Cognition & Senses 2: Orbital Dz Flashcards
5 components of ASSESSMENT of the ORBITAL REGION?
what are 4 common ANCILLARY TESTS that can be done? what’s the ORDER?
- HISTORY
–> chronic/acute
–> signs of TRAUMA including SURGERY/DENTALS - EXAMINE FROM A DISTANCE
–> SYMMETRY is vital
–> DEVIATION of OPTIC AXIS - PALPATION of ORBITAL REGION
–> CRACKLING, EMPHYSEMA - FULL EYE EXAM
- ORAL EXAM
–> look at SOFT PALATE
ANCILLARY TESTS?
1. FNA, but MUST DO IMAGING PRIOR TO KNOW WHERE TO POKE!
2. RADS
3. U/S
4. CT/MRI
DEFINE IMAGING MODALITY & LESION
FUNDIC EXAM
LESION = RETROBULBAR MASS
chemosis definition
swelling of the TISSUE that LINES THE EYELIDS & SURFACE OF THE EYE
MOST often, only ____ clinical signs are SEEN with ORBITAL DZ
what are the PATHOGNOMONIC signs of ORBITAL DZ? (4)
SOME
pathognomonic?
1. EXOPHTHALMOS
- LACK of RETROPULSION (thumb on upper EYELID)
- GLOBE DEVIATION
- FUNDUS LESION of GLOBE INDENTATION from RETROBULBAR MASS
which CLINICAL SIGN can be HARDER TO DETERMINE in BRACHYCEPHALIC BREEDS with ORBITAL DZ?
LACK OF RETROPULSION bc ALREADY HAS HIGH IOP
EPIPHORA definition
= EXCESSIVE WATERING of the eye
ID CLINICAL SIGN
PATHOGNOMONIC FOR…
GLOBE DEVIATION
PATHOGNOMONIC FOR ORBITAL DZ
EXOPHTHALMOS…
= definition?
3 common causes?
pathognomonic for…
= PROTRUSION of the GLOBE OUT OF THE ORBIT caused by AN INCREASE IN ORBITAL CONTENT
3 common causes?
1. ABSCESS
2. TUMOR
3. SWELLING of ORBITAL MUSCLES
pathognomonic for ORBITAL DZ
if we see PROTRUSION OF THE GLOBE…
what CLINICAL SIGN is this?
what are 6 PE FINDINGS that should coincide?
what ADDITIONAL ASSESSMENT should we do?
CLINICAL SIGN = EXOPHTHALMOS
3 PE FINDINGS?
1. SCLERA is exposed
- OBSERVE FROM ABOVE to see PROTRUSION OF CORNEAL APEX
- LACK of RETROPULSION
- PROTRUSION of THIRD EYELID
- CHEMOSIS
- LAGOPHTHALMOS (incomplete closure of eyelid)
ADDITIONAL ASSESSMENT = check BOTH EYES for SYMMETRY
LAGOPHTHALMOS definition
what can it often cause? (2 words)
= INCOMPLETE closure of the EYELID
can OFTEN CAUSE EXPOSURE KERATITIS
ID CLINICAL SIGN
EXOPHTHALMOS
EXOPHTHALMOS…
give 7 DDxs
- ZYGOMATIC MUCOCELE
- VASCULAR ANOMALIES (VARICES or AV FISTULA)
- EXTENSION of DZ from NASAL/ORAL CAVITY, TEETH, SINUSES
- RETROBULBAR ABSCESS
- ORBITAL INFLAMMATION
- ORBITAL TUMORS
- MYOSITIS (enlargement of temporal muscle)
EURYBLEPHARON / LAGOPHTHALMOS…
= definition
COMMON in what breed w/ what presentation?
can resemble WHAT PE finding?
