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/386740?maxheight=300&maxwidth=300)
Fig. 84: Fig.84.
Extraocular muscles. Sagittal view.
1.TROCHLEA
2.SUPERIOR OBLIQUE MUSCLE
3.LEVATOR PALPEBRAE SUPERIORIS MUSCLE
4.SUPERIOR RECTUS MUSCLE
5.MEDIAL RECTUS MUSCLE
6.TRIGEMINAL GANGLION
7.CN II
8.INFERIOR RECTUS MUSCLE
9.INFERIOR OBLIQUE MUSCLE
10.LATERAL RECTUS MUSCLE
11.CN III. OCULOMOTOR NERVE
12.CN IV. TROCHLEAR NERVE
13.CN VI. ABDUCENS NERVE
14.CN V1. TRIGEMINAL NERVE
References: Used with permission from Amirsys Publishing, Inc. Harnsberger. [et al.]. Diagnostic and surgical imaging anatomy. Brain, head &neck, spine . Section II pg 91. Amirsys. Salt Lake City, Utah. 2006
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385181?maxheight=300&maxwidth=300)
Fig. 85: Fig.85.
CT of the orbit. Sagittal reconstruction. Anatomy.
OS. Orbital septum
ECS. Extraconal space
ICS. Intraconal space
SRM Superior rectus muscle
IRM Inferior rectus muscle
OIM. Oblique inferior muscle
ON. Optic nerve
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385183?maxheight=300&maxwidth=300)
Fig. 86: Fig.86.
Extraocular muscles. MRI and CT correlation.
Coronal plane
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385184?maxheight=300&maxwidth=300)
Fig. 87: Fig.87.
Extraocular muscles. MRI and CT correlation.
Coronal and axial planes
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385187?maxheight=300&maxwidth=300)
Fig. 88: Fig.88.
Extraocular muscles. MRI correlation. Axial and coronal planes
2.- PATHOLOGY: TRAUMA,
INFLAMMATION AND TUMOURS
Figures 89-97
Common causes of muscle involvement
- Graves Disease (Fig.
89-91)
- Acromegaly
- Myositis (Fig.93)
- Inflammatory pseudotumor (Fig.94)
- Orbital cellulitis
- Granulomatous diseases: Sjögren,
Wegener, sarcoidosis.
- Foreign body reaction
- Rhabdomyosarcoma
- Metastasis
- Traumatic injury and spontaneous haematoma (Fig.92)
- Leukemia
- Lymphoma (Fig.95-96)
- Carotid cavernous fistula
- AV malformation
- Rheumatoid nodule
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385199?maxheight=300&maxwidth=300)
Fig. 89: Fig.89.
Grave's disease: T1WI and T2WI in axial plane.
Thyroid ophthalmopathy.
Involvement of the right superior rectus muscle.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385200?maxheight=300&maxwidth=300)
Fig. 90: Fig.90.
Grave's disease: T1WI and T1-T2WI with fat saturation in coronal plane.
Thyroid ophthalmopathy.
Involvement of the right superior rectus muscle.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385188?maxheight=300&maxwidth=300)
Fig. 91: Fig.91.
Order of likelihood of muscle involvement in thyroid ophthalmopathy:
Inferior, medial, superior, lateral recti muscles, and oblique muscles.
Thyroid ophthalmopathy:
Predilection for muscle bellies. It does not affect the tendons.
Bilateral in 70-80%. Asymmetric involvement in 10-30%,Affecting a single muscle,
in 10% of them. However,
when it affects only one muscle,
the rectus superior muscle is the most common affected. Order of impairment: Inferior-Superior-Medial-Lateral,
and Oblique muscles although all are affected in similar proportion.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385201?maxheight=300&maxwidth=300)
Fig. 92: Fig.92.
Extraocular muscles.Traumatic injury. (See floor and medial wall orbital fractures).
- Inferior rectus muscle herniation secondary to orbital floor fracture. Enlarged detail.
