Lessons from the Past: Cribra Orbitalia, An Orbital Roof Pathology

Abstract

Aims: To define a computed tomography protocol that may be used in future clinical practice for the reliable detection and analysis of cribra orbitalia.

Materials and Methods: Two osteological assemblages from the Museum of London were used to select 13 cribratous skulls and 5 non-cribratous skulls. Area of cribra orbitalia was measured using image analysis. Morphology of cribra orbitalia, orbital roof density and the associated optic canal diameter was analysed using computed tomography reconstructions.

Results: The presence of cribra orbitalia was associatedwith changes in the internal diploë layer as well as the cortical bone table. A novel radiological grading system and protocol was developed to identify the pathology. A decrease in the orbital roof density by 210 Hounsfield units and a reduction in the optic canal diameter, up to 1 mm, were found to be associated with the presence of cribra orbitalia.

Conclusions: The occurrence of cribra orbitalia is found to be associated with stenosis of the optic canal, and could explain a proportion of cases ofoptic nerve entrapment. This study provides a guideline for radiologists and oculoplastic surgeons to help detect the presence of cribra orbitalia in suspected patients.

KEYWORDS::

• Cribra orbitalia
• Pathology
• Imaging
• Orbit

ACKNOWLEDGMENTS

We dedicate this paper to the memory of the late Bill White, Senior Curator of Human Osteology at the Centre for Human Bioarchaeology, Museum of London, who coined the idea of initiating this project to bridge osteoarchaeology and clinical medicine. We are extremely thankful to Jelena Bekvalac and the staff at the Centre for Human Bioarchaeology, Museum of London for their guidance. We are also grateful to the staff at the X-ray Department of Moorfields Eye Hospital and the Jean Shanks Foundation for their support.

Declaration of interests: There are no competing interests, and this research received no specific funding. The authors are responsible for the content and the writing of this paper.