Evaluation of Orbital Disorders Flashcards
Salmon colored mass in cul-de-sac?
lymphoma
Eyelid retraction and lid lag?
thyroid eye disease
Vascular congestion over the insertions of the rectus muscles (esp. lateral rectus)?
thyroid eye disease
Corkscrew conjunctival vessels?
AV fistula
Vascular anomaly of eyelid skin?
Lymphatic malformation, varix, or hemangioma
S-shaped eyelid?
plexiform neurofibroma or lacrimal gland mass
Eczematous lesions of eyelids?
mycosis fungoides (T-cell lymphoma)
Ecchymosis of eyelid skin?
metastatic neuroblastoma, leukemia, or amyloidosis
Prominent temple?
sphenoid wing meningioma, metastatic neuroblastoma
Edematous swelling of lower eyelid?
meningioma, inflammatory tumor, metastases
Optociliary shunt vessels?
meningioma, CRVO, glaucoma, chronic papilledema
Frozen globe?
metastases or zygomycosis
Black crusted lesions in nasopharynx?
mucormycosis
Facial asymmetry?
fibrous dysplasia or neurofibromatosis
What is exorbitism?
angle between lateral orbital walls greater than 90 degrees
What is hypertelorism, or telorbitism?
wider than normal separation between medial orbital walls (“wide-clopse”)
What is telecanthus?
abnormally increased distance between medial canthi
Location and types of lesions causing axial displacement of globe?
intraconal mass behind globe, such as cavernous hemangioma, glioma, meningioma, metastases, and AVMs
Most common cause of bilateral proptosis in adults? What are other causes?
- thyroid eye disease
- lymphoma, vasculitis, NSOI, mets, CC-fistulas, cavernous sinus thromboses, leukemic infiltrates
Most common cause of unilateral proptosis in adults?
TED
Differential for bilateral proptosis in children?
TED, NSOI, metastatic neuroblastoma, leukemic infiltrates
What is the cutoff for a clinically significant difference in exophthalmometry between fellow eyes?
2 mm
What EOM is most commonly affected in TED?
inferior rectus
What is the von Graefe sign, and what is it highly suggestive of?
delay in the upper eyelid’s descent (“lid lag”) in downgaze; TED
Most common physical signs of TED?
lid lag of upper eyelid and eyelid retraction of upper and lower lids
Differential for palpable lesion in superonasal quadrant?
mucocele, mucopyocele, encephalocele, neurofibroma, rhabdomyosarcoma, or lymphoma
Differential for palpable lesion in superotemporal quadrant?
prolapsed lacrimal gland, dermoid cyst, lacrimal gland tumor, lymphoma, NSOI
Orbital locations where MRI is better than CT?
orbitocranial junction and soft tissues of orbital apex
