Orbitaerkrankungen im Kindesalter

Zusammenfassung

Orbitale Erkrankungen kommen im Säuglings- und Kindesalter relativ häufig vor, wie z. B. Fehlbildungen der Orbita im Rahmen von kraniofazialen Syndromen, gutartige und bösartige Raumforderungen. Aber auch entzündliche und infektiöse Erkrankungen und Verletzungen treten in dieser Altersgruppe auf. Dieser Beitrag gibt einen Überblick über die wichtigeren klinischen und differenzialdiagnostischen Orbitaerkrankungen im Kindesalter.

Abstract

Orbital disorders in childhood include various pathologies. Whereas neoplastic lesions and structural anomalies (which frequently cause strabismus) predominate in newborns and infants, vascular lesions become more common in toddlers. Inflammatory lesions are less common than in adults and affect mostly older children and adolescents. The most common orbital mass in infants and young children is a dermoid cyst, a benign lesion.

Rhabdomyosarcoma as the most common primary orbital malignancy and neuroblastoma as a common metastasis to the orbit should be considered in children with new onset orbital space-occupying lesions.

Capillary hemangioma and lymphangioma (lymphatic malformation) are relatively common vascular orbital lesions in children. Novel therapeutic options include systemic betablockers for capillary hemangioma and sirolimus for lymphangioma. In contrast to adults, external signs of an orbital fracture may be absent or mild in children. If ocular motility restriction after orbital trauma is present in a child without obvious external signs, a „white-eye blowout fracture“ of the orbit should be considered and requires prompt surgical repair if present.

Inflammatory disorders of the orbit such as thyroid-related orbitopathy and idiopathic orbital inflammation are uncommon in young children and occur more frequently in adolescents. In young children, amblyopia may complicate any orbital disease. It should be treated using part-time occlusion or pharmacologic penalisation of the fellow eye and the underlying cause should be addressed.

Kernaussagen

• Verschiedene Krankheitsprozesse können die kindliche Orbita betreffen, einschließlich struktureller Anomalien, benigner und maligner Raumforderungen, entzündlicher und vaskulärer Läsionen sowie aus benachbarten Strukturen übergreifenden Prozessen.

• Bei orbitalen Pathologien im Kindesalter ist die klinische Untersuchung wegweisend, bildgebende Verfahren können diese ergänzen.

• Orbitale Raumforderungen bei jungen Kindern sind meist zystischer Natur (insbesondere Dermoidzyste).

• Der häufigste maligne orbitale Tumor bei Kindern ist das Rhabdomyosarkom, das zumeist im Alter von 5 – 7 Jahren auftritt, durch Biopsie gesichert und dringend in Zusammenarbeit mit pädiatrischen Onkologen behandelt werden muss.

• Orbitale Infektionen müssen intravenös mit Antibiotika therapiert werden, orbitale Abszesse bedürfen meist (insbesondere bei Kindern über 9 Jahren) einer chirurgischen Behandlung.

• Bei der Therapie vaskulärer orbitaler Pathologien gab es in den letzten Jahren große Fortschritte. Kapilläre Hämangiome können mit Betablockern, Lymphangiome mit Sirolimus wirksam behandelt werden.

• Im Gegensatz zu Erwachsenen können Orbitafrakturen bei Kindern ohne deutliche äußere Zeichen bestehen. Die „white-eyed blowout fracture“ (reizarmes Auge, keine oder nur geringe Schwellung bzw. subkutane Einblutung) mit Einschränkung der Motilität des Auges bedarf einer zügigen operativen Versorgung.

• Bei Kindern mit orbitalen Erkrankungen muss immer eine Amblyopie ausgeschlossen werden und diese gegebenenfalls behandelt sowie deren Ursache behoben werden.