= CONGENITAL eyelid anomaly characterized by HORIZONTAL ENLARGEMENT OF PALPEBRAL FISSURE
common in BRACHYCEPHALIC BREEDS with SHALLOW ORBITS
can resemble EXOPHTHALMOS but IT ISN’T
BUPHTHALMIA…
= definition
can RESEMBLE…
= GLOBE ENLARGEMENT secondary to GLAUCOMA
can RESEMBLE EXOPHTHALMOS but ISN’T
ID DZ & definition
BUPHTHALMIA
= GLOBE ENLARGEMENT secondary to GLAUCOMA
ID DZ (2 names) & definition
EURYBLEPHARON or LAGOPHTHALMOS
= CONGENITAL eyelid anomaly characterized by HORIZONTAL ENLARGEMENT OF PALPEBRAL FISSURE
ID DZ
this ____ ____ can RESEMBLE… (2)
ANISOCORIA
this MYDRIATIC PUPIL can RESEMBLE EXOPHTHALMOS or BUPHTHALMIA
ID DZ
pathognomonic for…
we expect the MASS to be located in the ___ region
GLOBE DEVIATION
pathognomonic for ORBITAL DZ
we expect the MASS to be located in the NASAL region!
ENOPHTHALMOS…
can be seen RARELY in ____ DISEASES
= definition?
4 clinical findings? which one is present in SEVERE cases?
ORBITAL
= RECESSION of the GLOBE into the ORBIT
4 clinical findings?
1. GLOBE RETRACTED INTO ORBIT
2. REDUCED PALPEBRAL PRESSURE
3. THIRD EYELID PROTRUSION
4. ENTROPION in SEVERE CASES
ENTROPION…
= definition
can often cause ____ SECONDARILY, & give definition
is often seen in WHAT clinical sign?
= the EYELID is ROLLED INWARD AGAINST THE EYEBALL
can often cause TRICHIASIS SECONDARILY = IRRITATION of the EYE by the EYELASHES
is often seen in ENOPHTHALMOS
ENOPHTHALMOS etiologies? (4)
- INTRAOCULAR PAIN like UVEITIS
- HORNER’S SYNDROME
- EMACIATION/SEVERE DEHYDRATION
- DECREASED ORBITAL CONTENT due to INFLAMMATION/ATROPHIC MYOSITIS
HORNER’S SYNDROME is associated with DYSFUNCTION of _____ INNERVATION
SYMPATHETIC
ID CLINICAL SIGN
ENOPHTHALMOS
what 2 things SHOULD WE NOT confuse ENOPHTHALMOS with? & give definitions
- MICROPHTHALMIA = SMALL EYE CONGENITALLY
- PHTHISIS BULBI = when the EYE PERMANENTLY SHRINKS secondary to DISEASE
ETIOLOGIES for ORBITAL DISEASES..
what are 4 MOST COMMON?
what are 2 UNCOMMON?
what is 1 RARE?
MOST COMMON?
1. TUMORS
- TRAUMA –> hemorrhage, FB, fracture
- ABSCESSES
- INFLAMMATION/CELLULITIS
UNCOMMON?
1. MYOSITIS
2. ZYGOMATIC CYSTS & MUCOCELES
RARE?
1. VASCULAR ANOMALIES –> AV fistula, varices
TRAUMA to ORBIT…
give 3 MANIFESTATIONS?
3 MANIFESTATIONS?
1. ORBITAL FRACTURE
2. PENETRATING FOREIGN BODY
3. PROPTOSIS following some BLUNT TRAUMA
PROPTOSIS definition
usually found in ____ breeds after experiencing ____
ABNORMAL PROTRUSION or DISPLACEMENT of the EYE
BRACHYCEPHALIC, TRAUMA
if we have a PROPTOTIC EYE, it’s considered a(n) ____ ____
what is the MOST IMPORTANT thing to do for this patient?
after this is achieved, what should we do?
give an ADDITIONAL step & when we should follow up
OPHTHALMIC EMERGENCY
MOST IMPORTANT = STABILIZE THE PATIENT!
after stabilization, we should REPOSITION THE GLOBE while KEEPING THE CORNEA LUBRICATED
additional step = make LATERAL CANTHOTOMY (make incision) to SUTURE & REPLACE EYELIDS ABOVE THE GLOBE
–> check back again 2 weeks later!
ABSCESS/CELLULITIS…
clinical signs & presentation looks ___ between the two
progression?
unilateral vs. bilateral?
give 2 IMPORTANT clinical signs!
