Skip to main content

Advertisement

SpringerLink
Log in

Pediatric orbital lesions: ocular pathologies

  • Pictorial Essay
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Orbital pathologies can be broadly classified as ocular, extra-ocular soft-tissue (non-neoplastic and neoplastic), osseous, and traumatic. In part 1 of this orbital series, the authors will discuss the differential diagnosis and key imaging features of pediatric ocular pathologies. These include congenital and developmental lesions (microphthalmos, anophthalmos, persistent fetal vasculature, coloboma, morning glory disc anomaly, retinopathy of prematurity, Coats disease), optic disc drusen, infective and inflammatory lesions (uveitis, toxocariasis, toxoplasmosis), and ocular neoplasms (retinoblastoma, retinal hamartoma, choroidal melanoma, choroidal nevus). This pictorial review provides a practical approach to the imaging work-up of these anomalies with a focus on ocular US as the first imaging modality and additional use of CT and/or MRI for the evaluation of intracranial abnormalities. The characteristic imaging features of the non-neoplastic mimics of retinoblastoma, such as persistent fetal vasculature and Coats disease, are also highlighted.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Fig. 26
Fig. 27
Fig. 28
Fig. 29

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not applicable.

References

  1. Bhat R, Al-Samarraie M, Nada A et al (2020) Spotlight on the pediatric eye: a pictorial review of orbital anatomy and congenital orbital pathologies. Neuroradiology J 34(1):21–32. https://doi.org/10.1177/1971400920949232

    Article  Google Scholar 

  2. Malhotra A, Minja FJ, Crum A, Burrowes D (2011) Ocular anatomy and cross-sectional imaging of the eye. Semin Ultrasound CT MRI 32:2–13. https://doi.org/10.1053/j.sult.2010.10.009

    Article  Google Scholar 

  3. Jamieson RV, Grigg JR (2012) Embryology and development of the eye. In: Hoyt CS (ed). Pediatric ophthalmology and strabismus, 4th ed. Elsevier Health Sciences, p. 9–13

  4. Kubal WS (2008) Imaging of orbital trauma. Radiographics 28:1729–1739. https://doi.org/10.1148/rg.286085523

    Article  PubMed  Google Scholar 

  5. Lorente-Ramos RM, Armán JA, Muñoz-Hernández A et al (2012) US of the eye made easy: a comprehensive how-to review with ophthalmoscopic correlation. Radiographics 32:E175-200. https://doi.org/10.1148/rg.325115105

    Article  PubMed  Google Scholar 

  6. Gullopalli V, Patel S, Feldman BH et al (2023) American Academy of Ophthalmology. Retinal detachment. https://eyewiki.aao.org/Retinal_Detachment. Accessed 31 Dec 2023.

  7. Alexander JL, Wei L, Palmer J, Darras A et al (2021) A systematic review of ultrasound biomicroscopy use in pediatric ophthalmology. Eye 35:265–276. https://doi.org/10.1038/s41433-020-01184-4

    Article  PubMed  Google Scholar 

  8. Abramowicz JS, Adhikari S, Dickman E et al (2022) Ocular ultrasound: review of bioeffects and safety, including fetal and point of care perspective. J Ultrasound Med 41:1609–1622. https://doi.org/10.1002/jum.15864

    Article  PubMed  Google Scholar 

  9. Harris GR (2019) Safety considerations for diagnostic ultrasound in the eye. J Ultrasound Med 38:1163–1165. https://doi.org/10.1002/jum.14977

    Article  PubMed  Google Scholar 

  10. Burns NS, Iyer RS, Robinson AJ, Chapman T (2013) Diagnostic imaging of fetal and pediatric orbital abnormalities. AJR Am J Roentgenol 201(6):W797-808. https://doi.org/10.2214/AJR.13.10949

    Article  PubMed  Google Scholar 

  11. Coley BD (2019) Caffey’s pediatric diagnostic imaging. Elsevier, Philadelphia

    Google Scholar 

  12. Aghajani A, Chaibakhsh S (2022) Comment on: “Meta-analysis of ocular axial length in newborns and infants up to 3 years of age.” Surv Ophthalmol 67(2):631–632. https://doi.org/10.1016/j.survophthal.2021.11.010

