Epidemiology

Question 1

Preseptal cellulitis

Answer 1

More common than orbital cellulitis, more common in young adults and children, especially in winter months

Question 2

Orbital cellulitis

Answer 2

Recent sinus infection or trauma. Leading cause of exophthalmos in children

Question 3

Thyroid eye disease

Answer 3

8:1 F>M, 40-50yo, Most commonly caused by HYPERthyroidism, TED occurs in 30-70% of pts w/Graves disease. Cigarette smoking is strongest risk factor (2-9X). TED is the most common cause of unilateral or bilateral proptosis in middle-aged patients.

Question 4

Capillary hemangioma

Answer 4

Most common benign orbital tumour in children. Almost always dx by age 6mo.

Question 5

Cavernous hemangioma

Answer 5

Most common benign orbital tumour in adults, occurs in 40-60yo, F>M

Question 6

Optic nerve glioma

Answer 6

Most common intrinsic tumour of the optic nerve (65% of such tumours). Symptoms within first decade of life (2-6yo)

Question 7

Meningioma

Answer 7

Most common benign brain tumour, typically in middle-aged women. Sphenoid meningiomas are the most common intracranial tumour to invade the orbit

Question 8

Rhabdomyosarcoma

Answer 8

Most common primary pediatric orbital malignancy. Average age of dx is 7yo

Question 9

Neuroblastoma

Answer 9

Most common secondary pediatric orbital malignancy (2nd most common overall malignancy after rhabdomyosarcoma), most commonly arises from a tumour in the abdomen, mediastinum, or neck (may have assoc. Horners). Presents by 10yo.

Question 10

Lymphoma

Answer 10

Most common in pts 50-70yo, 30-50% with orbital disease develop systemic involvement of which 60% have a 5-yr survival rate

Question 11

Orbital pseudotumour / Idiopathic Orbital Inflammatory Syndrome

Answer 11

Rare condition. May be acute, recurrent, or chronic. Most commonly affects young to middle-aged pts (20-50yo). 3rd most common orbital disorder in adults. 2nd most common cause of exophthalmos

Question 12

Ocular rosacea

Answer 12

Most common in middle-aged adults of Northern European ancestry. F>M, M more severe disease. Affects approx 10% of population including and estimated 50% with acne rosacea

Question 13

Ocular cicatricial pemphigoid

Answer 13

Rare condition, F>M 2:1, average age of dx is 65yo

Question 14

Chalazion/hordeola

Answer 14

Often have a history of similar recurrent lesions or assoc w acne rosacea and seborrheic dermatitis

Question 15

Floppy eyelid syndrome

Answer 15

Most common in obese men with obstructive sleep apnea. Assoc w/DM, hyperthyroidism, and HTN

Question 16

Benign essential blepharospasm

Answer 16

Most common in 50-70yo, mean onset of 56yo, 2:1 F>M

Question 17

Basal cell carcinoma

Answer 17

The most common skin cancer in the US, M>F, most common eyelid cancer (90% of eyelid malignancies), assoc w/fair skin and UV exposure, especially UV-B (290-320nm), pt may report a chronic lesion that occasionally bleeds and will not heal

Question 18

Squamous cell carcinoma

Answer 18

More common M>F 2:1, 2nd most common eyelid cancer, but still 40-50x less common than BCC

Question 19

Sebaceous gland carcinoma

Answer 19

Rare, with a similar incidence to SCC. More common in elderly women. Pts may have a history of chronic unilateral blepharitis or recurrent chalazia

Question 20

Malignant melanoma

Answer 20

Rare (<1% of all eyelid malignancies) but most lethal primary skin cancer

Question 21

Dacryoadenitis

Answer 21

More common in children and young adults. May have history of recent fever or systemic infection

Question 22

Nasolacrimal duct obstruction

Answer 22

Congenital or acquired. F>M 2:1

Question 23

Primary acquired melanosis (PAM) and Conjunctival melanoma

Answer 23

elderly white patients >50yo

Question 24

Conjunctival intraepithelial neoplasia (CIN)

Answer 24

most common conjunctival neoplasia in US. also known as Bowens disease or conj squamous dysplasia. risk for CIN -> SCC include UV-B exposure, smoking, exposure to petroleum derivatives, fair skin, xeroderma pigmentosa, HIV, and HPV*

Question 25

Conjunctival squamous cell carcinoma (OSSN)

Answer 25

elderly white pts (90%), males (81%), most commonly derived from CIN and assoc w UV and HPV

Question 26

Simple bacterial conjunctivitis

Answer 26

more common in children, H. influenzae
(S. Aureus or epidermidis for adults)

Question 27

gonococcal conjunctivitis

Answer 27

STI most common in YA but can also be transmitted to infants from birth canal

Question 28

adenoviral conjunctivitis

Answer 28

more common in adults than children except for PCF (“swimming pool conjunctivitis”). most common cause of “pink-eye”, highly contagious for up to 14 days and transmitted via contact

Question 29

molluscum contagiosum

Answer 29

rare, common in communities with noted poor hygiene, most common in children and YA

Question 30

Allergic conjunctivitis

Answer 30

common, affects all ages, history of allergies common, can be seasonal or perennial

Question 31

VKC - vernal keratoconjunctivitis

Answer 31

very rare, <1% of allergic conj., young males under 10yo, in hot dry climates, in spring or fall, resolves around puberty, symptoms upper lid

Question 32

AKC - atopic keratoconjunctivitis

Answer 32

rare, <3% of allergic conj., teens to 40s, history of atopy (esp dermatitis), can also develop shield cataract

Question 33

GPC - giant papillary conjunctivitis

Answer 33

most commonly from SiHy CL extended wear, exposed sutures, glaucoma blebs, scleral buckles, or ocular prosthetics. Also can be from environment. CL risk factors: SiHy, extended wear, high water-ionic lenses, higher modulus, poor replacement compliance