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Abstract

Hydatidosis of the orbit has been reported in about 1 % of all cases of hydatid disease. Its prevalence has been reported from 0.3 to 5 % of all the orbital diseases in the literature. Usually the cyst is located in the intraconal space of the orbit. Hydatidosis is common among children and young adults, who usually present with unilateral, progressive axial proptosis of a few months’ duration, associated with pain or discomfort and defective vision. Clinical suspicion and appropriate investigations are important. Serology may be positive but imaging is definitive for diagnosis. Computed tomography scan of orbit is preferred over orbital ultrasonography. Evaluation for associated systemic hydatidosis is mandatory. If neglected, the cyst can assume a very large size and lead to total loss of vision. Surgical excision of the cyst is recommended which is facilitated by aspiration of the fluid from the cyst after the cyst wall has been exposed and cryoextraction. Other modalities include percutaneous aspiration and injection of hypertonic saline and reaspiration and medical management.

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References

  • Abbassi R, Kacemi L, Bricha M, El Quessar A, El Hassani MR, Chakir N, et al. Cervico-facial hydatid disease: a case report. J Radiol. 2007;88(Pt I):1725–7.

    Article  CAS  PubMed  Google Scholar 

  • Agarwal MB, Kamdar MS, Tilve GH, Bapat RD, Vakil NB, Desai MB. Splenic and orbital hydatid cysts and treatment with mebendazole (a case report). J Postgrad Med. 1982;28:115–7.

    CAS  PubMed  Google Scholar 

  • Akhan O, Bilgic S, Akata D, Kiratli H, Ozmen MN. Percutaneous treatment of an orbital hydatid cyst: a new therapeutic approach. Am J Ophthalmol. 1998;125:877–9.

    Article  CAS  PubMed  Google Scholar 

  • Aksoy FG, Tanrikulu S, Kosar U. Inferiorly located retrobulbar hydatid cyst: CT and MRI features. Comput Med Imaging Graph. 2001;25:535–40.

    Article  CAS  PubMed  Google Scholar 

  • Ali M, Khan H, Khan KH, Khwanzada K, Ayub S, Rahman S. Cranioorbital hydatidosis. J Pediatr Neurol. 2008;6:125–8.

    Google Scholar 

  • Alparslan L, Kanberoglu K, Peksayar G, CokyĂĽksel O. Orbital hydatid cyst: assessment of two cases. Neuroradiology. 1990;32:163–5.

    Article  CAS  PubMed  Google Scholar 

  • Amaya C, Villarejo F, Izquierdo JM, Perez-Higueras A, Blazquez MG. Hydatid cyst: unusual cause of unilateral exophthalmos. Surg Neurol. 1980;14:351–4.

    CAS  PubMed  Google Scholar 

  • Apple DJ, Fajoni ML, Garland PE, Kuhr L, Moel SA. Orbital hydatid cyst. J Pediatr Ophthalmol Strabismus. 1980;17:380–3.

    CAS  PubMed  Google Scholar 

  • Baghdassarian SA, Zakharia H. Report of three cases of hydatid cyst of the orbit. Am J Ophthalmol. 1971;71:1081–4.

    Google Scholar 

  • Bagheri A, Fallahi MR, Yazdani S, Rezaee Kanavi M. Two different presentations of orbital echinococcosis: a report of two cases and review of the literature. Orbit. 2010;29:51–6.

    Article  PubMed  Google Scholar 

  • Bassiri A, Jabi A. Computerised tomography in orbital echinococcosis. Br J Radiol. 1984;57:270–2.

    Google Scholar 

  • Basset D, Girou C, Nozais IP, D’Hermies F, Hoang C, Gordon R, et al. Neotropical echinococcosis in Suriname: Echinococcus oligarthrus in the orbit and Echinococcus vogeli in the abdomen. Am J Trop Med Hyg. 1998;59:787–90.

    CAS  PubMed  Google Scholar 

  • Belmekki M, El Bakkali M, Abdellah H, Benchrifa F, Berraho A. Epidemiology of orbital processes in children. 54 cases (in French). J Fr Ophthalmol. 1999;22:394–8.

