11 - Opth - Orbital Disease - Thyroid eye disease + Encephalocele + Idiopathic orbital inflammatory disease (IOID)

Question 1

Ocular manifestations are most common in which thyroid disease

Answer 1

Graves

Question 2

What can happen to the eyelid in Thyroid eye disease

Answer 2

eyelid retraction - upper eyelid retracted, showing sclera above limbus -> can lead to exposure keratopathy
eyelid lag - lid lags and moves jerkily when moving gaze downwards
periorbital oedema - eyelids puffy

Question 3

what rarely happens as a result of thyroid eye disease

Answer 3

optic nerve compression ~5%

Question 4

What else can happen in thyroid eye disease

Answer 4

exopthalmos (1/3rd) permanent in 70%
chemosis of conjunctiva
opthalmoplegia - due to oedema then fibrosis

Question 5

Encephalocele- what is it?

Answer 5

herniation of intracranial contents through congenital defect in orbit

Question 6

Encephalocele - where?

-presentation?

Answer 6

may be anterior(frontal) or posterior (sphenoidal)

pres - swelling, unilateral proptosis without bruit

Question 7

IOID - classed as a what? and why?

Answer 7

pseudotumour - non-neoplastic, non-infectious orbital lesion - involves soft tissue

Question 8

IOID - two usual features

Answer 8

usually middle aged adults and usually unilateral

Question 9

IOID - presentation

Answer 9

acute painful opthalmoplegia, proptosis, redness, periorbital swelling and chemosis

Question 10

IOID - mgmt

Answer 10

my resolve spontaneously

if recurrent - NSAIDs, steroids, cytotxics, immsuppressives, radiotherapy