23. Orbital inflammation – preseptal & retroseptal involvement. Thrombosis of cavernous sinus. Pseudotumor.

Question 1

what is the layers of the eyelid ?

Answer 1

from anterior to posterior

skin

subcutaneous fat - eyelash and sebaceous gland of eyelash

orbicularis oculi muscle - tendon of levatotos palbebra superioir attached

orbital septum from the periosteum - lens with the tendon of levitator pallbearer superior and tarsal plate

tarsus plate - connected with the tendon of levitator paler superior
and orbicularis oculi
there is memobian glands in the tarsal plate

the the conjuctiva

Question 2

what is the orbital septum ?

Answer 2

extends from the orbital rims of the eyelid and forms the fibrous portion of the eyelid

extends from the periosteum

upper eyelid blends with tendon of levitator pallbearer superior

in the lower eyelid with he tarsal late

when eyes closed the whole oribt covered by orbital septum and tarsal plate

Question 3

what is important of the orbital septum ?

Answer 3

barrier in eyelids to prevent contagious spread and infection from eyelid

Question 4

what are the perseptal inflammation ?

Answer 4

tissue anterior to orbital septum

skin trauma superficial to orbital septum - laceration
horedolum or insect bites - with concomitant superinfection of bacteria - staph areas and b haemolytic strep

spread of locall inflammation - dracycystitis - inflammation of lacrimal gland

infections of adjacent structures - middle ear , upper repertory treat - h influenza , strep pyigenes

Question 5

what are the signs and symptoms of preseptal inflammation ?

Answer 5

uniltateral , tender , erythematous , periorbital , lid swelling

NO PROPTOSIS , CHEMOSIS - sweeping of conjuctiva
visual acuity , occular movements should NOT be impaired

Question 6

what is post septal orbital celulaitis ?

Answer 6

inflammtion of the tissue posterior to septum

Question 7

what causes postseptal orbital cellulitis ?

Answer 7

bacterial infection deep into the orbital septum
or from paranasal sinusitis - the venous drainage goes through the orbit - acute sinusitis of ethmoid bones - e.g. h influenza , s pneumonia

Question 8

immediate treatment is mandatory in post septal orbital cellulitis

Answer 8

lead to blindness , optic nerve compression , septic cavernous sinus thrombosis or intrcranila sepsis

Question 9

postseptal orbital cellulitis occurs more in who ?

Answer 9

children

Question 10

what are the signs and symptoms of post septal orbital cellulitis ?

Answer 10

fever 
pain 
eyelid swelling , erythema 
PROPTOSIS
CHRMOSIS
limitation of extraoccular movements 
leukocytosis 
NON axial proptosis- sub periiosteal / intraorbital abcess

Question 11

what re the complication of post septal cellulitis

Answer 11

meningitis & possibly brain abscess

Question 12

Differentiation of pre-/retroseptal inflammation?

Answer 12

symptoms,
CT/MRI - also toexclude abscess
formation, intracranial involvement

Question 13

treatment for preseptal inflammation

Answer 13

outpatients, with oral antibiotics e.g. amoxicillin/clavulinic acid

suspicions of gram negative organisms add
cephalosporins

Question 14

treatment for Retroseptal inflammations ?

Answer 14

Hospital admission with parenteral antibiotics should be administered: 3rd / 4th generation cephalosporins, penicillins

metronidazole -in suspicion of anaerobes

surgical drainage of paranasal sinuses

Question 15

causes of rapidly evolving proptosis?

Answer 15

inflammatory pseudotumor
such vasculitis -Wegener’s granulomatosis

inflammatory process can be diffuse or localized, involving any orbital structure
- myositis, dacyrocystitis

Question 16

what are the sign and symptoms of inflammatory pseudotumor

Answer 16

Unilateral, very painful

Question 17

complication of inflammatory pseudotumor?

Answer 17

extension to involve the cavernous sinuses & intracranial meninges

Question 18

treatment for inflammatory pseudotumor

Answer 18

systemic NSAID’s, corticosteroids

if corticosteroids improve the condition, a
neoplastic lesion can be diagnostically excluded

Question 19

where is the location of cavernous sinus

Answer 19

either side of the sella turcica & are immediately posterior to the optic chiasm

Question 20

Cavernous sinus receives venous blood

Answer 20

facial veins, vena sphenoidales & vena cerebralis media

Question 21

xavernous sinus empty into the

Answer 21

vena jugularis via petrosal sinuses

Question 22

what goes through the lateral wall of cavernous sinus?

Answer 22

3rd, 4th & 6th CN
ophthalmic &
maxillary branch

Question 23

The most common causes of a cavernous sinus thrombosis are:?

Answer 23

Sinusitis especially of
sphenoid/ethmoid sinuses

Midface infection e.g. furuncle
which has been manipulated by
squeezing

Question 24

what is the treatment for cavernous sinus iinflammtion

Answer 24

immediate broad spectrum internees antibiotics

anticoagulants prevent intracranial spread