    CAS  Google Scholar 

  • Benazzou S, Arkha Y, Derraz S, El Ouahabi A, El Khamlichi A. Orbital hydatid cyst: review of 10 cases. J Craniomaxillofac Surg. 2010;38:274–8.

    Article  PubMed  Google Scholar 

  • Betharia SM, Pushker N, Sharma V, Avinash M, Kashyap S. Disseminated hydatid disease involving orbit, spleen, lung and liver. Ophthalmologica. 2002;216:300–4.

    Article  CAS  PubMed  Google Scholar 

  • Betharia SM, Sharma V, Pushker N. Ultrasound findings in orbital hydatid cysts. Am J Ophthalmol. 2003;135:568–70.

    Article  CAS  PubMed  Google Scholar 

  • Bhaduri G, Chatterjee SS, Gayen S, Goswami S. Hydatid cyst of orbit. J Indian Med Assoc. 2011;109:681–2.

    PubMed  Google Scholar 

  • Chaabouni M, Ben Zina Z, Ben Ayez H, Tounsi R, Trigui A, Ben Mansour H. Kyste hydatique de l’orbite: localisation intra-orbitaire unique. A propos d’une observation. J Fr Ophthalmol. 1999;22:329–34.

    CAS  Google Scholar 

  • Chana HS, Klauss V, Shah A. Orbital hydatid disease in Kenya. Am J Trop Med Hyg. 1986;35:991–4.

    CAS  PubMed  Google Scholar 

  • Ciurea AV, Giuseppe G, Machinis TG, Coman TC, Fountas KN. Orbital hydatid cyst in childhood: a report of two cases. South Med J. 2006;99:620–4.

    Article  PubMed  Google Scholar 

  • Cooney RM, Flanagan KP, Zehyle E. Review of surgical management of cystic hydatid disease in a resource limited setting: Turkana, Kenya. Eur J Gastroenterol Hepatol. 2004;16:1233–6.

    Article  PubMed  Google Scholar 

  • Crompton JL, Iyer PV, Merry DJ, Tomich J, Perrett LV. Hydatid cyst: an unusual cause of diplopia. Aust N Z J Ophthalmol. 1985;13:195–203.

    Article  CAS  PubMed  Google Scholar 

  • D’Alessandro A. Polycystic echinococcosis in tropical America: Echinococcus vogeli and E. oligarthrus. Acta Trop. 1997;67:43–65.

    Article  PubMed  Google Scholar 

  • Danziger A, Price H. Computed tomographic findings in orbital echinococciasis; case report. J Comput Assist Tomogr. 1980;4:128–9.

    Article  CAS  PubMed  Google Scholar 

  • Diatchuk V, Rumelt S, Rehany U. Orbital hydatid cyst manifested as expanding exophthalmos following blunt orbital trauma. J Pediatr Ophthalmol Strabismus. 2005;42:369–71.

    PubMed  Google Scholar 

  • Diren HB, Ozcanli H, Boluk M, Kilic C. Unicellular orbital, cerebral and intraventricular hydatid cysts. Neuroradiology. 1993;35:149–50.

    Article  CAS  PubMed  Google Scholar 

  • ErgĂĽn R, Ă–kten AI, YĂĽksel M, GĂĽl B, EvliyaoĂ°lu C, ErgĂĽngör F, et al. Orbital hydatid cysts: report of four cases. Neurosurg Rev. 1997;20:33–7.

    Article  PubMed  Google Scholar 

  • Fink AM, Newman DE, Stringer DA. Pediatric case of the day. Radiographics. 1995;15:731–4.

    Article  CAS  PubMed  Google Scholar 

  • Garrity JA, Henderson JW. Cyst and cele. In: Hendersons orbital tumor. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 34–61.

    Google Scholar 

  • Gelisken F, Erda S, Kreissig I. Exudative retinal detachment in intraorbital echinococcal cyst (in German). Klin Monbl Augenheilkd. 1994;205:109–11.

