Tenonitis

Last updated
Tenonitis
Specialty Ophthalmology

Tenonitis is a rare eye disease [1] that is represented by inflammation of Tenon's capsule. Tenon's capsule, also known as the fascial sheath of the eyeball, is a structure surrounding the eyeball, and when it becomes inflamed it may cause issues in regards to vision. Also known as orbital tenonitis, tenonitis is associated with the SLC26A3 gene. [2] The inflammation of the Tenon capsule resulting from heightened blood flow may also affect the lacrimal gland and the extraocular muscles.

Contents

Eye anatomy Schematic diagram of the human eye.png
Eye anatomy

Signs and Symptoms

Signs and symptoms depend on the severity of the case with tenonitis. In mild cases it may just be an uncomfortable sensation in the eye socket. In extreme cases it may cause permanent blindness or eye removal is needed.

Causes

There are no specific causes of this disease. With this being so rare not enough research has been allocated to pinpoint a specific cause of this disease. The main thing that we know about this disease is that the inflammation of the Tenon capsule may be related to macular retinal edema and intraocular pressure quantitative trait locus. [2]

Mechanism

With the lack of research and understanding about this specific disease it is hard to come up with a mechanism that outlines how this arises in the body. Although we cannot pinpoint specifically how it occurs, there are some findings that may help us get to that point in the future. A gene that is associated with orbital tenonitis is the SLC26A3 gene. This gene mediates chloride and bicarbonate exchange and additionally transports sulfate and other anions at the apical membrane, part of the plasma membrane of enterocytes. [3] It is also known that related phenotypes are Increased shRNA abundance (Z-score > 2). [2]

Diagnosis

Tenonitis can be identified and diagnosed a few different ways. Tenon's capsule may have inflammation from a disease called idiopathic orbital inflammation syndrome. [4] There is no history of trauma or adjacent focus of infection with this disease. In order to diagnose tenonitis some type of imaging is needed, such as a CT or MRI. The imaging is used to capture the inflammation and to spot any possible chance of infection. For chronic diseases a biopsy may be needed to determine an underlying condition that may be causing the recurring inflammation. [5]

Treatment

The main course of treatment for this specific disease would be to surgically excise the capsule. There is no info that implies the inflammation of this capsule will go down over time so the known course of action would be to have it surgically removed in order to relieve discomfort and to prevent further irritation to this area. [6]

Prognosis

Although this may not be a lethal disease, it will progressively get worse over time. Depending on the severity of the disease, this may have months of progression. When going past 3 months of having issues, the main course of action would be to surgically relieve the pain or total excision of the affected area.

Epidemiology

This disease has no specific population it targets more. With the information that is provided by previous research, this is a typically universal disease that can affect any population.

Research Directions

Currently there haven't been many studies conducted in regards to Tenon's capsule. In one study the objective was to see the efficacy of excision of the capsule by way of trabeculectomy alone, and also combined with partial tenonectomy. [7] There is further research needed to be done to determine the cause of this specific disease, what happens during the progression of it, and treatment plans that need to be put in place. [7]

Related Research Articles

Glaucoma Eye disease in which high intraocular pressure damages the optic nerve

Glaucoma is a group of eye diseases that result in damage to the optic nerve and cause vision loss. The most common type is open-angle glaucoma, in which the drainage angle for fluid within the eye remains open, with less common types including closed-angle glaucoma and normal-tension glaucoma. Open-angle glaucoma develops slowly over time and there is no pain. Peripheral vision may begin to decrease, followed by central vision, resulting in blindness if not treated. Closed-angle glaucoma can present gradually or suddenly. The sudden presentation may involve severe eye pain, blurred vision, mid-dilated pupil, redness of the eye, and nausea. Vision loss from glaucoma, once it has occurred, is permanent. Eyes affected by glaucoma are referred to as being glaucomatous.

Eye surgery Surgery performed on the eye or its adnexa

Eye surgery, also known as ophthalmic or ocular surgery, is surgery performed on the eye or its adnexa, by an ophthalmologist. Eye surgery is synonymous with ophthalmology. The eye is a very fragile organ, and requires extreme care before, during, and after a surgical procedure to minimize or prevent further damage. An expert eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. Today it continues to be a widely practiced type of surgery, with various techniques having been developed for treating eye problems.

