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KMK Ocular Disease > 3 - Adnexa/Orbit/External > Flashcards

3 - Adnexa/Orbit/External Flashcards

1
Q

Prolapsed orbital fat

  • cause/what it is
  • concerns with large prolapses
A

Aging -> weakened orbital septum -> extraconal fat prolapses

Lid malposition + subsequent exposure keratopathy

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2
Q

Preseptal cellulitis

  • who/when
  • causes
  • signs/symp
A

Children during winter months

#1 HORDEOLUM
Other: dacryocystitis, upper respiratory/mid-ear infxn, SKIN TRAUMA (puncture wound, insect bite)

NO PAIN
Lid edema, erythema, ptosis, warmth

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3
Q

Orbital cellulitis

  • who
  • causes
A

Children - one of the leading causees of exophthalmos in kids

Infections: sinus (#1 ETHMOID/LAMINA PAPYRACEA), orbital (dacryoadenitis/cystitis, progression of preseptal), dental
Orbital fracture
Adults = STAPH AUREUS
Kids = H. INFLUENZAE

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4
Q

Orbital cellulitis

  • signs/symp
  • progression
A

Ask about recent fever, sinus/dental infxns, trauma
EOM PAIN/RESTRICTION, FEVER, PROPTOSIS, DECR VA

Can lead to cav.sinus thrombosis, brain abscess, MENINGITIS

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5
Q

Mucormycosis

A

Aggressive, life-threatening fungal infxn in pts with orbital cellulitis that are diabetic/immunocompromised

Characteristic black eschar (necrotic tissue) in mouth and nose

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6
Q

TED

  • who
  • strongest risk factor
A

Females (8:1)
4th-5th decades
1% have/will develop Myasthenia Gravis

Smoking = 2-9x incr risk

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7
Q

TED

-pathophysiology

A

TSH receptor autoantibodies directed against EOMs and orbital tissue -> fibroblast proliferation, significant inflammation, thickening of EOMs -> optic nerve compression

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8
Q

TED

-signs/symp

A

Signs: uni or bilateral PROPTOSIS*, UL RETRACTION, lid erythema/edema, conj/caruncle injection, decr color vision, EOM restrictions, APD, IOP ELEVATED IN PRIMARY/UPGAZE
*MOST COMMON CAUSE OF UNI/BILATERAL PROPTOSIS IN MID-AGE

Symp: prominent eyes, chemosis, FBS, tearing, photophobia, diplopia, decr vision, color vision loss

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9
Q

TED

-no specs

A 
N: no signs/symp
O: only signs - dalrymple’s stare app
S: soft tissue involvement
P: proptosis
E: EOM involvement - IMSLOw
C: corneal involvement - SLK (superior limbic keratoconj-itis)
S: sight loss - ON compression
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10
Q

3 things assoc with superiorlimibic keratoconjunctivitis

A

Thyroid (TED)
CLS
Dry eye

*all = friction!

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11
Q

TED

-implications of ON compression (4)

A

Disc edema
APD
Decr color vision
VF loss

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12
Q

TED signs

  • Von Graefe
  • Kocher
  • Dalrymple
A

VG: upper lid lag during downgaze

K: globe lag compared to lid movement when looking up

D: lid retraction = stare app

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13
Q

TED

-dx

A 
(+) forced ductions
CT/MRI - EOM enlargement, tendons spared (vs orbital pseudotumor)
Exophthalmometry
VFs
Blood work T3/4/SH
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14
Q

Hertel exophthalmometry norms

A

12-18 mm Asian
12-22 mm Caucasian
12-24 mm Black

Abnormal if >3mm asymmetry

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15
Q

Carotid-Cavernous Fistula

  • who
  • cause
A

20yo M

Abnormal communication between arterial and venous systems
Usually from CLOSED HEAD TRAUMA

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16
Q

Carotid-Cavernous Fistula

-signs/symp

A

Chemosis (-) itch
Pulsatile proptosis
Ocular bruit

*from build-up of pressure posterior to globe due to impeded blood flow

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17
Q

Capillary hemangioma

A

Most common benign orbital tumor in children

Deprivation amblyopia is major concern

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18
Q

Cavernous hemangioma

A

Most common benign orbital tumor in adults (4th-6th decades, females)

