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Augenheilkunde up2date 2019; 9(03): 215-235
DOI: 10.1055/a-0819-2776
Tränenwege, Augenlider, Orbita
Georg Thieme Verlag KG Stuttgart · New York

Orbitaerkrankungen im Kindesalter

Orbital Disorders in Childhood
Daniel J. Salchow
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Publikationsverlauf

Publikationsdatum:
16. August 2019 (online)

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Update zu:

Orbitaerkrankungen im KindesalterAugenheilkunde up2date 2013; 3(04): 243-261
DOI: 10.1055/s-0033-1346701

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
 

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