Phacoemulsification Type of cataract surgery

Phacoemulsification is a modern cataract surgery method in which the eye's internal lens is emulsified with an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the anterior chamber.

Cataract surgery Surgery for the eye

Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye that has developed an opacification, which is referred to as a cataract, and its replacement with an intraocular lens. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract, causing impairment or loss of vision. Some infants are born with congenital cataracts, and certain environmental factors may also lead to cataract formation. Early symptoms may include strong glare from lights and small light sources at night, and reduced acuity at low light levels.

Chemosis Medical condition

Chemosis is the swelling of the conjunctiva. The term derives from the Greek chem- meaning chemical and -osis meaning denoting action. A chemical reaction, or in this case, a chemical reaction of the conjunctiva which is due to the oozing of exudate from abnormally permeable capillaries. In general, chemosis is a nonspecific sign of eye irritation. The outer surface covering appears to have fluid in it. The conjunctiva becomes swollen and gelatinous in appearance. Often, the eye area swells so much that the eyes become difficult or impossible to close fully. Sometimes, it may also appear as if the eyeball has moved slightly backwards from the white part of the eye due to the fluid filled in the conjunctiva all over the eyes except the iris. The iris is not covered by this fluid and so it appears to be moved slightly inwards.

Red eye (medicine) Eye that appears red due to illness / injury. It is a common diseases

A red eye is an eye that appears red due to illness or injury. It is usually injection and prominence of the superficial blood vessels of the conjunctiva, which may be caused by disorders of these or adjacent structures. Conjunctivitis and subconjunctival hemorrhage are two of the less serious but more common causes.

Enucleation of the eye Type of ocular surgery

Enucleation is the removal of the eye that leaves the eye muscles and remaining orbital contents intact. This type of ocular surgery is indicated for a number of ocular tumors, in eyes that have sustained severe trauma, and in eyes that are otherwise blind and painful.

Ectopia lentis Medical condition

Ectopia lentis is a displacement or malposition of the eye's crystalline lens from its normal location. A partial dislocation of a lens is termed lens subluxation or subluxated lens; a complete dislocation of a lens is termed lens luxation or luxated lens.

A glaucoma valve is a medical shunt used in the treatment of glaucoma to reduce the eye's intraocular pressure (IOP).

Trabeculectomy is a surgical procedure used in the treatment of glaucoma to relieve intraocular pressure by removing part of the eye's trabecular meshwork and adjacent structures. It is the most common glaucoma surgery performed and allows drainage of aqueous humor from within the eye to underneath the conjunctiva where it is absorbed. This outpatient procedure was most commonly performed under monitored anesthesia care using a retrobulbar block or peribulbar block or a combination of topical and subtenon anesthesia. Due to the higher risks associated with bulbar blocks, topical analgesia with mild sedation is becoming more common. Rarely general anesthesia will be used, in patients with an inability to cooperate during surgery.

Tenons capsule

Tenon's capsule, also known as the Tenon capsule, fascial sheath of the eyeball or the fascia bulbi, is a thin membrane which envelops the eyeball from the optic nerve to the corneal limbus, separating it from the orbital fat and forming a socket in which it moves.

Buphthalmos Medical condition

Buphthalmos is enlargement of the eyeball and is most commonly seen in infants and young children. It is sometimes referred to as buphthalmia. It usually appears in the newborn period or the first 3 months of life. and in most cases indicates the presence of congenital (infantile) glaucoma, which is a disorder in which elevated pressures within the eye lead to structural eye damage and vision loss.

Pseudoexfoliation syndrome, often abbreviated as PEX and sometimes as PES or PXS, is an aging-related systemic disease manifesting itself primarily in the eyes which is characterized by the accumulation of microscopic granular amyloid-like protein fibers. Its cause is unknown, although there is speculation that there may be a genetic basis. It is more prevalent in women than men, and in persons past the age of seventy. Its prevalence in different human populations varies; for example, it is prevalent in Scandinavia. The buildup of protein clumps can block normal drainage of the eye fluid called the aqueous humor and can cause, in turn, a buildup of pressure leading to glaucoma and loss of vision. As worldwide populations become older because of shifts in demography, PEX may become a matter of greater concern.

