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Duke Elder Exam Prep > Disease's of the Orbit > Flashcards

Disease's of the Orbit Flashcards

1
Q

What is the most common cause of axial proptosis both uni- and bilaterally in adults?

A

Thyroid eye disease

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2
Q

How does hyperthyroidism lead to the development of proptosis?

A

Hyperthyroidism is an autoimmune disease. There are two phases to the eye disease. Firstly the active inflammatory stage which causes read and painful eyes, Then there is the inactive fibrotic phase which involves the extraocular muscles and connective tissues.

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3
Q

What causes eyelid retraction in graves disease?

A

The overstimulation of the muller muscle, due to high levels of Thyroid hormones.

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4
Q

what is von Graefe sign?

A

The lid lag on downward gaze

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5
Q

What is Kocher sign?

A

A ‘staring’ appearance

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6
Q

What order are the EOM typically affected by the deposition of the glycosaminoglycans?

A 
IR
MR
SR
LP
LR
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7
Q

What investigations should be done for suspected thyroid disease?

A

TFTs
Imaging - CT or MRI is indicated if orbital decompression is planned
Visual field testing

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8
Q

What management options are there for thyroid eye disease?

A 
Smoking cessation
Thyroid management
Watchful waiting
Lubricating orbit
topical ciclosporin
overnight lid taping
IV methylprednisolone
Orbital radiotherapy
Surgery - post inflammatory phase. May require orbital decompression, strabismus surgery or eyelid surgery.
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9
Q

What are some complications of thyroid eye disease?

A

Dysthyroid optic neuropathy
Superior limbic keratoconjunctivitis
Exposure keratopathy

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10
Q

What is another orbital disease, which is similar to cellulitis but presents more gradually and is often seen in immunocompromised patients on in DKA?

A

Orbital mucormycosis

A fungal infection caused by mucoracea

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11
Q

What is a characteristic of orbital murcomycosis?

A

Necrotic black eschars over the nasal turbinates and palate.

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12
Q

What are the most common causative organisms of orbital cellulitis?

A

Strep Pneumoniae
Staph Aureus
Haemophilus influenzae

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13
Q

What investigation should you do for orbital cellulitis?

A

CT

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14
Q

What is the appropriate management for orbital cellulitis?

A

IV antibiotics - ceftriaxone + flucloxacillin

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15
Q

List some complications of orbital cellulitis?

A

Abscess
Cavernous sinus thrombosis
Brain abscess / meningitis
Neuropathy

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16
Q

What type of rare tumours present in childhood and form a blood-filled ‘chocolate’ cyst?

A

Lymphangioma

17
Q

What are some characteristics of an anterior lymphangioma?

A

Bluish mass
Superonasally on the eyelid
Exacerbated by Valsalva manoeuvre

18
Q

What are the two types of optic nerve tumours?

A

Glioma

Meningioma

19
Q

What is the most common primary orbital malignancy in children?

A

Rhabdomyosarcoma

20
Q

Give some characteristics of rhabdomyosarcoma’s of the orbit?

A

Typically affect children, mean age 8y/o.
Has the ability to differentiate into striated muscle from undifferentiated mesenchymal cells
Rapidly progressing unilateral proptosis
Diplopia may occur

21
Q

What is a carotid-cavernous fistula?

A

This is the development of an arteriovenous connection between the cavernous sinus (venous) and the carotids (arterial)
Direct are often due to trauma while indirect can be due to hypertension and will occur spontaneously

22
Q

What is the most common solid, extracranial tumour in children that forms from the neural crest of the sympathetic?

A

Neuroblastoma.

23
Q

What are some features of a neuroblastoma?

A

Homer-Wright rosettes

Child with periorbital ecchymosis and uni/bilateral proptosis.

24
Q

What condition can be associated with optic nerve gliomas?

A

Neurofibromatosis 1

25
Q

What condition can be associated with optic nerve sheath meningiomas?

A

Neurofibromatosis 2

26
Q

What are some features of a direct cavernous-carotid fistula?

A 
Acute onset
Triad of pulsatile proptosis, conjunctival chemosis and whooshing sound in head
Ophthalmoplegia
IOP raised
Visual loss
Papilloedema
27
Q

What are some features of indirect CC fistula?

A

Gradual onset of redness and irritation of the eyes
Raised IOP
Moderate venous dilation with tortuosity of retinal vasculature
Corkscrew epibulbar vessels
Mild proptosis

28
Q

What are a common neonatal benign orbital tumour than usually spontaneously regress?

A

Capillary haemangioma

aka Strawberry naevi

29
Q

What is a cavernous sinus thrombosis?

A

This is when there is a clot formation in the cavernous sinus, and is often due to the spreading of infection from the paranasal sinuses ear OR orbital cellulitis.

30
Q

What are some clinical features of a cavernous sinus thrombosis?

A

Rapid onset of headache, nausea and vomiting
Chemosis, uni/bilateral proptosis
Diplopia

31
Q

How is a cavernous sinus thrombosis managed

A

IV antibiotics, steroids and / or LMWH

Surgical drainage

Duke Elder Exam Prep (18 decks)

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