DIAGNOSTIC VALUE OF ORBITAL ANGIOGRAPHY*

THE value of the various methods of x-ray examination of the orbit is uncontested for the diagnosis of a space-occupying lesion in the orbit. These methods represent therefore an indispensable diagnostic tool, but nevertheless in many instances the nature of the space-occupying orbital lesion remains obscure. It is the purpose of this paper to discuss the value of orbital angiography as an accessory diagnostic method for such lesions. Curtis (1949), Schurr (1951), and Decker (1955) were amongst the first to describe the angiography of the normal ophthalmic artery and the choroidal plexus of the eye. But angiography of pathological orbital structures is a field which is so far largely unexplored. In Schurr's opinion the ophthalmic artery is nearly always visible for at least part of its course in lateral carotid angiograms. But in 200 carotid angiograms performed with 35 per cent. contrast medium (Diodrast) we have been able to demonstrate the ophthalmic artery and its branches in only 24 per cent., i.e. in only about one-fourth of our cases. However for the last 2 years we have used the 60 per cent. contrast medium Urografin-Schering, with the result that the ophthalmic artery could be demonstrated in 98 per cent. of 200 carotid angiograms. In 11 per cent. of the cases this artery was visible for only 1 to 2 cm., but in 87 per cent. all the branches up to the frontal branches were demonstrated. In 74 per cent. the choroidal plexus of the eyeball was also seen as a thin crescent in the outer two-thirds of the orbit. The normal course of the ophthalmic artery is to be seen in the diagrammatic interpretation of Fig. 1 (opposite) and in the arteriograms of Fig. 2 (a, b, opposite). Its course is as a rule fairly constant. It is seen to arise from the internal carotid as it emerges from the cavernous sinus close to the anterior clinoid process. According to Schurr, the artery pursues a slightly tortuous course largely because of the freedom of movement which must be allowed to its branches in order to permit rotation of the eyeball. It is unlikely, therefore, that displacements by space-occupying lesions within the orbit would be easy to detect. The recognition of the different branches of the ophthalmic artery and of the choroidal plexus is not easy, especially in distinguishing them from the outlines of the bone which overlies them. In our experience the stereoscopic views of the angiograms were of great help in the demonstration of these vessels.