Associations/Progression

Question 1

Preseptal cellulitis

Answer 1

Can become orbital cellulitis

Question 2

Orbital cellulitis

Answer 2

Diabetic/immunocompromised pts can develop mucormycosis, with black eschar
Life-threatening

Question 3

Thyroid eye disease

Answer 3

1% of pts will have to develop myasthenia gravis
Enlarged EOMs and inflamed orbital fat can compress the optic nerve, which is the greatest threat to vision from TED and occurs in 5% of pts
Often have severe dry eye from exposure keratopathy

Question 4

Capillary hemangioma

Answer 4

Rapid growth and spontaneous involution (70-75% of lesions gradually involute by age 7)

Question 5

Neurofibroma

Answer 5

Neurofibromatosis 1 (neuro-oculo-cutaneous syndrome)

Question 6

Optic nerve glioma in infants

Answer 6

Assoc. w/ NF1 in up to 30-50% of cases

Question 7

Bilateral orbital pseudotumour in adults

Answer 7

Raises suspicion for systemic vasculitis (Wegener’s granulomatosis, poly arthritis nodosa) or lymphoma

Question 8

Ocular cicatricial pemphigoid

Answer 8

Significant number of pts develop bilateral blindness an estimated 10-30yrs after dx, destruction of goblet cells, meibomian glands, Krause, Wolfring, ducts of main lacrimal gland, resulting in severe ocular surface disease. Entropion, trichiasis, corneal ulceration, neo, and keratinization

Question 9

Trachoma

Answer 9

Scarring -> entropion -> trichiasis -> corneal ulceration and pannus

Question 10

Benign essential blepharospasm

Answer 10

Over 50% of pts also have OSD/dry eye that may exacerbate the spasms. Also 50% of pts with BEB have Meige’s syndrome. Meige’s syndrome is characterized by BEB and lower facial abnormalities (jaw spasms/pain)

Question 11

Actinic keratosis

Answer 11

Most common precancerous skin lesion, precursor to SCC in 25% of cases. Elevated, pink/red, scaly lesion on sun-exposed skin that does not heal

Question 12

Keratoacanthoma

Answer 12

Found in sun-exposed areas and has an early appearance that is similar to BCC and SCC. Grow very quickly to a large size (1-2cm) before they slowly shrink and often spontaneously resolve

Question 13

Lacrimal system disorders

Answer 13

25% of patients with idiopathic orbital inflammation will have lacrimal gland involvement

Question 14

Chronic dacryocystitis

Answer 14

Raises suspicion for epithelial carcinomas and malignant lymphomas, carcinomas can express blood into the tear film with palpation of the lacrimal sac

Question 15

PAM

Answer 15

can progress to conjunctival melanoma

Question 16

CIN

Answer 16

can progress to SCC (squamous cell carcinoma)/OSSN

Question 17

Atopic dermatitis

Answer 17

assoc w/ AKC and also can develop a shield cataract in 10% of severe types bw ages 15 and 30

Question 18

Corneal neovascularization

Answer 18

chronic hypoxia, can cause superior pannus, larger than 1.5mm is abnormal, stromal scarring and hemorrhage are uncommon but can occur

Question 19

Corneal warpage

Answer 19

due to CL material, long-term PMMA or GP wearers with poorly fitting CLs, rare but can happen with soft CLs, typically low Dk, extended wear, and/or toric