The edema of the optic disc was made by a computer tomogram

Home Treatment Standards Benignosteoporosis (hemangioma, lymphangioma, hemangioperitocyte, neurofibroma, optic nerve meningioma, dermoid and epidermoid cysts, teratoma, glioma of the optic nerve)

Protocol for the provision of medical care to patients withbenign oedemas (hemangioma, lymphangioma, hemangioperitocyte, neurofibroma, optic nerve meningioma, dermoid and epidermoid cysts, teratoma, optic glioma)

Code of the ICD - 10
D 31.6

Signs and diagnostic criteria:

Symptoms of orbital neoplasms - proptosisor the displacement of the eyeball in the opposite direction relative to the tumor, the presence of a tumor during palpation, the restriction of eye movements, edema of the optic nerve, the folds of the choroid; tumor on a computer tomogram.

Hemangioma (capillary) - found in infants and young children,progresses slowly, is localized in the upper nasal part of the orbit, can be transmitted through the eyelid in the form of a bluish formation or accompanied by red hemangiomas of the skin, pales with pressure. Proptosis may worsen during crying, hemangioma may increase in the first year of life, but then spontaneously regress for several years. On a computer tomogram - the formation of an irregular shape.

Cavernous hemangioma
- typically occurs in young and middle age,symptoms from the side of the orbit develop gradually. On a computer tomogram - education with clear contours, mostly inside the muscle cone.

Lymphangioma
- occurs in the first 10 years of life, graduallyprogresses, but the condition can suddenly deteriorate with bleeding from the tumor. Proptosis is intermittent, increasing with respiratory infections. On a computer tomogram - a tumor of irregular shape.

In adults it occurs in middle age,gradually progressing, localized in the upper-forward portion of the orbit, may be accompanied by a subconjunctival lesion (salmon color). On a computer tomogram - the formation of an irregular shape.

Hemangiopericytoma - occurs at any age, slowlyprogresses, is localized in the upper part of the orbit. On a computer tomogram can have clear contours and does not differ from a cavernous hemangioma. Can spread through the bones of the orbit into the temporal fossa and the cavity of the skull.

Neurofibroma (plexiform neurofibroma) - occurs in the first 10 years of life, note ptosis,hypertrophy of the eyelid, S-shaped deformation of the upper eyelid, palpable volume formation in the anterior part of the orbit. On a computer tomogram - a diffuse, irregularly shaped soft tissue formation, there may be a defect in the upper wall of the orbit. Local neurofibroma occurs in young and middle age with a gradual development of orbital symptoms. Patients may have neurofibromatosis. On a computer tomogram - formation with a clear contour in the upper part of the orbit.

Meningioma - the optic nerve shell, occurs inwomen of middle age, is accompanied by a painless, gradually progressive loss of vision and moderate ptosis. When ophthalmoscopy is visible - edema or atrophy of the optic nerve, collaterals around the disc. On a computer tomogram - tubular thickening of the optic nerve, sometimes in the form of a "railway track" (linear shadow inside the lesion).

Dermoid and epidermoid cysts - can manifest themselves as soon after birth,and at a young age; progresses slowly, can be localized in the upper part of the orbit or outside it, outside the orbit (in the upper-temporal region). The cyst, which is localized outside the orbit, is predominantly a round, painless formation with a smooth surface. On a computer tomogram - formation with precise contours, which can do a dent in the bones of the orbit wall.

Teratoma - is at birth, pronounced proptosis,which can progress. Vision is often lost due to high intraocular pressure, optic nerve atrophy, transillumination of the tumor is noted. On a computer tomogram - a multi-chamber soft tissue tumor and an increase in the orbit, it is possible to spread the tumor into the cranial cavity.

Glioma of the optic nerve - occurs at the age of 2-6 years, slowlyprogresses, reduced visual acuity - edema or atrophy of the optic nerve. On a computer tomogram, spindle-shaped enlarged optic nerve. Can spread to the visual canal and chiasmus.

Levels of medical care:
Third level - hospital of ophthalmological profile

Surveys:
1. External inspection
2. Visometry
3. Perimetry
4. Biomicroscopy
5. Ophthalmoscopy
6. Radiography of the orbit and skull
7. Computerized tomography of the skull
8. Echography
9. Fine needle aspiration tumor biopsy (according to indications)

Mandatory laboratory tests:
1. The general analysis of a blood
2. General analysis of urine
3. Blood on RW
4. Blood sugar
5. Hbs antigen

Consultations of specialists on indications:
1. Therapist
2. ENT
3. Oncologist
4. The vascular surgeon

Characteristics of treatment activities:

Hemangioma - cavernous - complete surgical removal; capillary - surgical treatment is indicated in persons older than8-10 years; corticosteroid therapy - topical administration of betamethasone, celeston (may cause complications - skin necrosis, skin and subcutaneous tissue atrophy, embolization of the vessels of the fundus); racemose - the ligation of feeding vessels or their embolization is necessary; The operation should be done with the participation of a vascular surgeon.

Lymphangioma - a tumor, if it is located in front oforbit, can be cured by brachytherapy; at deep localization - application of CO-2 laser scalpel; Sometimes a phased re-surgical procedure is performed.

Hemangiopericytoma - Complete surgical removal, mandatory laser or diathermic coagulation of the tumor bed. Radiation therapy is prescribed based on the histological examination of the removed tumor.

Neurofibroma (plexiform neurofibroma)
- surgical removal using a laser scalpel.

Meningioma - surgical removal within the limits of healthytissues effective in cases of tumor restriction by the optic nerve shells, when there is no lesion of the distal nerve on a computer tomogram; or external exposure is carried out.

Dermoid and epidermoid cysts - Subperiosteal orbitotomy is indicated; with retrobulbar arrangement - osteoplastic orbitotomy.

Teratoma
- surgical removal, with significant size of the cyst, you can first aspirate its contents.

Glioma of the optic nerve
- surgical treatment is indicated with restrictiontumor by an orbital segment of the optic nerve in cases of sharp decrease in visual acuity; if the tumor sprouts the scleral ring, as seen on a computer tomogram, the damaged optic nerve is removed along with the eye.

If it is impossible to conduct adequate treatment on site - refer the patient to the onco-ophthalmologic center of the Institute of Eye Diseases and Tissue Therapy. Filatova AMS of Ukraine.

The final expected result
- preservation of the eye

Term of treatment - 7-10 days

Criteria of quality of treatment:

Removal of the tumor, absence of inflammatory symptoms, preservation of the eye and possibly visual functions, cosmetic effect.

Possible side effects and complications:

Bleeding, ptosis of the upper eyelid, relapse of neoplasm (neurofibroma, teratoma), damage to orbital tissues, optic nerve, vascular disorders in the optic nerve with loss of vision.

Requirements for dietary appointments and restrictions:

No

Requirements for working, rest and rehabilitation:
Patients are disabled for 4 weeks. The period of incapacity for work with lymphangioma, hemangioperitocyte, meningioma, glioma of the optic nerve is determined by the timing of radiation treatment. Clinical examination.

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