    Article  CAS  PubMed  Google Scholar 

  • Gokcek C, Gökçek A, Akif Bayar M, Tanrikulu S, Buharali Z. Orbital hydatid cyst: CT and MRI. Neuroradiology. 1997;39:512–5.

    Article  CAS  PubMed  Google Scholar 

  • Gokcek C, Bayar N, Buharai Z. Total removal of an unruptured orbital hydatid cyst. Can J Ophthalmol. 2001;36:218–20.

    Google Scholar 

  • Gomez Morales A, Croxatto JO, Crovetto L, Ebner R. Hydatid cysts of the orbit. A review of 35 cases. Ophthalmology. 1988;95:1027–32.

    Article  CAS  PubMed  Google Scholar 

  • Groves MW, Muller S, Gathere S, Gachii A, 3rd Johns MM. Pathology quiz case 1. Sino-orbital cystic echinococcosis (CE). Arch Otolaryngol Head Neck Surg. 2009;135:1056, 1058–9.

    Article  PubMed  Google Scholar 

  • Guerinel CL, Roux FX, Bonin A, Lucerna S, Lariche B. Intra-orbital hydatid cyst. An uncommon site of hydatidosis. Discussion apropos of a recent case (in French). Neurochirurgie. 1991;37:200–5.

    PubMed  Google Scholar 

  • Hamza R, Touibi S, Jamoussi M, Bardi-Bellagha I, Chtioui R. Intracranial and orbital hydatid cysts. Neuroradiology. 1982;22:211–4.

    Article  CAS  PubMed  Google Scholar 

  • Handousa AB. Proptosis caused by hydatid disease. Br J Ophthalmol. 1951;35:607–13.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Hanioglu S, Saygi S, Yazar Z, Saltik G, GĂĽrsel E. Orbital hydatid cyst. Can J Ophthalmol. 1997;32:334–7.

    CAS  PubMed  Google Scholar 

  • Holland H. Hydatid of the orbit. Br J Ophthalmol. 2012;32:395–6.

    Google Scholar 

  • Jeblaoui Y, Bouguila J, Yacoub K, Bouguila H, Ben Neji N, Besbes G. Orbital hydatid cyst. Rev Stomatol Chir Maxillofac. 2008;109:117–9.

    Article  CAS  PubMed  Google Scholar 

  • Jimenenez-Mejias ME, Alarcon-Cruz JC, Marquez-Rivas FJ, Palomino-Nicas J, Montero JM, PachĂłn J. Orbital hydatid cyst: treatment and prevention of recurrences with albendazole plus praziquantel. J Infect. 2000;41:105–7.

    Article  CAS  PubMed  Google Scholar 

  • Kahveci R, Sanli AM, Gurer B, Sekerci Z. Orbital hydatid cyst. J Neurosurg Pediatr. 2012;9:42–4.

    Article  PubMed  Google Scholar 

  • KarakaĹź HM, Tokoglu F, Kacar M, Boyacigil S. Retrobulbar hydatid cyst: assessment of two cases. Australas Radiol. 1997;41:179–80.

    Article  PubMed  Google Scholar 

  • Kargi SH, Kargi E. An unusual case of orbital hydatid cyst: a surgical emergency. Ann Plast Surg. 2000;44:574.

    Article  CAS  Google Scholar 

  • Kars Z, Kansu T, Ozcan OE, Erbengi A. Orbital echinococcosis. Report of two cases studied by computerized tomography. J Clin Neuroophthalmol. 1982;2:197–9.

    CAS  PubMed  Google Scholar 

  • Kashyap S, Pushker N, Meel R, Sen S, Bajaj MS, Khuriajam N, et al. Orbital schwannoma with cystic degeneration. Clin Exp Ophthalmol. 2009;37:293–8.

    Article  Google Scholar 

  • Kaymaz M, Dogulu F, Kurt G, Kardes O, Baykaner MK. Orbital hydatid cyst. Case illustration. J Neurosurg. 2002;97:724.