    Article  PubMed  Google Scholar 

  13. Sukonpan K, Phupong V (2009) A biometric study of the fetal orbit and lens in normal pregnancies. J Clin Ultrasound 37:69–74. https://doi.org/10.1002/jcu.20537

    Article  PubMed  Google Scholar 

  14. Samara A, Eldaya RW (2020) Ocular and brain imaging findings in Peters’ anomaly: a case report and literature review. Radiol Case Rep 15(7):863–866. https://doi.org/10.1016/j.radcr.2020.04.011

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ragge NK, Subak-Sharpe ID, Collin JR (2007) A practical guide to the management of anophthalmia and microphthalmia. Eye 21(10):1290–1300. https://doi.org/10.1038/sj.eye.6702858

    Article  CAS  PubMed  Google Scholar 

  16. Searle A, Shetty P, Melov SJ, Alahakoon TI (2018) Prenatal diagnosis and implications of microphthalmia and anophthalmia with a review of current ultrasound guidelines: two case reports. J Med Case Rep 12(1):250. https://doi.org/10.1186/s13256-018-1746-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Joseph AK, Guerin JB, Eckel LJ et al (2022) Imaging findings of pediatric orbital masses and tumor mimics. Radiographics 42(3):880–897. https://doi.org/10.1148/rg.210116

    Article  PubMed  Google Scholar 

  18. Lingam G, Sen AC, Lingam V et al (2021) Ocular coloboma—a comprehensive review for the clinician. Eye 35(8):2086–2109. https://doi.org/10.1038/s41433-021-01501-5

    Article  PubMed  PubMed Central  Google Scholar 

  19. Smith M, Castillo M (1994) Imaging and differential diagnosis of the large eye. Radiographics 14(4):721–728. https://doi.org/10.1148/radiographics.14.4.7938763

    Article  CAS  PubMed  Google Scholar 

  20. Ellika S, Robson CD, Heidary G, Paldino MJ (2013) Morning glory disc anomaly: characteristic MR imaging findings. Am J Neuroradiol 34(10):2010–2014. https://doi.org/10.3174/ajnr.A3542

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. D’Amico A, Ugga L, Cuocolo R et al (2019) Persisting embryonal infundibular recess in morning glory syndrome: clinical report of a novel association. Am J Neuroradiol 40(5):899–902. https://doi.org/10.3174/ajnr.A6005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lenhart PD, Lambert SR, Newman NJ et al (2006) Intracranial vascular anomalies in patients with morning glory disc anomaly. Am J Ophthalmol 142(4):644–650. https://doi.org/10.1016/j.ajo.2006.05.040

    Article  PubMed  Google Scholar 

  23. Chiang MF, Quinn GE, Fielder AR et al (2021) International Classification of Retinopathy of Prematurity, Third edition. Ophthalmology 128:E51–E68. https://doi.org/10.1016/j.ophtha.2021.05.031

    Article  PubMed  Google Scholar 

  24. Modrzejewska M, Kulik U, Lubiński W (2014) Iris rubeosis, severe respiratory failure and retinopathy of prematurity – case report. Ginekol Pol 85(1):70–73. https://doi.org/10.17772/gp/1695

    Article  PubMed  Google Scholar 

  25. Sen M, Shields CL, Honavar SG, Shields JA (2019) Coats’ disease: an overview of classification, management and outcomes. Indian J Ophthalmol 67(6):763–771. https://doi.org/10.4103/ijo.IJO_841_19

    Article  PubMed  PubMed Central  Google Scholar 

  26. Singh SR, Jayakumar K, Jain S et al (2019) Diagnosis and treatment of bilateral Coats’ disease in a 5-year-old girl. J AAPOS 23(4):243–245. https://doi.org/10.1016/j.jaapos.2019.04.002

