SECTION Ⅱ DISEASES OF THE LACRIMAL APPARATUS 595
CHAPTER Ⅸ DISEASES OF THE LACRIMAL GLAND 595
Ⅰ．Disorders of Secretion 596
(a) Lacrimal Hypersecretion 597
(b) Lacrimal Hyposecretion 599
Ⅱ．Inflammations of the Lacrimal Gland 601
(a) Acuter Dacryoadenitis 601
1．Acute Palpebral Dacryoadenitis 601
2．Acute Orbital and Orbito-palpebral Dacryoadenitis 604
Primary 605
epidemic 606
secondary 606
gonococcal 606
mumps 607
infectious mononucleosis 608
zoster 608
African histoplasmosis 608
(b) Chronic Dacryoadenitis 610
Trachomatous 612
tuberculous 613
leprotic 615
syphilitic 615
actinomycetic 617
(c) Sarcoidosis 618
(d) Mikulicz＇s Syndrome 620
Ⅲ．Lacrimal Involvement in General Disease 622
(a) Thyrotoxicosis 622
(b) Hypothyroidism 623
(c) Other Diseases 623
Blood and connective-tissue diseases;primary amyloidosis 623
Ⅳ．Atrophies of the Lacrimal Gland 625
(a) Senile Atrophy 625
(b) Idiopathic Atrophy (the Gougerot-Sjogren Syndrome) 626
(c) Consecutive Atrophy 635
Ⅴ．Cysts of the Lacrimal Gland 638
(a) Simple Dacryops of the Palpebral Lobe 638
(b) Multiple Cystic Degeneration 640
(c) Simple Cysts of the Orbital Lobe 641
(d) Parasitic and Dermoid Cysts 641
(e) Cysts of Krause＇s Glands 642
Ⅵ．Tumours and Pseudo-tumours of the Lacrimal Gland 643
(a) Pseudo-tumours 647
(b) Tumours 650
1．Epithelial Tumours 650
(ⅰ) Mixed Tumours 652
Benign pleomorphic adenoma 652
malignant pleomorphic adenocarcinoma 655
(ⅱ) Adenocarcinoma 657
(ⅲ) Oncocytoma (Oxyphil-cell Adenoma) 659
(ⅳ) Tumours of Krause＇s Glands 660
(ⅴ) Tumours of Ectopic (Aberrant) Lacrimal Gland Tissue 661
2．Lympho-reticular Tumours 662
(ⅰ) Lymphoma 663
(ⅱ) Leucaemia 664
(ⅲ) Hodgkin＇s Disease 664
(ⅳ) Lymphosarcoma 664
(ⅴ) Reticulo-histiocytoma 665
(ⅵ) Giant Follicular Lymphoma 665
(ⅶ) Plasmocytoma 668
3．Other Tumours 668
Angioma 668
melanoma 668
ganglioneuroma 668
4．Secondary Tumours 669
5．Metastatic Carcinoma 669
Ⅶ．Fistulae of the Lacrimal Gland 670
Ⅷ．Dacryoliths 672
Ⅸ．Prolapse of the Lacrimal Gland 672
CHAPTER Ⅹ DISEASES OF THE LACRIMAL PASSAGES 675
Ⅰ．Epiphora 675
Methods of Inyestigation 677
Instillation of coloured fluids 678
syringing 679
probing 680
radiological examination 682
microscintigraphy 686
nasal examination 686
Ⅱ Insufficiency of the Lacrimal Passages 687
(a) Insufficiency of the Puncta 687
(b) Insufficiency of the Lacrimal Sac 690
(c) Valvular Insufficiency (Pneumatocele) 691
Ⅲ．Inflammations of the Lacrimal Passages 693
(a) Canaliculitis 693
Suppurative 694
trachomatous 695
tuberculous 695
viral 696
actinomycotic 696
mycotic 698
(b) Dacryocystitis 699
Incidence 699
aetiology 700
1．Chronic Dacryocystitis 704
Catarrhal 704
mucocele 704
suppurative 706
2．Acute Dacryocystitis 707
