Blowout Fracture of the Orbit

Blowout fractures of the orbit are fractures of the orbital wall that are caused by trauma to the orbit. There are a variety of different locations that orbital fractures can occur depending on the force and location of the direct blow. "Buckling" and "Retropulsion" are the two ways to describe what happens to cause an blowout fracture. With the idea of "buckling", the orbital floor fractures due to the buckling of the orbital rim and the transferred pressure to the orbital wall. The idea behind "retropulsion" is that the trauma causes an increased pressure within the orbital cavity, which results in a fracture. Blowout fractures are the result of "retropulsion". These most commonly occur in the floor of the orbit, but cal also occur in the medial wall of the orbit. They are caused by a direct blow to the orbit by an object that is larger in diameter than the orbital socket itself. Naso-orbital fractures also occur from a direct blow, but from an object smaller than the diameter of the orbit. These fractures typically occur to the medial wall in combination with the nasal bones and ethmoid sinus. CT imaging is used to best visualize the location on the fracture. A coronal image is shown above with a orbital floor fracture. Surgery is primarily the only way to treat blowout fractures, because of the location and severity of the fracture they are not likely to heal on their own.

Brown's Syndrome

Brown's Syndrome occurs when the the superior oblique muscle does not move correctly, causing difficulty looking up and in. It can occur as a congenital defect or can occur later in life from surgery, trauma, inflammatory disease, or tumors. The image above is an example of Brown's Syndrome that is caused by a tumor in the sinus. Brown's syndrome is more common in the right eye, and almost always occurs in only one eye. Treatment of this syndrome varies from oral NSAIDs, steroidal injections into the muscle, and surgery. The cause and severity of the syndrome dictate the treatement used. It is not life threatening, and in most cases can be treated.

Pituitary Microadenoma

Pituitary microadenomas are benign tumors affecting the pituitary gland that smaller than 10mm. They can be functional or non-functional. Functional microadenomas produce one of several different types of hormones, while non-functional do not produce any hormones. Some examples of hormones produce by functional microademonas are thyroid, prolactin, growth, and ACTH. Symptoms vary depending on if the tumor is functional or not and also the location of the tumor. Symptoms can include tiredness, restlessness, headaches, vomiting, and dizziness. These tumors can be diagnosed in a variety of ways. MRI, CT, blood tests, petrosal sinus testing, and eye exams are all used in determining a diagnosis. Treatment again is dependent upon the type and location of the microadenoma. It ranges from drug therapy to surgery to radiation treatment. I have included 2 MRI images showing pituitary microadenomas.