    Article  PubMed  Google Scholar 

  27. Jansen RW, de Bloeme CM, Brisse HJ et al (2020) MR imaging features to differentiate retinoblastoma from Coats’ disease and persistent fetal vasculature. Cancers (Basel) 12(12):E3592. https://doi.org/10.3390/cancers12123592

    Article  Google Scholar 

  28. Chang MY, Pineles SL (2016) Optic disc drusen in children. Surv Ophthalmol 61(6):745–758. https://doi.org/10.1016/j.survophthal.2016.03.007

    Article  PubMed  PubMed Central  Google Scholar 

  29. McNicholas MM, Power WJ, Griffin JF (1994) Sonography in optic disc drusen: imaging findings and role in diagnosis when funduscopic findings are normal. AJR Am J Roentgenol 162(1):161–163. https://doi.org/10.2214/ajr.162.1.8273656

    Article  CAS  PubMed  Google Scholar 

  30. Nagaraj UD, Koch BL (2021) Imaging of orbital infectious and inflammatory disease in children. Pediatr Radiol 51:1149–1161. https://doi.org/10.1007/s00247-020-04745-7

    Article  PubMed  Google Scholar 

  31. Dunn JP (2015) Uveitis. Prim Care Clin Office Pract 42:305–323. https://doi.org/10.1016/j.pop.2015.05.003

    Article  Google Scholar 

  32. Barisani-Asenbauer T, Maca SM et al (2001) Treatment of ocular toxocariasis with albendazole. J Ocul Pharmacol Ther 17:287–294. https://doi.org/10.1089/108076801750295317

    Article  CAS  PubMed  Google Scholar 

  33. Levine D, Jani JC, Castro-Aragon I, Cannie M (2017) How does imaging of congenital Zika compare with imaging of other TORCH infections? Radiology 285:744–761. https://doi.org/10.1148/radiol.2017171238

    Article  PubMed  Google Scholar 

  34. Razek AA, Elkhamary S (2011) MRI of retinoblastoma. Br J Radiol 84:775–784. https://doi.org/10.1259/bjr/32022497

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. De Graaf P, Göricke S, Rodjan F et al (2012) Guidelines for imaging retinoblastoma: imaging principles and MRI standardization. Pediatr Radiol 42(1):2–14. https://doi.org/10.1007/s00247-011-2201-5

    Article  PubMed  Google Scholar 

  36. Silvera VM, Guerin JB, Brinjikji W, Dalvin LA (2021) Retinoblastoma: what the neuroradiologist needs to know. AJNR Am J Neuroradiol 42:618–626 (19.3174/ajnr.A6949)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Kadom N, Sze RW (2008) Radiological reasoning: leukocoria in a child. AJR Am J Roentgenol 191:S40-44. https://doi.org/10.2214/AJR.07.7022

    Article  PubMed  Google Scholar 

  38. Crespo MA, Villegas VM, Echevarria ME et al (2021) Adolescent plaque brachytherapy for large choroidal metastasis from lung carcinoid tumor. Case Rep Oncol 14(3):1483–1489. https://doi.org/10.1159/000519045

    Article  PubMed  PubMed Central  Google Scholar 

  39. Martin K, Rossi V, Ferrucci S, Pian D (2010) Retinal astrocytic hamartoma. Optometry 81:221–233. https://doi.org/10.1016/j.optm.2009.12.009

    Article  PubMed  Google Scholar 

  40. Batu Oto B, Yilmaz Çebi A, Kiliçarslan O, Sarici AM (2022) Multimodal imaging of a sporadic retinal astrocytic hamartoma simulating retinoblastoma in a newborn. GMS Ophthalmol Cases 12:Doc11. https://doi.org/10.3205/oc000198

    Article  PubMed  PubMed Central  Google Scholar 

  41. Tailor TD, Gupta D, Dalley RW et al (2013) Orbital neoplasms in adults: clinical, radiologic, and pathologic review. Radiographics 33:1739–1758. https://doi.org/10.1148/rg.336135502

    Article  PubMed  Google Scholar 

  42. Fry MV, Augsburger JJ, Hall J, Corrêa ZM (2018) Posterior uveal melanoma in adolescents and children: current perspectives. Clin Ophthalmol 12:2205–2212. https://doi.org/10.2147/OPTH.S142984