Suppurative 707
peridacryocystitis 709
gangrenous peridacryocystitis 709
Pathology of dacryocystitis 711
treatment 714
3．Dacryocystitis Neonatorum 721
4．Specific Types of Dacryocystitis 724
Trachomatous 724
tuberculous 725
leprotic 728
syphilitic 728
other bacterial infections 729
viral 729
mycotic 729
parasitic 731
myiasis 731
sarcoidosis 731
Ⅳ．Cysts and Diverticula 733
Ⅴ．Tumours and Pseudo-tumours 735
(a) Tumours and Pseudo-tumours of the Canaliculi 735
1．Non-specific Granulomata 735
2．Tumours 737
Papilloma 737
maevus 737
malignant tumours 737
secondary tumours 738
(b) Tumours and Pseudo-tumours of the Lacrimal Sac 738
1．Non-specific Granulomata:Pseudo-tumours 743
2．Epithelial Tumours 745
(ⅰ) Transitional-cell Epithelial Tumours 745
(ⅱ) Adenoma 752
(ⅲ) Pleomorphic Adenoma 752
(ⅳ) Oncocytoma 752
3．Lympho-reticular Tumours 753
Lymphoma 753
lymphosarcoma 754
giant follicular lymphoma 755
reticulum-cell sarcoma 756
Hodgkin＇s disease 756
4．Pigmented Tumours 756
5．Rare Tumours 758
Fibroma 758
haemangioma 758
glomus tumour 758
Kaposi＇s sarcoma 758
lymphangio-endothelioma 758
neurofibroma 758
granular-cell schwannoma 758
sarcomata 758
6．Secondary Tumours 759
7．Metastatic Tumours 759
Ⅵ．Dacryostenosis 759
Of the punctum 759
of the canaliculus 760
of the lacrimal sac and duct 763
Ⅶ．Foreign Bodies;Dacryoliths 766
SECTION Ⅲ DISEASES OF THE ORBIT 771
CHAPTER Ⅺ GENERAL CONSIDERATIONS 773
Ⅰ．Anatomical Considerations 774
Ⅱ．Surgical Approaches 776
Ⅲ．Methods of Investigation 779
(a) Clinical Examination 779
(b) Exophthalmometry 780
(c) Orbitonometry 788
(d) Radiological Investigation 791
1．Plain Radiographs;Tomographs 791
2．Orbital Angiography 797
Arteriography 797
venography 798
3．Orbitography 801
4．Radio-active Isotope Scanning 803
5．Ultrasonography 804
6．Thermography 808
7．Biopsy 809
CHAPTER Ⅻ DISTURBANCES OF THE CIRCULATION 811
Ⅰ．Orbital OEdema 811
Reactive 813
static 814
toxic 815
vasomotor 815
Ⅱ．Venous Congestion and Thrombosis 816
Idiopathic thrombosis of the orbital veins, 816
of the cavernous sinus 818
Ⅲ．Orbital Haemorrhages 819
Spontaneous 819
congestive 821
traumatic 822
Ⅳ．Orbital Varix 825
The Klippel-Trénaunay-Weber syndrome 832
Ⅴ．Aneurysms 834
(a) Saccular Aneurysms 835
1．Of the Carotid Artery 835
2．Of the Ophthalmic Artery 836
3．Of the Lacrimal Artery 839
(b) Arterio-venous Fistula 839
1．Carotico-cavernous Fistula 839
2．Of Orbital Vessels 848
The Wyburn-Mason syndrome 850
general arterial dilatation 850
general arterial dilatation 850
CHAPTER ⅩⅢ INFLAMMATIONS OF THE ORBIT 859
Ⅰ．General Considerations;AEtiology 859
Ⅱ．Non-specific Orbital Inflammations 866
(a) Acute Orbital Inflammations 866
1．Cellulitis and Intra-orbital Abscess 867