Schlüsselwörter

Kinder - Orbita - Erkrankung - Anomalie - Amblyopie

Key words

children - orbit - disorder - anomaly - amblyopia

• Literatur

• 1 Lyons CJ, Chang W, Rootman J. Orbital Disease in Children. In: Taylor D, Hoyt C. eds. Pediatric Ophthalmology. Philadelphia: Elsevier Saunders; 2005: 295-301
• 2 Bullock JD, Goldberg SH, Rakes SM. Orbital tumors in children. Ophthal Plast Reconstr Surg 1989; 5: 13-16
• 3 Brenner D, Elliston C, Hall E. et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001; 176: 289-296
• 4 Hintschich C. Dermis-Fett-Transplantat. Möglichkeiten und Grenzen. Ophthalmologe 2003; 100: 518-524
• 5 Fanella S, Singer A, Embree J. Presentation and management of pediatric orbital cellulitis. Can J Infect Dis Med Microbiol 2011; 22: 97-100
• 6 McKinley SH, Yen MT, Miller AM. et al. Microbiology of pediatric orbital cellulitis. Am J Ophthalmol 2007; 144: 497-501
• 7 Garcia GH, Harris GJ. Criteria for nonsurgical management of subperiosteal abscess of the orbit: analysis of outcomes 1988–1998. Ophthalmology 2000; 107: 1454-1456 discussion 1457–1458
• 8 Bartley GB, Fatourechi V, Kadrmas EF. et al. The incidence of Gravesʼ ophthalmopathy in Olmsted County, Minnesota. Am J Ophthalmol 1995; 120: 511-517
• 9 Gogakos AI, Boboridis K, Krassas GE. Pediatric aspects in Gravesʼ orbitopathy. Pediatr Endocrinol Rev 2010; 7 (Suppl. 02) 234-244
• 10 Krassas GE, Gogakos A. Thyroid-associated ophthalmopathy in juvenile Gravesʼ disease-clinical, endocrine and therapeutic aspects. J Pediatr Endocrinol Metab 2006; 19: 1193-1206
• 11 Durairaj VD, Bartley GB, Garrity JA. Clinical features and treatment of graves ophthalmopathy in pediatric patients. Ophthal Plast Reconstr Surg 2006; 22: 7-12
• 12 Bartalena L, Baldeschi L, Boboridis K. et al. The 2016 European Thyroid Association/European Group on Gravesʼ Orbitopathy Guidelines for the Management of Gravesʼ Orbitopathy. Eur Thyroid J 2016; 5: 9-26
• 13 Sahlmuller M, Schroeter J. [Idiopathic inflammatory orbitopathy]. Klin Monbl Augenheilkd 2011; 228: 827-840 quiz 841–842
• 14 Bau V, Ropke E, Marquardt L. [Idiopathic orbital inflammation syndrome in childhood – case report and literature review]. Klin Monbl Augenheilkd 2010; 227: 760-764
• 15 Mottow LS, Jakobiec FA. Idiopathic inflammatory orbital pseudotumor in childhood. I. Clinical characteristics. Arch Ophthalmol 1978; 96: 1410-1417
• 16 Kwon JH, Moon JH, Kwon MS. et al. The differences of blowout fracture of the inferior orbital wall between children and adults. Arch Otolaryngol Head Neck Surg 2005; 131: 723-727
• 17 Jordan DR, Allen LH, White J. et al. Intervention within days for some orbital floor fractures: the white-eyed blowout. Ophthal Plast Reconstr Surg 1998; 14: 379-390
• 18 Carroll SC, Ng SG. Outcomes of orbital blowout fracture surgery in children and adolescents. Br J Ophthalmol 2010; 94: 736-739
• 19 Sires BS, Goodrich SD, Holds JB. Spontaneous orbital hemorrhage in a child with autoimmune hepatitis. Am J Ophthalmol 1993; 116: 384-385
• 20 Shields JA, Shields CL. Pediatric ocular and periocular tumors. Pediatr Ann 2001; 30: 491-501
• 21 Shields JA, Shields CL. Orbital cysts of childhood – classification, clinical features, and management. Surv Ophthalmol 2004; 49: 281-299
• 22 Castillo Jr BV, Kaufman L. Pediatric tumors of the eye and orbit. Pediatr Clin North Am 2003; 50: 149-172
• 23 Shields JA, Bakewell B, Augsburger JJ. et al. Space-occupying orbital masses in children. A review of 250 consecutive biopsies. Ophthalmology 1986; 93: 379-384
• 24 Sterker I, Frerich B. [Orbital diseases in childhood]. Klin Monbl Augenheilkd 2006; 223: 59-67
• 25 Mahesh L, Krishnakumar S, Subramanian N. et al. Malignant teratoma of the orbit: a clinicopathological study of a case. Orbit 2003; 22: 305-309
• 26 Schaal ST, Kampik A, Hasenfratz G. et al. [Teratoma orbitae in the neonatal period]. Klin Monbl Augenheilkd 1988; 193: 295-300
• 27 International Society for the Study of Vascular Anomalies. ISSVA Classification of Vascular Anomalies. 2018. Im Internet: http://www.issva.org/classification Stand: 10.04.2019
