Diplopia Flashcards
What is the most common thyroid dysfunction
Graves
What does cigarette smoking worsen
AMD
Graves
Things about Graves
- TSH autoAB targeted EOMs-significant imflammation-fibroblast proliferation
- # 1 risk of bilateral/unilateral proptosis in middle aged patient
- BIG risk factor=cigarette smoking
- female prediclection (8:1)
- TSH autoAB may also attack thyroid gland-graves with thyroid dysfunction (hyper).
- 1% have concurrent MG
Grading system for graves
NOSPECS
- No signs to symptoms
- Only signs, but no symptoms
- Soft tissue involvement
- Proptosis
- EOM involvement with resulting diplopia; the IR is most commonly affected first, followed by the medial, superior, and LR. (IMSLO)
- Corneal involvement
- Sight Loss due to ONH compression (enlarged EOMs)
Von Graef sign
Upper lid lag on down gaze
Dalrymple sign
Upper lid retraction, “stare appearance”
EOM restrictions and Graves
IMSLO
-+ forced duction
Greates threat to vision in graves
ONH compression
Dx of graves
CT/MRI-enlarged EOM with sparing of tendons
Increased exophthalmometry
T3/T4/TSH blood work
Treatment for graves
- stop smoking
- exposure K: aggressive lubrication
- diplopia: prism or surgery
- ON compression: steroids, orbital decompression
- concurrent hyperthyroidism: radioiodine, anti-thyroid meds, thyroidectomy
Normal exophthalmometry
12-22mm for whites
12-18 for asians
12-24 for AA
Browns syndrome
- abnormal SO muscle or tendon or trochlea
- unilateral hypotropia in primary gaze and limited elevation during adduction
- acquired or congenital
- chin up posture
- (+) FD
- Tx: prism or surgery
Duanes
- congenital, abnornal muscles or abnormal CN3 or 6 nuclei.
- ET in primary
- type 1=cant abduct
- type 2=cant adduct
- type 3=cant adduct or abduct
- contralateral glob retraction and narrowed palpebral fissure with adduction
- (+) FD
- Tx=prism or surgery
Ocular MG
- Ach receptor autoABs
- muscle weakness/fatigue
- variable ptosis and diplopia worse at end of day
- 70% have ocular findings as first presentation
- ice pack test, Cogans lid twitch,
- Dx=tensilon test
- management: 10% have a thymoma, do chest CT; 5% have graves, do thyroid testing, ACH inhibitors
EOM entrapment
- orbital floor fracture
- entrapped IR/IO
- restricted upgaze with diplopia and (+) FD
- treatment: don’t blow nose for 48 hours, abx to decrease chance of infection, fresnel prism for temp diplopia, sx if persistent diplopia after 7-14 days
Kochers sign
Globe lag compared to eyelid movement on upgaze
What drug can make ocular MG worse
B blockers
Intraoribital mass
- takes up space in orbit
- unilateral painless progressive proptosis and EOM restrictions with diplopia and ON compression (unilateral optic disc edema with decreased VA, APD, and decreased color vision
Cavernous sinus hemangioma
Most common benign orbital tumor in adults
Capillary hemangioma
Most common benign orbital tumor in kids, Dx prior to 6m, spontaneous involution by 7y
Rhabdomyosarcoma
Most common primary pediatric orbital malignancy
Rapid bone destruction tumor
Avg dx age 7
Neuroblastoma
Msot common secondary pediatric orbital malignancy
-originates from abdomen, mediastinum and neck