Progressive, painless, unilateral proptosis

Tumor most commonly arises posterior to globe within muscle cone

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19
Q

Dermoid cyst

A

Superior-temporal
Congenital
Well-defined

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20
Q

Neurofibroma

A

Benign, yellow-white, well-defined tumor of astrocytes, esp superior orbit
Young to mid-age adults
Isolated, multiple, uni or bilateral

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21
Q

Neurolemmoma

A

Aka Schwannoma
Benign tumor of schwann cells, esp superior orbit
Young to mid-age adults
Develops within V1
Gradual onset painless, progressive proptosis

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22
Q

Optic nerve glioma

A

Aka juvenile pilocytic astrocytoma
Most common intrinsic tumor of optic nerve (65%)
Symptoms in 1st decade of life
Infant cases assoc with NF1 (up to half)

23
Q

Meningioma

A

Most common benign brain tumor
Mid-age women
Sphenoid - arise from sphenoid bone, most common intracranial tumor to invade orbit

24
Q

Rhabdomyosarcoma

A

Most common primary pediatric orbital malignancy
Rapid bone destruction
Progressive unilateral proptosis
Avg age of dx is 7 years

25
Q

Neuroblastoma

A

Most common secondary pediatric orbital malignancy
Most commonly arises from abdomen
May have assoc Horner’s if from mediastinum or neck

26
Q

Lymphoma

A

50-70yo
APD, insidious progressive proptosis, vision loss
30-50% develop systemic involvement: 60% of those have 5-year survival rate

27
Q

Proptosis: TED vs lymphoma

A

TED think mid-age

L think older (70)

28
Q

Orbital pseudotumor/idiopathic orbital inflammatory syndrome

-who

A

Rare
Acute, recurrent, or chronic
Young to mid-age (20-50)
3rd most common orbital disorder in adults

29
Q

Orbital pseudotumor/idiopathic orbital inflammatory syndrome

-pathophys/dx

A

Idiopathic inflammatory process, impacts any soft tissues of the orbit
May resemble TED (mild cases) or orbital cellulitis (severe cases)

30
Q

Orbital pseudotumor/idiopathic orbital inflammatory syndrome

-signs/symptoms

A

ALWAYS UNILATERAL

Signs = inflammation

  • ptosis, PERIORBITAL/ON SWELLING -> HYPEROPIC SHIFT, incr IOP, dacryoadenitis
  • EOM AND TENDON swelling/restriction

Symp: acute onset unilateral pain, red eye, dipolopia, and/or decr vision
-can be bilateral in children (30%), half will also have fever, nausea, vomiting

31
Q

Orbital pseudotumor/idiopathic orbital inflammatory syndrome VS thyroid eye disease

A

IOIS: tendon swelling, unilateral

TED: no tendon swelling, can be bilateral

Both: mid-age pts

32
Q

Chemosis (-) itch = think (2)

A

CCF: chemosis (-) itch, pulsatile proptosis, ocular bruit

IOIS/OPseudo: chemosis (-) itch, unilateral, etc.

33
Q

Tolosa-Hunt syndrome

A

Rare type of IDIOPATHIC orbital inflammation of cav.sinus and superior orbital fissure

Acute and PAINFUL EXOPHTHALMOPLEGIA
Diplopia: ipsi palsies of CN 3/4/6
Sensory loss: V1, V2

34
Q

Bilateral orbital psedotumor in adults

A

Suspicious for:

  • systemic vasculitis (Wegener’s, polyarteritis nodosa)
  • lymphoma
35
Q

Phthisis bulbi

A

Shrinkage + atrophy of globe
From: trauma, infection, surgery, advanced dz
Assoc: inflammation, hypotony, blind eye

36
Q

Anophthalmos

A

Absence of ocular tissue within globe

Primary is very rare

37
Q

Microphthalmos

A

Small globe

Congenital

38
Q

Enophthalmos

A

Retraction of globe within orbit

Often from ocular trauma

39
Q

Prosthesis
-usually made of
-anophthalmos is secondary to:
—enucleation vs evisceration vs exenteration