    Article  PubMed  Google Scholar 

  • Khalili AH. CT values in orbital hydatid cyst. Comput Radiol. 1987;11:193–7.

    Article  CAS  PubMed  Google Scholar 

  • Kiratli H, Bilgic S, OztĂĽrkmen C, Aydin O. Intramuscular hydatid cyst of the medial rectus muscle. Am J Ophthalmol. 2003;135:98–9.

    Article  PubMed  Google Scholar 

  • Klauss V, Chana HS. Ocular tumors in Africa. Soc Sci Med. 1983;17:1743–50.

    Article  CAS  PubMed  Google Scholar 

  • Lamba PA, Bhatia PC, Jain M, Baweja U. Hydatid cyst of orbit. Indian J Ophthalmol. 1983;31:23–5.

    CAS  PubMed  Google Scholar 

  • Lerner SF, Gomez Morales A, Croxatto JO. Hydatid cyst of the orbit. Arch Ophthalmol. 1991;109:285.

    Article  CAS  PubMed  Google Scholar 

  • Li Y, Zheng H, Cao X, Liu Z, Chen L. Demographic and clinical characteristics of patients with anaphylactic shock after surgery for cystic echinococcosis. Am J Trop Med Hyg. 2011;85:452–5.

    Article  PubMed Central  PubMed  Google Scholar 

  • Lidgett K. Hydatid cyst of the orbit: report of a case. Med J Aust. 1955;42:796.

    CAS  PubMed  Google Scholar 

  • Limaiem F, Bellil S, Bellil K, Chelly I, Mekni A, Khaldi M, et al. Primary orbital hydatid cyst in an elderly patient. Surg Infect. 2010;11:393–5.

    Article  Google Scholar 

  • Lopera RD, MelĂ©ndez RD, Fernandez I, Sirit J, Perera MP. Orbital hydatid cyst of Echinococcus oligarthrus in a human in Venezuela. J Parasitol. 1989;75:467–70.

    Article  CAS  PubMed  Google Scholar 

  • Malde HM, Gadkari SS, Chadha D, Gondhalekar N. Water lily sign in an orbital hydatid cyst. Spontaneous rupture of an intraorbital hydatid cyst. A rare cause of acute visual loss. J Clin Ultrasound. 1993;21:458–9.

    Article  CAS  PubMed  Google Scholar 

  • Mazhar M. Hydatid cyst of the orbit. Br J Ophthalmol. 1954;38:753.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Mehra KS, Banerjee C, Somani PN, Rajyashree K. Hydatid cyst in orbit. Acta Ophthalmol (Copenh). 1965;43:761–3.

    Article  CAS  Google Scholar 

  • Mehta M, Sen S, Sethi S, Pushker N, Bajaj MS, Chandra M. Large orbital hydatid cyst presenting as subconjunctival mass. Ann Trop Med Parasitol. 2010;104:601–4.

    Article  CAS  PubMed  Google Scholar 

  • Menghi CI, Gatta CL. Unusual localization of an hydatid cyst: first reported case in Buenos Aires, Argentina. Braz J Infect Dis. 2011;15:81–2.

    Article  PubMed  Google Scholar 

  • Mohammad Ael-N A, Ray CJ, Karcioglu ZA. Echinococcus cysts of the orbit and substernum. Am J Ophthalmol. 1994;118:676–8.

    Google Scholar 

  • Murthy R, Honavar SG, Vemuganti GK, Naik M, Burman S. Polycystic echinococcosis of the orbit. Am J Ophthalmol. 2005;140:561–3.

    Article  PubMed  Google Scholar 

  • Nahri GE. A simplified technique for removal of orbital hydatid cysts. Br J Ophthalmol. 1991;75:743–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Okelo GB, Kyobe J, Shah AK, Musyoki JJ. Retro-orbital hydatid: case report. East Afr Med J. 1980;57:285–8.

