Ch1: Lid Lash Lac

Question 1

Describe carotid-cavernous fistula (CCF)

Answer 1

Triad: significant chemosis, pulsatile exophthalmos, ocular bruit

Cause:

• 77% CCFs closed head trauma
• ruptured carotid artery aneurysm

MRI/A: asymmetric enlarged cav sinus or superior ophthalmic vein

Concussion symptoms

50% also have CN4 palsy (trauma)

Question 2

Describe thyroid eye disease (TED)

Answer 2

Autoimmune: TSH autoABs against EOMs, soft tissue

Low TSH, high T3/4

Assoc with Myasthenia G

Cigarettes worsen

Worst case: optic nerve

Question 3

Describe orbital pseudotumor (OP)

Answer 3

“TED’s little brother”

• proptosis, mid-age
• inflamm everywhere: EOMs + tendons

ALWAYS unilateral

Idiopathic

Inflammation: lids (ptosis), lac gland (dacryoadenitis), ON, periorbital (hyperopic shift), V1 issues, incr IOP

*consider in pts 20-50yo with chemosis (-)allergic symptoms

Question 4

Leading cause of proptosis in:

• unil or bilat in young/mid-age
• children

Answer 4

TED

Orbital cellulitis