3 etiologies?
IDENTICAL
ACUTE
UNILATERAL
IMPORTANT clinical signs…
1. FEVER
2. PAIN upon RETROPULSION or OPENING MOUTH
etiologies?
1. FB
2. WOUND
3. SECONDARY to SINUSITIS, TOOTH ROOT ABSCESS or INFECTION of ZYGOMATIC/LACRIMAL GLAND
CELLULITIS definition
= NON-SUPPURATIVE inflammation of the PERCUTANEOUS tissue
why can we see PAIN UPON OPENING MOUTH in ABSCESSES/CELLULITIS of the ORBIT?
when opening mouth, mechanism can PUSH ON THE SOFT TISSUE OF THE ORBIT that MAY BE INFLAMED/PAINFUL
3 DIAGNOSTICS for ABSCESSES/CELLULITIS of ORBIT? list why for each
- CBC –> confirm INFECTION/INFLAMMATION
- IMAGING (US, CT, MRI)
- FNA –> INFLAMMATORY or INFECTIOUS?
TREATMENT for ORBITAL CELLULITIS/ABSCESSES..
it’s USUALLY (duration, type of medication & name)
what OTHER 2 MEDICATIONS do we often give?
what medication SHOULD WE NOT GIVE?
name 1 +/- treatment?
it’s USUALLY = SYSTEMIC ANTIBIOTICS for 2-3 WEEKS that is GOOD AGAINST ANAEROBES, such as AMOXICILLIN + CLAVULANIC ACID
other 2 meds?
1. SYSTEMIC NSAIDs
2. SYSTEMIC OPIOIDS (for pain)
DO NOT GIVE STEROIDS!
+/- = TOPICAL LUBRICATION OF CORNEA if it’s exposed
how do we DRAIN an ORBITAL ABSCESS/CELLULITIS? (2)
is this always done?
what is a MAJOR CONCERN we should keep in mind?
- need to MAKE SHALLOW INCISION BEHIND THE LAST UPPER MOLAR to FIND MASS/ABSCESS
- after making incision, use CLOSED HEMOSTATS & do BLUNT DISSECTION to GET THROUGH MUSCLES to GAIN ACCESS TO ORBITAL CAVITY
NOT ALWAYS DONE
concern? = we have to WORRY ABOUT HITTING THE MAXILLARY ARTERY that is RIGHT ABOVE THE SOFT PALATE, so WORK CAREFULLY!
describe process
DRAINAGE of ORBITAL ABSCESSS
MOST orbital tumors are what 2 things?
PRIMARY & MALIGNANT
6 CLINICAL SIGNS/SIGNALMENT for ORBITAL TUMORS…
what is the MOST COMMON presentation?
- OLDER animals
- UNILATERAL
- INITIALLY no pain unless PUSHING EYE OUT & causing EXPOSURE KERATITIS/ULCERS
- EXOPHTHALMOS –> MOST COMMON PRESENTATION
- LIMITED to NO RETROPULSION
- GLOBE INDENTATION
how can an ORBITAL TUMOR cause ENOPHTHALMOS
if the tumor is LOCATED ROSTRAL TO THE GLOBE (pushing from OUT to IN)
TRUE/FALSE
the GLOBE is ALWAYS DEVIATED with ORBITAL TUMORS
FALSE, only sometimes
TRUE/FALSE
VISION is RETAINED WITH ORBITAL TUMORS
TRUE
DIAGNOSTICS for ORBITAL TUMORS (2)
TREATMENT if BENIGN vs. MALIGNANT?
- FNA
- IMAGING (x-rays, US, CT, MRI)
Tx?
BENIGN = ORBITOTOMY & REMOVAL OF TUMOR if BENIGN & VISUAL and RESECTABLE
MALIGNANT = EXENTERATION +/- CHEMO
EXENTENERATION definition
removal of the ENTIRE EYE & surrounding TISSUES & NERVES
ZYGOMATIC MUCOCELE/CYST
= definition
5 clinical signs?
TYPICALLY NOT ASSOCIATED WITH ___ and THEREFORE ___
= when SALIVA from ZYGOMATIC GLAND LEAKS OUT & forms a CYST in ORBITAL CAVITY
clinical signs?