    Article  PubMed  PubMed Central  Google Scholar 

  43. Jiblawi A, Chanbour H, Tayba A et al (2021) Magnetic resonance imaging diagnosis of choroidal melanoma. Cureus 13:e16628. https://doi.org/10.7759/cureus.16628

    Article  PubMed  PubMed Central  Google Scholar 

  44. Chien JL, Sioufi K, Surakiatchanukul T et al (2017) Choroidal nevus: a review of prevalence, features, genetics, risks, and outcomes. Curr Opin Ophthalmol 28:228–237. https://doi.org/10.1097/ICU.0000000000000361

    Article  PubMed  Google Scholar 

  45. Shields CL, Dalvin LA, Ancona-Lezama D et al (2019) Choroidal nevus imaging features in 3,806 cases and risk factors for transformation into melanoma in 2,355 cases: the 2020 Taylor R. Smith and Victor T. Curtin lecture Retina 39:1840–1851. https://doi.org/10.1097/IAE.0000000000002440

    Article  PubMed  Google Scholar 

  46. Peyster RG, Augsburger JJ, Shields JA et al (1988) Intraocular tumors: evaluation with MR imaging. Radiology 168:773–779. https://doi.org/10.1148/radiology.168.3.3406407

    Article  CAS  PubMed  Google Scholar 

  47. Ashour OZ, Stalling M, Ramsey J et al (2018) Intraocular medulloepithelioma. Radiographics 38:194–199. https://doi.org/10.1148/rg.2018170160

    Article  PubMed  Google Scholar 

  48. Bryan RN, Lewis RA, Miller SL (1983) Choroidal osteoma. AJNR Am J Neuroradiol 4(3):491–494. content/4/3/491

  49. Karimi S, Nourinia R, Mashayekhi A (2015) Circumscribed choroidal hemangioma. J Ophthalmic Vis Res 10(3):320–328. https://doi.org/10.4103/2008-322X.170353

    Article  PubMed  PubMed Central  Google Scholar 

  50. Helmi HA, Alkatan HM, Al-Essa RS et al (2021) Choroidal hemangioma in Sturge Weber syndrome: case series with confirmed tissue diagnosis. Int J Surg Case Rep 89:106626. https://doi.org/10.1016/j/ijscr.2021.106626

    Article  PubMed  PubMed Central  Google Scholar 

  51. Stroszczynski C, Hosten N, Bornfeld N et al (1998) Choroidal hemangioma: MR findings and differentiation from uveal melanoma. AJNR Am J Neuroradiol 19(8):1441–1447. http://www.ajnr.org/content/19/8/1441

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Radiology, BC Children’s Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada

    Samantha K. Gerrie, Heena Rajani, Cassidy S. Frayn & Emily C. M. Hughes

  2. Department of Radiology, University of British Columbia, Vancouver, Canada

    Samantha K. Gerrie, Heena Rajani, Cassidy S. Frayn & Emily C. M. Hughes

  3. Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada

    Helen M. Branson & Oscar M. Navarro

  4. Department of Medical Imaging, University of Toronto, Toronto, Canada

    Helen M. Branson & Oscar M. Navarro

  5. Department of Ophthalmology, BC Children’s Hospital, Vancouver, Canada

    Christopher J. Lyons

  6. Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada

    Christopher J. Lyons

  7. Department of Diagnostic Imaging, McMaster Children’s Hospital, McMaster University, Hamilton, Canada

    Eman Marie

Authors
  1. Samantha K. Gerrie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heena Rajani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Helen M. Branson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher J. Lyons
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eman Marie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cassidy S. Frayn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emily C. M. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Oscar M. Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samantha K. Gerrie.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflicts of interest

None

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gerrie, S.K., Rajani, H., Branson, H.M. et al. Pediatric orbital lesions: ocular pathologies. Pediatr Radiol (2024). https://doi.org/10.1007/s00247-024-05869-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00247-024-05869-w

Keywords

Search

Navigation