- Dislocation of the medial rectus muscle and displacement through bone defect in lamina papyracea of ethmoid
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385202?maxheight=300&maxwidth=300)
Fig. 93: Fig.93.
Inflammatory diffuse thickening in right orbit. Relatively homogeneous enhancement of contrast media in inferior rectus muscle.
Myosistis.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385203?maxheight=300&maxwidth=300)
Fig. 94: Fig.94.
Idiopathic orbital pseudotumor-Myositic orbital pseudotumor. Extraocular muscle involvement confined to the medial rectus muscle and with superior extension to the common annular tendon.
CT without and after contrast media administration. Homogeneous enhancement.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385204?maxheight=300&maxwidth=300)
Fig. 95: Fig.95.
Lymphoma with extraocular muscle involvement: T1-weighted images and T1WI after gadolinium contrast media administration. Coronal and axial planes.
Mainly peripheral enhancement of the affected enlarged muscles.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385205?maxheight=300&maxwidth=300)
Fig. 96: Fig.96.
Lymphoma with extraocular muscle involvement.
T2WI and T1WI after gadolinium contrast media administration. Coronal plane.
Mainly peripheral enhancement of the affected enlarged muscles.
See also temporal and masseter muscles lymphomatous infiltration
Brown Syndrome:
Cause of strabismus due to congenital or acquired causes that produce shortening, thickening,
swelling or adhesions in the tendon sheath of superior oblique muscle; causing the eye to have difficulty moving upward,
particularly during adduction.
Acquired causes of this syndrome are rheumatic diseases,
surgery or orbital trauma,
and tumors from the orbital roof (as mucocele - Fig.97) or from the superomedial angle invade the orbit and affect superior oblique tendon sheath.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385506?maxheight=300&maxwidth=300)
Fig. 97: Fig.97.
Frontal mucocele with orbital extension. Brown syndrome. Inability to direct eye upward. Acquired cause of this syndrome
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385206?maxheight=300&maxwidth=300)
Fig. 98: Fig.98.
Graphic of the section.
Extraconal space(asterisk).
1.- ANATOMY
- Content
* Extraconal fat
* Lacrimal gland
* Lacrimal sac
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/386741?maxheight=300&maxwidth=300)
Fig. 99: Fig.99.
Extraconal space. Frontal graphic. Content.
1. LACRIMAL GLAND
2. LACRIMAL SAC
3. SUPERIOR LACRIMAL CANAL
4. INFERIOR LACRIMAL CANAL
5. LACRIMAL DUCT
6. EXTRACONIC FAT
- Measures to remember
LACRIMAL GLAND
Man Woman
Thickness (mm) 4.9+-0.8 5.7+-1.2
Area (mm2) 68.5 89.93
* From the seventh decade of life,
lacrimal apparatus reduces its volume up to 30% in women.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/386742?maxheight=300&maxwidth=300)
Fig. 100: Fig.100.
Lacrimal gland. CT and MR Images.
Lacrimal gland lesions
Lacrimal gland lesions are listed in the table on the left.
Inflammatory conditions are by far the most common lesions of the lacrimal gland (i.e.
Sjögren's,
TB,
fungus,
pseudotumor).
These conditions do not cause masses.
The most common mass of the lacrimal gland is lymphoma followed by pleomorphic adenoma.
Epithelial tumors including adenoid cystic tumors are uncommon.
2.- PATHOLOGY: TRAUMA,
INFLAMMATION AND TUMOURS
Common extraconal disease:
- Capillary hemangioma
- Sarcoidosis
- Lacrimal lymphoma
- Lacrimal Inflammatory pseudotumor
- Lymphangioma
- Venous angioma
- Epithelial Tumors
- Dacryoadenitis
- Dermoid and epidermoid tumors
- Hemangiosarcoma and hemangiopericytoma
- Rhabdomyosarcoma
- Orbital encephalocele
- Fibrohystiocitoma
- Cholesterol granuloma
- Peripheral nerve tumors
- Hematocele
- Wegener's granulomatosis
- Lipoma
- Amyloidosis
- Plasmacytoma
Figures 101-114
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385210?maxheight=300&maxwidth=300)
Fig. 101: Fig.101.
