Orbital disorders

Ophthalmology atlases abound. It seems that not a month goes by without a new retinal or corneal atlas being published and packaged as the definitive one for practitioners. They are, of course, generally quite good, packed with extremely high-quality photographs and painstakingly organised according to ocular sub-specialty, etiology or clinical symptomatology. However, they often assume a high level of knowledge and insight into the topic covered. Such an assumption often means that the atlas immediately delves into great detail and sometimes impractical complexity involving hand-wringing and hair-splitting.

This is not the case in a new book by Apjit Kaur Chhabra, professor of orbital disease and oculoplasty at the Chhatapati Shahuji Maharaj Medical University in Lucknow in northern India, a book that apparently seeks to reverse this trend. Assuming that the reader has little more than a medical degree and an interest in diagnosing patients’ orbital disease, Prof Chhabra has written the Clinico-Radiological Atlas of Orbital Disorders with a different idea in mind.

Starting with a very short, basic introduction to orbital anatomy and its appearance on CT scan, she quickly jumps straight into the heart of pathology.

The book’s design is extremely practical. Each page covers a single pathological entity with one clinical photograph and between one and three radiological images from the same patient. Expensive or exotic diagnostic modalities such as positron emission tomography or genetic studies are not considered. The text is concise. Accompanying every photograph are several short sentences describing the patient’s initial presentation, the duration of symptoms, a succinct differential diagnosis and prior treatment if applicable. The CT scan images’ text provides the requisite information and whether a biopsy was needed to make or confirm the diagnosis. This last bit of information is crucial: the reader of an atlas often finds him/herself wondering, “Am I really supposed to be able to make the diagnosis based on what I see here?! Help!†The answer of course depends on the pathology (thyrotoxic orbitopathy – yes; Ewing’s sarcoma – no), but the answer is frequently no. Biopsy is often necessary, as the dozens of intraorbital tumors and malformations strongly resemble one another clinically.

Thankfully, the author spares us, the clinicians, the details of the microscopic findings, trusting that we have access to a pathologist for histopathological analysis. But she does assume that we are motivated enough to make an effort to make our own diagnostic contribution based on the radiology, keeping in mind that the average, non-specialist radiologist is often not up to the task when asked to help diagnose ophthalmic disorders. The result is a true, unintimidating clinical companion.

This being a purely diagnostic text, no information is given regarding the treatment and prognosis of either the specific patients shown or the condition in general.

Enthusiasts of this text will hope that Prof Chhabra will publish a similar book discussing the treatment course and outcome of these or analogous patients.

In our Western practices we rarely see such advanced pathology and it would be edifying to learn how such end-stage cases are managed.