Canine glaucoma

Canine glaucoma refers to a group of diseases in dogs that affect the optic nerve and involve a loss of retinal ganglion cells in a characteristic pattern. An intraocular pressure greater than 22 mmHg (2.9 kPa) is a significant risk factor for the development of glaucoma. Untreated glaucoma in dogs leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness.

Primary juvenile glaucoma Medical condition

Primary juvenile glaucoma is glaucoma that develops due to ocular hypertension and is evident either at birth or within the first few years of life. It is caused due to abnormalities in the anterior chamber angle development that obstruct aqueous outflow in the absence of systemic anomalies or other ocular malformation.

Phacolytic glaucoma Medical condition

Phacolytic glaucoma (PG) is a form of glaucoma which is caused due to a leaking mature or immature cataract. Inflammatory glaucoma which occurs in phacolysis is a condition which is a result of the leakage of protein within the lens into the capsule of a mature or hyper mature cataract and involves a simple procedure to be cured that is referred to as cataract extraction.

Secondary glaucoma

Secondary glaucoma is a collection of progressive optic nerve disorders associated with a rise in intraocular pressure (IOP) which results in the loss of vision. In clinical settings, it is defined as the occurrence of IOP above 21 mmHg requiring the prescription of IOP-managing drugs. It can be broadly divided into two subtypes: secondary open-angle glaucoma and secondary angle-closure glaucoma, depending on the closure of the angle between the cornea and the iris. Principal causes of secondary glaucoma include optic nerve trauma or damage, eye disease, surgery, neovascularization, tumours and use of steroid and sulfa drugs. Risk factors for secondary glaucoma include uveitis, cataract surgery and also intraocular tumours. Common treatments are designed according to the type and the underlying causative condition, in addition to the consequent rise in IOP. These include drug therapy, the use of miotics, surgery or laser therapy.

Uveitic glaucoma Glaucoma caused by uveitis or its treatments

Uveitic glaucoma is most commonly a progression stage of noninfectious anterior uveitis or iritis.

Topical prednisolone is a type of glucocorticoid, mainly used in the ophthalmic pathway as eye drops in numerous eye conditions, such as corneal injuries caused by chemicals, burns and alien objects, inflammation of the eyes, mild to moderate non-infectious allergies, disorders of the eyelid, conjunctiva or sclera, ocular inflammation caused by operation and optic neuritis. Some side effects include glaucoma, blurring of vision, eye discomfort, impaired recovery of injured site, scarring of the optic nerve, clouding of lenses and urticaria. However, their prevalence is not known.

Ocular hypotony, ocular hypotension or hypotony is the medical condition in which intraocular pressure (IOP) of the eye is very low.

References

  1. Schlossberg, David (2012). Infections of the Head and Neck. Springer Science & Business Media. p. 38. ISBN   9781461246404 . Retrieved 10 September 2017.
  2. 1 2 3 "Orbital Tenonitis disease: Malacards - Research Articles, Drugs, Genes, Clinical Trials". www.malacards.org. Retrieved 2020-11-12.
  3. "Chloride anion exchanger", Wikipedia, 2020-10-12, retrieved 2020-11-12
  4. Espinoza, Gabriela M. (2010-12-01). "Orbital Inflammatory Pseudotumors: Etiology, Differential Diagnosis, and Management". Current Rheumatology Reports. 12 (6): 443–447. doi:10.1007/s11926-010-0128-8. ISSN   1534-6307. PMID   20803107. S2CID   40726756.
  5. "Inflammatory Orbital Disease - Eye Disorders". Merck Manuals Professional Edition. Retrieved 2020-12-15.
  6. Dubey, Suneeta; Singh, Nishtha (March 2017). "Excision of the Tenon Capsule in Pediatric Trabeculectomy". Journal of Glaucoma. 26 (3): e126–e127. doi:10.1097/IJG.0000000000000469. ISSN   1057-0829. PMID   27367129. S2CID   35439410.
  7. 1 2 Awadein, Ahmed; El Sayed, Yasmine M. (2016-01-01). "Excision of Tenon Capsule in Pediatric Trabeculectomy: A Controlled Study". Journal of Glaucoma. 25 (1): 39–44. doi:10.1097/IJG.0000000000000220. PMID   25651203. S2CID   5193273.