Retroseptal cellulitis.
Orbital edema with chemosis after nasal cold. Preseptal and retroseptal cellulitis. Ethmoid lamina papyracea discontinuity . Note subperiosteal extension.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385212?maxheight=300&maxwidth=300)
Fig. 102: Fig.102.
Several cases of extraconic air presence after orbital trauma. In 1,2,3 with intra and extraconal air. In example 4; emphysema is due to rise of the thoracic subcutaneous emphysema with pneumothorax, pneumomediastinum, and air presence between cervicothoracic muscle planes dissected.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385213?maxheight=300&maxwidth=300)
Fig. 103: Fig.103.
Palpebral hematoma over the orbital septum and affecting extraconal space with air bubbles presence, after trivial trauma in anticoagulated patient.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385217?maxheight=300&maxwidth=300)
Fig. 104: Fig.104.
Nonspecific lacrimal swelling. At 15 days, parotid enlargement with intraparotid lymph nodes increased. Preseptal extension of inflammation with erosion of the orbital roof.
Sarcoidosis
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385219?maxheight=300&maxwidth=300)
Fig. 105: Fig.105.
Cellulitis-infectious myositis. Ethmoid sinus changes with extraocular muscle involvement and pre-and retroseptal cellulitis. Medial and lateral extension to the lacrimal sac and to the lacrimal gland.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385222?maxheight=300&maxwidth=300)
Fig. 106: Fig.106.
Wegener's Disease.
Frontal sinusitis (right). T2WI and T1 after gadolinium administration.
T2WI (Up and left, and right inferior corner) and T1 after contrast (left inferior corner) showing secondary spindle morphology intraorbital abscess formation. Note high signal on T2WI, ring enhancement after gadolinium administration, delineating the capsule and the fluid content of the collection.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385223?maxheight=300&maxwidth=300)
Fig. 107: Fig.107.
Lacrimal Idiopathic Pseudotumor. Large mass occupying extraorbital conal fat. Medial displacement of the right optic nerve. Enhancing mass, with some heterogeneous foci, isointense on T1WI and hyperintense on STIR images respect of muscle.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385224?maxheight=300&maxwidth=300)
Fig. 108: Fig.108.
Dermoid cyst: T1WI (1 and 5) in axial and coronal planes. See the well-defined oval mass occupying extraconal and palpebral fat ahead of Tenon's fascia. Homogeneous appearance, no infiltration, and higher signal than muscle..
T1WI with fat saturation (2).
PDWI with FATSAT (3) and T2WI (4). High signal in both, and loss of signal in T1WI with saturation of fat.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385225?maxheight=300&maxwidth=300)
Fig. 109: Fig.109.
Lipoma of orbit.
T1WI and T1WI with fat saturation. Increased volume of extraconic fat; nodular area demarcated in upper outer quadrant, which suppresses fat saturation techniques relating lipoma.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385226?maxheight=300&maxwidth=300)
Fig. 110: Fig.110.
Left: extraaxial metastasis of prostate carcinoma with orbital extension.
Right: stable over time tumour with wide spread -en plaque to sphenoid great wing. Extraconal fusiform orbital mass corresponding with meningioma en plaque.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385227?maxheight=300&maxwidth=300)
Fig. 111: Fig.111.
Lymphoma B of orbit: Invasion of ethmoid sinus and superior orbital fissure with clinical signs of oculomotor dysfunction. Intermediate signal on T1WI and T2WI with enhancement after gadolinium administration. Note areas of cystic degeneration and necrosis.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385376?maxheight=300&maxwidth=300)
Fig. 112: Fig.112.
Eye rupture secondary to suicide attempt. View bone fragments detached from the contralateral temporal fossa.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385377?maxheight=300&maxwidth=300)
Fig. 113: Fig.113.