    CAS  PubMed  Google Scholar 

  • Ozek MM, Pamir MN, Sav A. Spontaneous rupture of an intraorbital hydatid cyst: a rare cause of acute visual loss. J Clin Neuroophthalmol. 1993;13:135–7.

    Article  CAS  PubMed  Google Scholar 

  • Papathanassiou M, Petrou P, Zampeli E, Vergados I, Paikos P. Disseminated hydatid disease in a child: albendazole treatment of orbital cyst. Eur J Ophthalmol. 2008;18:1034–6.

    CAS  PubMed  Google Scholar 

  • Rastogi A, Arora R, Chaturvedi K. Orbital hydatid cyst: an unusual presentation. Orbit. 1998;17:107–11.

    Article  PubMed  Google Scholar 

  • Reddy MV, Satyndran OM, Krishna KS. Orbital hydatid cyst. J Indian Med Assoc. 1970;55:203–4.

    CAS  PubMed  Google Scholar 

  • Ryou JY, Kim KH, Kim SY. Hydatid cyst of the orbit (in Korean). J Korean Ophthalmol Soc. 2002;47:484–8.

    Google Scholar 

  • Saenz-Santamaria J, Moreno-Casado J, Nunez C. Role of fine-needle biopsy in the diagnosis of hydatid cyst. Diagn Cytopathol. 1995;13:229–32.

    Article  CAS  PubMed  Google Scholar 

  • Sami A, Achouri M, Harouch M, Choukry M, Ouboukhlik A, Elkamar A, et al. Intra-orbital hydatid cysts. 10 cases (in French). Neurochirurgie. 1995;41:398–402.

    CAS  PubMed  Google Scholar 

  • Sangawe JL, Chitra NV, Venkataramaiah NR, Van Raalte JA. Hydatid cyst of the orbit. J Trop Med Hyg. 1982;85:149–51.

    CAS  PubMed  Google Scholar 

  • Sanli M, SabuncuoÄźlu H, Keskin T. Primary intraorbital hydatid cyst: an unusual location, case report and review of the literature. Minim Invasive Neurosurg. 2007;50:367–9.

    Article  CAS  PubMed  Google Scholar 

  • Saygi HS, Yazar Z, Saltik G, GĂĽrsel E. Orbital hydatid cyst. Can J Ophthalmol. 1997;32:334–7.

    PubMed  Google Scholar 

  • Seale EA. A case of Hydatid cyst of the orbit: Removal of cyst with preservation of eye and vision. Br Med J. 1926;1(3412):910–1.

    Google Scholar 

  • Sevel D, Sapeika RJ. Hydatid cyst of the orbit. Surv Ophthalmol. 1977;22:101–5.

    Article  CAS  PubMed  Google Scholar 

  • Sharma R, Vashisht S, Berry M. Orbital hydatid cysts: sonographic and CT appearance. Australas Radiol. 1995;39:246–8.

    Article  CAS  PubMed  Google Scholar 

  • Sharma RL, Thakur RC, Sud C, Sareen A. Extended lateral orbitotomy, an effective procedure to excise large orbital hydatid cyst: a rare case. Ann Trop Med Public Health. 2011;4:45–7.

    Article  Google Scholar 

  • Siddiqui MA, Rizvi SW, Rizvi SA, Ahmad I, Ullah E. Atypical multifocal hydatid disease of cranial vault: simultaneous orbital and extradural meningeal involvement. Emerg Radiol. 2010;17:427–30.

    Article  PubMed  Google Scholar 

  • Sihota R, Sharma T. Albendazole therapy for a recurrent orbital hydatid cyst. Indian J Ophthalmol. 2000;48:142–3.

    CAS  PubMed  Google Scholar 

  • Sodhani P, Das DK, Natarajan R, Khan IU. Cytological diagnosis of orbital echinococcosis. Diagn Cytopathol. 1996;15:52–3.

    Article  CAS  PubMed  Google Scholar 

  • Somay H, Emon ST, Orakdogen M, Berkman MZ. A primary orbital hydatid cyst. J Clin Neurosci. 2012;19:898–900.

