The Massachusetts Eye and Ear Infirmary Illustrated Manual by Peter K. Kaiser, Roberto Pineda II Neil J. Friedman

By Peter K. Kaiser, Roberto Pineda II Neil J. Friedman

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Co-contraction of medial and lateral rectus muscles causes globe retraction and narrowing of palpebral fissure; narrowing of palpebral fissure on adduction and widening on abduction in all three types; upshoots and downshoots (leash phenomenon) common; may have head turn to fuse; amblyopia rare; rarely associated with deafness and less commonly with other ocular or systemic conditions. Figure 2-10 • Duane's retraction syndrome type 3, demonstrating limited adduction, upshoot (leash phenomenon) and narrowing of the palpebral fissure of the left eye.

Orbital CT scan: Well-defined superotemporal mass with bony erosion. Aneurysmal Bone Cyst Idiopathic, osteolytic, expansile mass typically found in long bones of the extremities or less commonly in the superior orbit. Occurs during adolescence. Intralesional hemorrhage produces proptosis, diplopia, and cranial nerve palsies. • 42 Orbital CT scan: Well-defined soft-tissue mass with bony lysis. 43 Malignant Adult Orbital Tumors Lymphoid Tumors Lymphoid infiltrates account for 10% of orbital tumors.

Multiclonal infiltrates not fulfilling the criteria to be diagnosed as lymphoma may progress to malignant lymphoma. • Systemic evaluation by internist or oncologist in the presence of biopsy-proven orbital lymphoma: includes thoracic, abdominal, and pelvic CT scan, whole body positron emission tomography (PET) scan, complete blood count (CBC) with differential, serum protein electrophoresis, erythrocyte sedimentation rate, and possibly bone scan; bone marrow biopsy is reserved by select cases.

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