2．Gas in the Orbit 871
3．Orbital Thrombophlebitis 871
4．Orbital Osteo-periostitis 872
In adults 873
in infants 876
5．Tenonitis 878
6．The Treatment of Acute Inflammations 880
(b) Cavernous Sinus Thrombophlebitis 884
(c) Chronic Orbital Inflammations 889
1．Inflammatory Pseudo-tumours 889
2．Tolosa-Hunt Syndrome 899
3．Charonic Orbital Myositis 900
Ⅲ．Specific Infections 902
(a) Tuberculosis 902
(b) Syphilis 905
(c) Actinomycosis;Nocardiosis 910
(d) Glanders 913
(e) Anthrax 913
(f) Typhoid 913
(g) Mycotic Infections 914
Aspergillosis 914
phycomycosis (mucormycosis) 916
sporotrichosis 919
maduromycosis 919
cryptococcosis 919
blastomycosis 920
coccidioidomycosis 920
rhinosporidiosis 921
African histoplasmosis 921
candidiasis 921
(h) Parasitic Infestations 921
1．Protozoa:Amoebiasis 921
2．Nemathelminthes 921
Filariasis 921
trichiniasis 922
ascariasis 923
3．Platyhelminthes 924
Schistosomiasis 924
paragonimiasis 924
sparganosis 925
echinococcosis 925
cysticercosis 929
4．Molluscs 931
5．Arthropoda:Myiasis 931
CHAPTER ⅩⅣ ORBITAL INVOLVEMENT IN GENERAL DISEASE 935
Ⅰ．Endocrine Disorders (Thyrotoxicosis and Endocrine Exophthalmos) 935
(a) Clinical Picture 938
The eyelids 940
conjunctiva 943
pupils 944
motility 944
exophthalmos 944
(b) Differential Diagnosis 948
(c) Pathology 949
(d) Pathogenesis 953
(d) Pathogenesis 953
(e) Treatment 956
Ⅱ．Lipoidoses 968
(a) Histiocytosis X 968
Hand-Schüller-Christian disease 969
eosinophilic granuloma 972
Letterer-Siwe disease 978
(b) Sinus Histiocytosis with Massive Lymphadenopathy 974
(c) Juvenile Xanthogranuloma 975
(d) Orbital Xanthomatosis 975
Ⅲ．Amyloidosis 977
Ⅳ．Nodular Fasciitis 979
Ⅴ．Necrotizing Angiitis 979
(a) Polyarteritis Nodosa 980
(b) Giant-cell Arteritis 980
(c) Wegener＇s Granulomatosis 981
Ⅵ．Sarcoidosis 985
Ⅶ．Osteopathies 987
(a) Exostoses 987
(b) Hyperostosis 987
(c) Infantile Cortical Hyperostosis 988
(d) Morgagni＇s Syndrome 990
(e) Fibrous Dysplasia of Bone 992
(f) Osteitis Deformans (Paget＇s Disease) 998
(g) Leontiasis Ossea 1003
CHAPTER ⅩⅤ DEGENERATIONS AND ATROPHIES 1007
Ⅰ．Primary Fat Infiltration of the Orbit 1007
Ⅱ．(Sclerosing) Lipogranulomatosis 1007
Ⅲ．Progressive Lipodystrophy 1010
Ⅳ．Calcareous Degeneration 1011
Ⅴ．Orbital Atrophy 1012
CHAPTER ⅩⅥ CYSTS AND TUMOURS 1017
A．Orbital Cysts 1017
B．Orbital Tumours 1021
Symptomatology 1021
diagnosis 1204
treatment 1204
Ⅰ．Primary Orbital Tumors 1026
(a) Definitive Mesenchymal Tumours 1029
1．Fibroma 1029
Fibrohistiocytoma 1031
2．Lipoma 1031
3．Myxoma 1032
4．Chondroma 1033
5．Osteoma 1034
Osteoid osteoma 1035
osteoclastoma 1036
6．Sarcomata 1037
(ⅰ) Fibrosarcoma 1039
(ⅱ) Liposarcoma 1041
(ⅲ) Chondrosarcoma 1041
(ⅳ) Osteosarcoma 1044
