Common Disease Of Orbit Flashcards
What is pseudoproptosis?
slight prominence of eyes like myopia, paralysis of extra ocular muscles, obese people, mullers stimulation by cocaine
What is proptosis?
Abnormal protrusion of eyeballs
What is exophthalmos?
prominence of the eye secondary to thyroid disease
What are the causes of unilateral proptosis?
- orbital cellulitis
- idiopathic orbital inflammatory disease
- thrombosis of orbital vein
- arterio- venous aneurysms
- tumors of orbit
- orbital hemorrhage
- emphysema
What are the causes of bilateral proptosis?
- endocrine exophthalmos
- cavernous sinus thrombosis
- symmetrical orbital tumors
- oxycephaly (diminished orbital volume)
In which conditions are proptosis seen in children?
- Dermoid & epidermoid cyst
- Capillary hemangioma
- Optic nerve glioma
- Rhabdomyosarcoma
- Leukemia
- Metastatic neuroblastoma
- Plexiform neurofibromatosis
- Lymphomas
In which conditions are proptosis seen in adults?
- Metastases
- Cavernous hemangioma
- Mucocele
- Lymphoid tumors
- Meningiomas
What is axial proptosis?
eye is pushed directly forwards
lesions situated in optic nerve & central space
What is non-axial proptosis?
Lesions situated elsewhere in orbit pushes eye in opposite direction
In which condition is proptosis static?
Congenital cases
In which condition is proptosis increasing?
Rhabdomyosarcoma
Neuroblastoma
Hemopoietic
In which condition is proptosis gradual?
Meningiomas
In which condition is proptosis pulsatile?
Carotid cavernous fistula
In which condition is proptosis intermittent?
Orbital varicosity
What are the clinical signs of proptosis?
- Impaired mobility
- Diplopia
- Papilloedema
- Optic atrophy
- Hertel exophthalmometry = >18 mm
- Different btwn 2 eyes > 2 mm (+ve)
What are the investigation done for proptosis?
- ENT examination
- all lab investigation
- imaging of bony structure - orbital x-ray
- imaging of soft tissues - CT, MRI
What is orbital cellulitis?
Purulent inflammation of the cellular tissue of the orbit
What are the causes of orbital cellulitis?
- spread of infection from neighbouring structures like nasal sinuses, eyelids, eyeball (like in cases panopthalmitis)
- deep penetrating injuries (foreign body)
What is pre-septal cellulitis?
Situated in structures anterior to orbital septum
What is orbital cellulitis?
Situated behind orbital septum
What are the C/F of pre-septal cellulitis?
- erythema chemosis
- conjunctival discharge w/o restriction of ocular movement & visual impairment
What are the C/F of orbital cellulitis?
- severe pain, fever
- diminution of vision (due to retrobulbar neuritis or compression of optic nerve/vessel)
- massive swelling of eyelids
- chemosis
- proptosis
- restriction of ocular movements
- diplopia
What are the complications of orbital cellulitis?
- panopthamitis
- extension into brain through meninges, cavernous sinus thrombosis
- fungal superinfection
What is the management of orbital cellulitis?
- culture & sensitivity of pus/blood
- treatment = broad spectrum IV antibiotic & anti-inflammatory
- abscess incision & drainage
C/F of Graves’ disease
- exophthalmos
- all sign of thyrotoxicosis (tachycardia, muscular tremors, raised BMR)
What is Dalrympte sign in Graves’ disease?
palpebral aperture is wide open due to lid retraction
What is Von Graefe sign in Graves’ disease?
upper lid fail to follow downward movement of eye
What are ophthalmic signs of Graves’ disease?
- lid retraction, lag, edema
- infrequent blinking & incomplete closure of eyelid (stellwag sign)
- exophthalmos
- conjunctival congestion
- convergence insufficiency (mobius sign)
- raised IOP
Werner Classification of Signs (Score = 0)
No signs or symptoms
Werner Classification of Signs (Score = 1)
Only signs
Werner Classification of Signs (Score = 2)
Soft tissue involvement with symptoms & signs
Werner Classification of Signs (Score = 3)
Proptosis > 20mm
Werner Classification of Signs (Score = 4)
Extraocular muscle involvement
Werner Classification of Signs (Score = 5)
Corneal involvement
Werner Classification of Signs (Score = 6)
Sight loss (visual acuity < 0.67)
What is exophthalmic opthalmoplegia?
Proptosis + external opthalmoplegia
Asymmetrical limiting upward movement and abduction due to swollen, pale edematous, infiltrated ocular muscle
What is the risk of exophthalmic opthalmoplegia?
Exposure keratitis
Globe dislocation
Mechanical compression of optic nerve & ophthalmic vessels
Is exophthalmic opthalmoplegia reducible or irreducible?
It’s irreducible
What is the medical treatment for exophthalmic opthalmoplegia?
Short term oral steroid therapy (dose 40-60 mg) + radiotherapy (1000 rad)
- controls soft tissue inflammation
What is the surgical management for exophthalmic opthalmoplegia?
Exposed cornea protected by
- (lateral) tarsorrhaphy
OR
- Orbital decompression (severe cases)
Type 1 characterized by
Symmetrical mild proptosis
Lid retraction
Type 1 is associated with
Thyrotoxicosis
Type 2 is characterized by
Extreme exophthalmos
Compressive neuropathy
Extraocular muscle involvement
Type 2 is associated with
Hypothyroidism
After thyroidectomy
What are the investigations for Graves’ disease?
- Thyroid function test
- Thyroid antibody assay
- USG, CT, MRI
Clinical activity score (features of pain)
- Retrobulbar pain
- Pain on ocular movement
Clinical activity score (features of redness)
- Redness of lids
- Redness (congestion) of conjunctiva
Clinical activity score (features of swelling)
- Swelling of lids
- Swelling of conjunctiva
- Swelling of caruncle
- Proptosis (> 2mm increase over 1-3 months)
Clinical activity score (features of function)
- Decrease in eye movement by +/- 5 over 1-3 months
- Decreased vision by >1 snellen line over 1-3 months
What is the non-surgical management for grave disease?
- Smoking cessation
- Head elevation
- Lubricating artificial tear drops
- Eye lids tapping
- Guanethidine 5%
- Prisms
- Systemic steroid
- Radiotherapy
What is the surgical management for grave disease?
- Orbital decompression
- Extraocular muscle surgery
- Eyelid surgery
What is the cause of exophthalmos?
Edema, lymphocytic infiltration and fibrosis of orbital contents and extra-ocular muscle
What is the cause of lid retraction?
Contraction of muller muscle