Facial and orbital hematoma for aggression. Trimalar fracture-collapse of the zygomatic arch.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385378?maxheight=300&maxwidth=300)
Fig. 114: Fig.114.
Fragments of glass on right orbital region with proptosis and preseptal hematoma.
SURROUNDING STRUCTURES
Orbital pathologies are not limited only to primary disorders; many systemic diseases and diseases of the surrounding structures may affect the orbit secondarily.
The orbit is also secondarily affected by the diseases of the cranium and brain,
nasal cavity and paranasal sinuses mainly.
SECONDARY ORBITAL DISEASE: COMMON PATHOLOGY
- Involvement secondary to craniofacialtrauma
- Brain tumors: primary and metastatic.
- Sinusal pathology: ethmoid, sphenoid and maxillary sinus
- Otorhinolaryngological processes: nasal inflammatory disease and tumours
- Primary involvement of bone and soft tissue around the orbit
- Dermatologic Diseases
- Systemic disorders
* Some of these diseases have already been mentioned and displayed in the different sections,
for the specific involvement of any of the orbital compartments.
Figures 115-127
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385379?maxheight=300&maxwidth=300)
Fig. 115: Fig.115.
Subgaleal hematoma with orbital soft tissue extension and to the palpebral apparatus.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385381?maxheight=300&maxwidth=300)
Fig. 116: Fig.116.
Alar Meningioma: spread en-plaque.
MRI with T1-weighted images and T2WI (with and without fat saturation), and after gadolinium contrast media administration.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385382?maxheight=300&maxwidth=300)
Fig. 117: Fig.117.
Alar Meningioma: spread en plaque.
MRI with T1-weighted images with and without fat saturation, and after gadolinium administration. Axial and coronal planes. Note orbital invasion from sphenoid wing.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385499?maxheight=300&maxwidth=300)
Fig. 118: Fig.118.
Squamous cell carcinoma of maxilla. Extension to skull base, nose and orbit, conditioning intraconal space occupation and proptosis.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385500?maxheight=300&maxwidth=300)
Fig. 119: Fig.119.
Nasal chondrosarcoma. Medial orbital wall extension. Low-signal mass with focal hyperintense chondral material.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385501?maxheight=300&maxwidth=300)
Fig. 120: Fig.120.
Orbitofrontal cutaneous squamous cell carcinoma intensely enhanced after intravenous contrast media administration
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385502?maxheight=300&maxwidth=300)
Fig. 121: Fig.121.
Nasal plasmacytoma with orbital extension to lacrimal sac (arrow)
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385505?maxheight=300&maxwidth=300)
Fig. 122: Fig.122.
Solitary fibrous tumor of nasal cavity: orbital extension. Erosion of medial wall and medial displacement of the right internal rectus muscle. In addition to infiltrating the tendon and trochlear portion of the superior oblique (white arrow), while respecting the muscle belly (black arrow). Brown syndrome occurs.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385509?maxheight=300&maxwidth=300)
Fig. 123: Fig.123.
Frontal mucocele with mass effect over the orbital roof
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385510?maxheight=300&maxwidth=300)
Fig. 124: Fig.124.
Frontal mucocele with extension to orbital apex.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385511?maxheight=300&maxwidth=300)
Fig. 125: Fig.125.
Frontal mucocele. History of polyposis. Rupture of frontal sinus and orbital extension.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385512?maxheight=300&maxwidth=300)
Fig. 126: Fig.126.
Recurrence of squamous cell carcinoma in orbit in a patient with muscle and fatreconstructive plastia.
![](https://epos.myesr.org/posterimage/esr/ecr2012/110428/media/385513?maxheight=300&maxwidth=300)
Fig. 127: Fig.127.
Eosinophilic granuloma . US and axial CT through the orbit
(bone window) show retrobulbar mass, proptosis and erosion of the
external orbit wall (lesser wing of sphenoid). Axial and sagittal enhanced T1WI show enhancing soft tissue mass filling the pterion, temporal fossa, left lesser sphenoid wing and extraconal space.