(ⅴ) Ewing＇s Sarcoma of Bone 1045
(ⅵ) Osteogenic Sarcoma of Soft Tissues 1045
(ⅶ) Mesenchymoma 1046
7．Meningioma 1047
(b) Myomatous Tumours 1048
1．Rhabdomyoma 1049
2．Leiomyoma 1049
3．Rhabdomyosarcoma 1051
(c) Lympho-reticular Tumours 1061
1．Benign Lymphoma 1064
2．Lymphosarcoma 1065
3．Reticulum-cell Sarcoma 1067
4．Giant Follicular Lymphoma 1069
5．Burkitt＇s Lymphoma 1070
6．Orbital Involvement in Leucaemia 1073
7．Chloroma 1076
8．Hodgkin＇s Disease 1080
(d) Plasma-cell Tumours 1081
1．Extramedullary Plasmocytoma 1082
2．Multiple Myeloma 1083
(e) Vascular Tumours 1086
1．Haemangioma 1086
2．Gemmangioma 1096
3．Haemangio-endothelioma 1097
Ⅰ．Primary Orbital Tumours－contd． 1098
(e) Vascular Tumours－contd． 1099
4．Haemangio-pericytoma 1099
5．Haemangio-leiomyoma 1100
6．Lymphangioma 1102
(f) Neural Tumours 1105
1．Neurilemmoma 1105
2．Neurofibromatosis 1108
3．Ganglioneuroma 1113
4．Neuroblastoma 1113
5．Tumours of Chromaffin and Chemoreceptor Tissue 1114
(ⅰ) (Alveolar) Non-chromaffin Paraganglioma 1115
(ⅱ) Chemodectoma 1116
6．Tumours of Cerebral Character 1119
7．Granular-cell Schwannoma of Abrikossoff 1121
8．Retinal Anlage Tumour 1122
9．AEsthesioneuroblastoma 1123
10．(Amputation Neuroma) 1123
(g) Epithelial Tumours 1125
1．Carcinoma 1125
2．Dental Epithelial Tumours 1125
Post-radiational Tumours 1129
Ⅱ．Secondary Orbital Tumours 1130
(a) Meningioma 1131
(b) Chordoma 1137
(c) Glioma 1138
(d) Carcinoma 1138
(e) Sarcoma 1139
(f) Retinoblastoma 1139
(g) Malignant Melanoma 1141
Ⅲ．Metastatic Orbital Tumours 1144
(a) Carcinoma 1146
(b) The Carcinoid Syndrome 1149
(c) Renal Adenocarcinoma 1150
(d) Seminoma 1152
(e) Neuroblastoma 1153
(f) Phaeochromocytoma 1159
(g) Nephroblastoma (Wilms＇s Tumour) 1159
(h) Sarcoma 1160
(i) Ewing＇s Sarcoma 1162
(j) Malignant Melanoma 1163
SECTION Ⅳ DISEASES OF THE PARA-ORBITAL REGIONS 1167
Ⅰ．Diseases of the Nose and Paranasal Sinuses 1167
(a) Inflammatory Conditions 1169
(b) Fibrous Dysplasia of Bone 1169
(c) Cysts of the Sinuses 1171
1．Mucocele (Pyocele) 1171
2．Pneumo-sinus Dilatans 1177
3．Dental and Dentigerous Cysts 1178
(d) Tumours of the Nose and Sinuses 1180
1．Benign Tumours 1180
(ⅰ) Osteoma 1180
(ⅱ) Other Benign Tumours 1188
2．Malignant Tumours 1190
(ⅰ) Carcinoma 1191
(ⅱ) Malignant Salivary Tumours 1196
(ⅲ) AEsthesioneuroblastoma 1198
(ⅳ) Sarcoma 1200
Malignant lymphoma 1200
osteosarcoma 1202
fibrosarcoma 1203
rhabdomyosarcoma 1204
(ⅴ) Multiple Myeloma 1205
Ⅱ．Nasopharyngeal Tumours 1206
(a) Nasopharyngeal Fibroma 1208
(b) Malignant Tumours 1210
Carcinoma 1211
sarcoma 1214
plasmocytoma and myeloma 1214
APPENDIX DISPLACEMENTS OF THE GLOBE 1228
A．Proptosis:Exophthalmos 1228
B．Luxation of the Globe 1233
C．Enophthalmos 1235