• 28 Leaute-Labreze C, Dumas de la Roque E, Hubiche T. et al. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008; 358: 2649-2651
• 29 Drolet BA, Frommelt PC, Chamlin SL. et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics 2013; 131: 128-140
• 30 Ni N, Guo S, Langer P. Current concepts in the management of periocular infantile (capillary) hemangioma. Curr Opin Ophthalmol 2011; 22: 419-425
• 31 Bilaniuk LT. Vascular lesions of the orbit in children. Neuroimaging Clin N Am 2005; 15: 107-120
• 32 Tunc M, Sadri E, Char DH. Orbital lymphangioma: an analysis of 26 patients. Br J Ophthalmol 1999; 83: 76-80
• 33 Saha K, Leatherbarrow B. Orbital lymphangiomas: a review of management strategies. Curr Opin Ophthalmol 2012; 23: 433-438
• 34 Adams DM, Trenor 3rd CC, Hammill AM. et al. Efficacy and Safety of Sirolimus in the Treatment of Complicated Vascular Anomalies. Pediatrics 2016; 137: e20153257
• 35 Lagreze WA, Joachimsen L, Gross N. et al. Sirolimus-induced regression of a large orbital lymphangioma. Orbit 2019; 38: 79-80
• 36 Listernick R, Charrow J, Greenwald MJ. et al. Optic gliomas in children with neurofibromatosis type 1. J Pediatr 1989; 114: 788-792
• 37 Nicolin G, Parkin P, Mabbott D. et al. Natural history and outcome of optic pathway gliomas in children. Pediatr Blood Cancer 2009; 53: 1231-1237
• 38 Lewis RA, Gerson LP, Axelson KA. et al. von Recklinghausen neurofibromatosis. II. Incidence of optic gliomata. Ophthalmology 1984; 91: 929-935
• 39 Parsa CF, Hoyt CS, Lesser RL. et al. Spontaneous regression of optic gliomas: thirteen cases documented by serial neuroimaging. Arch Ophthalmol 2001; 119: 516-529
• 40 Brodsky M. The Phakomatoses. In: Brodsky M. ed. Pediatric Neuroophthalmology. Berlin: Springer; 2010: 503-510
• 41 DʼAmbrosio AL, Williams SC, Lignelli A. et al. Clinicopathological review: giant cell reparative granuloma of the orbit. Neurosurgery 2005; 57: 773-778
• 42 Shields JA, Shields CL. Rhabdomyosarcoma: review for the ophthalmologist. Surv Ophthalmol 2003; 48: 39-57
• 43 Crist WM, Anderson JR, Meza JL. et al. Intergroup rhabdomyosarcoma study-IV: results for patients with nonmetastatic disease. J Clin Oncol 2001; 19: 3091-3102
• 44 Raney RB, Walterhouse DO, Meza JL. et al. Results of the Intergroup Rhabdomyosarcoma Study Group D9602 protocol, using vincristine and dactinomycin with or without cyclophosphamide and radiation therapy, for newly diagnosed patients with low-risk embryonal rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Childrenʼs Oncology Group. J Clin Oncol 2011; 29: 1312-1318
• 45 Bullock JD, Goldberg SH, Rakes SM. et al. Primary orbital neuroblastoma. Arch Ophthalmol 1989; 107: 1031-1033
• 46 Rothenberg AB, Berdon WE, DʼAngio GJ. et al. The association between neuroblastoma and opsoclonus-myoclonus syndrome: a historical review. Pediatr Radiol 2009; 39: 723-726
• 47 Maris JM. Recent advances in neuroblastoma. N Engl J Med 2010; 362: 2202-2211
• 48 Lyons CJ, Rootman J. Histioytic, hematopoietic and lymphoproliferative disorders. In: Taylor D, Hoyt C. eds. Pediatric Ophthalmology. Philadelphia: Elsevier Saunders; 2005: 344-351
• 49 Dahlmann AH, Simmons I, Picton S. et al. Single-site Langerhans cell histiocytosis (eosinophilic granuloma) of the orbit. Eye (Lond) 2000; 14: 109-110
• 50 Woo KI, Harris GJ. Eosinophilic granuloma of the orbit: understanding the paradox of aggressive destruction responsive to minimal intervention. Ophthal Plast Reconstr Surg 2003; 19: 429-439
• 51 Chung EM, Smirniotopoulos JG, Specht CS. et al. From the archives of the AFIP: Pediatric orbit tumors and tumorlike lesions: nonosseous lesions of the extraocular orbit. Radiographics 2007; 27: 1777-1799
• 52 Bertelmann E, Erb K, Mai C. et al. Maligne Neoplasien der Orbita. Klin Monbl Augenheilkd 2012; 229: e15-e29
• 53 Shields JA, Shields CL, Brotman HK. et al. Cancer metastatic to the orbit: the 2000 Robert M. Curts Lecture. Ophthal Plast Reconstr Surg 2001; 17: 346-354