A

Methyl methacrylate

Enuc: removal of globe
Evisc: removal of inner contents of eye (sclera, other contents remain)
Exent: removal of ALL contents of orbit, incl EOMs, fat

40
Q

Ocular rosacea

-who

A

Mid-age
Northern European ancestry
Usually females, but males have more severe
Affects ~10% pop, incl ~50% with acne rosacea

41
Q

Ocular rosacea

-pathophys

A

IDIOPATHIC

Affects sebaceous (holocrine) glands of lids, cheek, forehead, nose
-meibomian, zeiss
Leads to chronic ocular surface dz

Ocular rosacea = lid dz -> ocular surf dz = phylctenules (lymphocytes), staph marginal keratitis, spk, corneal neo, dry eye

42
Q

Ocular rosacea

-signs/symp

A

Signs: papules on cheek/forehead with TELANGIECTASIA, RHINOPHYMA, FACIAL FLUSHING (malar, also seen with lupus, triggers)

Symp: redness, burning, FBS, ocular irritation

43
Q

Ocular diseases to associate with triggers (2)

A

Rosacea

Herpes

44
Q

Ocular diseases to assoc with telangiectasia (3)

A

RBCs:
Rosacea
Basal cell carcinoma
Coat’s

45
Q

Staph and the eye (4)

A

1) hordeolum
2) chalazia
3) peripheral/subepithelial infiltrate
- lead to ulcer (SEI + epi defect) due to overreaction of immunity
4) phlyctenule (lymphocytes)

46
Q

Contact dermatitis

  • pathophys
  • causes
A

T4 HS rxn, 48-72h after exposure

Cosmetics: makeup, shampoo, perfumes, CLS sol’n, etc.
Medications: aminoglycosides, trifluridine, cyclo/mydriatics, glaucoma meds, preservatives

47
Q

Contact dermatitis

-signs/symp

A

Signs: acute periorbital swelling (“raccoon eyes”), redness, itching, tearing
-pAbillae!

Symp: unil/bilateral erythema, crusting, chemosis

48
Q

Ocular cicatricial pemphigoid

  • who
  • significant number of these pts develop __
A

Rare, 65yo F

Bilateral blindness in 10-30 years after dx

49
Q

Ocular cicatricial pemphigoid

  • pathophys
  • causes
A

Chronic AUTOIMMUNE IDIOPATHIC MUCOUS MEMBRANE disorder
-conjunctiva

T2 HS rxn involving autoantibodies against conj basement membrane
Drug-induced: TIMOLOL (also epi or pilo)

50
Q

Ocular cicatricial pemphigoid

-signs/symp

A

Signs: conj fibrosis/scarring (app as white striae), bilateral symblepharon (palp + orbital conj stick together), ankyloblepharon (palp + palp conj), stretched inferior fornices (shortening of conj tissue)
-late: entropion, trichiasis, corneal ulceration/neo/keratinization

Symp: sub-acute onset of non-specific symp - redness, dryness, FBS, decr vision

51
Q

3 things to think of when see symblepharon

A

Ocular cicatricial pemphigoid
Stevens-Johnson syndrome
Atopic keratoconjunctivitis (AKC)

52
Q

Stevens-Johnson syndrome

  • pathophys
  • causes
A

Severe progression of T3 or T4 HS rxn -> affects mucous membranes

Drugs: SULFONAMIDES, phenytoin, penicillin, aspirin, barbituates, isoniazid, tetracyclines, etc.
Infectious: HSV, mycoplasma pneumoniae, adenovirus, streptococcus

53
Q

Stevens-Johnson syndrome

  • acute signs/symptoms
  • chronic signs/symptoms
A

Acute:

  • systemic prodrome fever, malaise, HA, nausea, vomiting
  • skin lesions (“target” or “bull’s eye”)
  • ocular lesions: severe bilateral diffuse conj-itis assoc with PSEUDOMEMBRANES -> can progress to endophthalmitis

Chronic:

  • deformed lids: en/ectropion, trichiasis, meibomian damage
  • conj: symblepharon, keratinization, stem cell damage -> corneal pathology
  • cornea: ulcers neo, scar, perforation

KMK Ocular Disease (17 decks)

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