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Fig. 7. Episcleritis. (A) External photograph showing conjunctival and episcleral congestion. (B) UMB showing a low-reflective dome-shaped elevation (arrows) and clearly distinct scleral borders (arrowheads).
INFLAMMATORY LEUKOCORIA (TOXOCARIASIS)
Leukocoria, a white pupil, manifests in a variety of conditions.60 B-scan ultrasound is key in assessing the globe and the underlying lesion (see the article
by Fu and colleagues, elsewhere in this issue). Among inflammatory conditions, toxocariasis can present with leukocoria in children. Ocular toxocariasis is caused by Toxocara canis, a common canine intestinal parasite found in up to 50% of healthy
Fig. 8. Anterior scleritis. (A) External photograph showing marked scleral congestion. (B) UBM of diffuse anterior scleritis shows episcleral thickening (arrow) and an irregular sclera with molted areas of low reflectivity (arrowheads). (C) UBM of nodular anterior scleritis shows episcleral thickening and extensive low-reflective infiltration within the sclera (arrow) extending to the ciliary body (arrowhead). (D) UBM of diffuse scleritis with iridocyclitis shows a poorly defined scleral border with low-reflective infiltration and a markedly enlarged ciliary body (arrow).
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Fig. 9. Metastasis to the ciliary body mimicking anterior scleritis. (A) Slit-lamp photograph shows scleral nodule (arrow). (B) UBM shows dome shaped ciliary mass (arrow). (C) CT of the chest reveals a right perihilar soft tissue mass.
dogs. It may infect humans through the ingestion of ova-contaminated soil or vegetables. Toxocariasis can produce three syndromes: (1) leukocoria from chronic endophthalmitis, (2) localized granuloma, and (3) peripheral granuloma (Fig. 11). In all forms, the eye may be asymptomatic or may present with minimal redness and photophobia.61,62
INFECTIOUS ENDOPHTHALMITIS
Infectious endophthalmitis is a devastating intraocular condition that affects both anterior and posterior segments, including the retina and choroid. B-scan ultrasonography has a key role in the evaluation of patients suspected of having
Fig. 10. Posterior scleritis. (A) Axial B-scan shows posterior scleral thickening and low-reflective infiltrate behind the peripapillary sclera and optic nerve creating the classical T-sign (arrows). (B) Axial B-scan shows marked thickening of the sclera with only a very thin band of low reflectivity behind the peripapillary sclera (arrows).
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Fig. 11. Toxocariasis. Transverse B-scan demonstrating a taut membrane (arrow) extending across the vitreous and adherent to an irregularly shaped, highly reflective granuloma that is causing shadowing of the orbit (arrowhead).
endophthalmitis, because vitreous and corneal opacity can preclude view of the posterior segment (see the article by Dadgostar and colleagues, elsewhere in this issue).
INFLAMMATORY ORBITAL DISEASES
Inflammatory orbital diseases can be of infectious or noninfectious origin. Most commonly, orbital inflammation is idiopathic and is labeled as ‘‘nonspecific orbital inflammation’’ or ‘‘orbital pseudotumor.’’ Nonspecific orbital inflammation is classified on the basis of the anatomic target, such as myositis (extraocular muscle), dacryoadenitis (lacrimal gland), or Tolosa-Hunt syndrome (orbital apex). Ultrasonography, CT, and MRI play important roles in differentiating these conditions.
Fig. 12. Orbital myositis. Longitudinal B-scan shows marked enlargement of the medial rectus muscle (arrows) and its inserting tendon (arrowhead).
Fig. 13. Graves’ ophthalmopathy. Longitudinal B-scan shows marked enlargement of the lateral rectus muscle (arrows) with an inserting tendon of normal thickness (arrowhead).
Orbital myositis is inflammation of one or more extraocular muscles. Patients present with restriction of ocular mobility, diplopia, periorbital pain, eyelid swelling, conjunctival congestion, and proptosis. Imaging reveals an enlargement of one or more extraocular muscles along with enlargement of their tendons (Fig. 12). Patients who have Graves’ ophthalmopathy may have symptoms similar to those of patients who have orbital myositis, but ultrasonography usually reveals enlargement of the extraocular muscles without involvement of the tendons (Fig. 13).63–68 Serious orbitopathy may occur when the muscle thicknesses are within the normal range, but such cases are exceptions.69 Serial B-scan imaging of the extraocular muscles and orbital structures also can be used to evaluate disease progression.70
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