1. ORBITAL SWELLING
2. EXOPHTHALMOS
3. THIRD EYELID PROTRUSION
4. PROTRUSION of ORAL MUCOSA BEHIND LAST MOLAR
5. NO PAIN
TYPICALLY NOT ASSOCIATED WITH INFLAMMATION and THEREFORE PAIN
what is DIAGNOSTIC for ZYGOMATIC MUCOCELE/CYST?
when doing ORBITOTOMY or FNA, see HONEYLIKE LIQUID that is SALIVA
TREATMENT for ZYGOMATIC MUCOCELE/CYST? (simple answer)
REMOVAL of the GLAND & its CONTENTS via SURGICAL EXCISION
POLYMYOSITIS…
what are the 2 SUB-CATEGORIES in EYES?
- EXTRAOCULAR POLYMYOSITIS
- MASTICATORY MUSCLE MYOSITIS
EXTRAOCULAR POLYMYOSITIS
= definition
etiology?
progression?
unilateral vs. bilateral?
3 clinical sign?
1 BREED predilection?
= INFLAMMATION of the MUSCLES THAT MOVE THE EYE/EXTRAOCULAR MUSCLES
etiology = IMMUNE-MEDIATED
progression = ACUTE
unilateral vs. bilateral = BILATERAL
clinical signs?
1. FEVER
2. ANOREXIA from PAIN when MOVING MOUTH INTO EXTRAOCULAR MUSCLES
3. ENOPHTHALMOS from ATROPHY of extra ocular muscles
breed = GOLDEN RETRIEVER
ID CLINICAL SIGN & likely DZs (2)
how can we DISTINGUISH one from the other? (first has 1, second has 2)
ENOPHTHALMOS BILATERALLY
DZ = likely EXTRAOCULAR MYOSITIS causing ATROPHY or MASTICATORY MUSCLE MYOSITIS
if EXTRAOCULAR POLYMYOSITIS = CT/MRI can see SWOLLEN EXTRAOCULAR MUSCLES
if MASTICATORY MUSCLE MYOSITIS…
1. do MUSCLE BIOPSY of TEMPORALIS or MASSETER muscle to see CELLULAR INFILTRATES
2. look for SERUM 2M ANTIBODIES on BLOODWORK
MASTICATORY MUSCLE MYOSITIS..
= definition
likely etiology?
duration?
unilateral vs. bilateral?
3 clinical signs?
3 breeds?
= INFLAMMATION of the MASTICATORY MUSCLES
etiology = IMMUNE-MEDIATED
duration = ACUTE
unilateral vs. bilateral = BILATERAL
3 clinical signs?
1. FEVER
2. ANOREXIA (pain from moving mouth)
3. LATER STAGE = MUSCLE ATROPHY & ENOPHTHALMOS
3 breeds?
1. GOLDEN RETRIEVER
2. GSD
3. WEIMARANER
TREATMENT for EXTRAOCULAR POLYMYOSITIS or MASTICATORY MUSCLE MYOSITIS? (name 3 potential drugs & duration of tx)
IMMUNOSUPPRESSIVE DOSES OF CORTICOSTEROIDS, AZATHIOPRINE OR CYCLOSPORINE for 3-4 WEEKS
DIFFERENCE between ENUCLEATION & EXENTENERATION?
when would you do ONE vs. ANOTHER?
ENUCLEATION = removal of OCULAR GLOBE but LEAVE THE SOFT ORBITAL TISSUE
–> DAMAGE of EYE but NOT ORBIT
–> if PAINFUL EYE from GLAUCOMA
EXENTENERATION = REMOVAL OF OCULAR GLOBE with RESECTION OF COMPLETE ORBITAL SOFT TISSUE
–> when there’s ORBITAL DZ such as ABSCESS, TUMOR or ZYGOMATIC MUCOCELE
why should we REMOVE THE THIRD EYELID in ENUCLEATION?
because if we remove everything else, IT WILL KEEP PRODUCING TEARS & FILL UP ORBITAL CAVITY WITH TEARS