    Article  PubMed  Google Scholar 

  • Souhail H, Mahi M, Akjouj S, Elhassani MR, Chakir N, Jiddane M. A rare cause of exophthalmos, hydatid cyst of the orbit. Presse Med. 2003;32:457–9.

    CAS  PubMed  Google Scholar 

  • Sperryn CW, Corr PD. CT evaluation of orbital hydatid disease: a review of 10 cases. Clin Radiol. 1994;49:703–4.

    Article  CAS  PubMed  Google Scholar 

  • Staindl O, Krenkel C. Echinococcosis of the orbit (in German). HNO. 1985;33:404–8.

    CAS  PubMed  Google Scholar 

  • Subrahmanyam M, Ather M, Madini P. Parasitic cysts of orbit. In: Subrahmanyam M, editor. Surgical atlas of orbital diseases. 1st ed. New Delhi: Jaypee Brothers; 2008. p. 206–18.

    Google Scholar 

  • Talib H. Orbital tumours in Iraq. Ann R Coll Surg Engl. 1972a;51:31–40.

    CAS  PubMed Central  PubMed  Google Scholar 

  • Talib H. Orbital hydatid disease in Iraq. Br J Surg. 1972b;59:391–4.

    Article  CAS  PubMed  Google Scholar 

  • Toledo EC, Szelagowski JC. Unilateral exophthalmos in orbital echinococciasis. J Comput Assist Tomogr. 1980;4:127.

    Google Scholar 

  • Tonjum AM. Hydatid cyst of the orbit. Acta Ophthalmol (Copenh). 1963;41:445–8.

    Article  Google Scholar 

  • Turgut M, Saglam S, Ozcan OE. Orbital hydatid cyst. Report of a case followed by serial computed tomography. J Clin Neuroophthalmol. 1992;12:43–6.

    CAS  PubMed  Google Scholar 

  • Turgut AT, Turgut M, Kosar U. Hydatidosis of the orbit in Turkey: results from review of the literature 1963-2001. Int Ophthalmol. 2004;25:193–200.

    Article  PubMed  Google Scholar 

  • Van Selm J. Some orbital swelling in children. S Afr Med J. 1964;38:590–2.

    Google Scholar 

  • Wood DJ. Hydatid cysts of the orbit. Br J Ophthalmol. 1925;9:4–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Xiao A, Xueyi C. Hydatid cysts of the orbit in Xinjiang: a review of 18 cases. Orbit. 1999;18:151–5.

    Article  PubMed  Google Scholar 

  • Yazdani N, Basam A, Heidarali M, Sharif Kashani S, Hasibi M, Mokhtari Z. Infratemporal hydatid cyst: a case presenting with blindness. J Laryngol Otol. 2010;124:456–9.

    Article  CAS  PubMed  Google Scholar 

  • Yurt A, Secer M, Selcuki M. Large primary intraorbital hydatid cyst. Childs Nerv Syst. 2011;27:693–5.

    Article  PubMed  Google Scholar 

  • Zahawi HM, Hameed OK, Abalkhail AA. The possible role of the age of the human host in determining the localization of hydatid cysts. Ann Trop Med Parasitol. 1999;93:621–7.

    Article  CAS  PubMed  Google Scholar 

  • Zaidi M. An unusual case of orbital hydatid cyst: a surgical emergency. Ann Plast Surg. 1999;42:327–9.

    Article  CAS  PubMed  Google Scholar 

  • Zakharia HS, Asdourian K, Matta CS. Unilateral exophthalmos. Aetiological study of 85 cases. Br J Ophthalmol. 1972;56:678–86.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Correspondence to Subrahmanyam Mallajosyula MS, DO, FUBC, FUW .

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Mallajosyula, S., Ul Kadir, S.M., Haddad, F.S., Ramavath, S. (2014). Hydatidosis of the Orbit. In: Turgut, M. (eds) Hydatidosis of the Central Nervous System: Diagnosis and Treatment. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54359-3_23

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