11 - Opth - Orbital Disease - Orbital cellulitis + Vascular orbital disorders Flashcards
describe orbital cellulitis in one sentence
acute sight threatening and life threatening infection
typical spread of orbital cellulitis
from paranasal sinus infection
or
eyelid/dental infection
Presentation of orbital cellulitis
Fever, malaise
lid swelling and orbital inflam
decreased eye mobility
proptosis
Which bacteria cause orbital cellulitis
staphs and streps
What is the management for orbital cellulitis
- what are indications for surgery
IV AB’s
- resistance to AB’s
- orbital/subperiosteal abscess
- optic neuropathy
Complications of Orbital cellulitis
ascesses, meningitis, cavernous sinus thrombosis, optic nerve damage (from pressure/thrombosis)
2 main vascular orbital disorders
- orbital venous anomalies
- carotico-cavernous fistula
Orbital venous anomalies
- what happens?
- usually sign?
- complication?
- varices of pre-existing venous channels around orbit
- usually unilateral proptosis (precipitated by valsalva)
- may bleed or thrombose
What is a carotico-cavernous fistula
communications between the carotid artery and the cavernous sinus
Two types of causes of carotico-cavernous fistula + how they may happen?
DIRECT - fast flow - usually trauma, spontaneous rupture of carotid aneurysm
INDIRECT - slow flow - congenital, spontaneous rupture
Carotico-cavernous fistula - DIRECT - presentation
- engorged eye vessels - lid and conjunctival oedema
- pulsatile proptosis
- bruit over eye
Carotico-cavernous fistula - INDIRECT - presentation
silated eye vessles
raised IOP
opthalmoplegia and mild proptosis if severe
Main difference between DIRECT and INDIRECT cause of carotic-cavernous fistula
DIRECT - carotid directly to cavernous sinus
INDIRECT - meningeal branches to cavernous sinus
