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ocular disease 3 > Facial Asymmetries of Orbit and Pseudo Orbit > Flashcards

Facial Asymmetries of Orbit and Pseudo Orbit Flashcards

1
Q

pseudo orbital dz: condition with a sign associated with orbital dz

A

inflammation of one of the upper lids (ie internal hordeolum)

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2
Q

unequal palpebral apertures not associated with exophthalmos (2)

A
  1. inflammation of one of the upper lids (internal hordeolum)
  2. microphthalmia
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3
Q
  • closure or winking of an eye because it is irritated,
  • blepharospasm (an extreme case of the above)
  • levator dehiscence
A

unequal palpebral apertures NOT associated with exophthalmos

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4
Q

weakening of the connection between the levator and the tarsal plate in the upper lid, often observed among the elderly

A

levator dehiscence

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5
Q

• over contraction of the muscles of facial expression in a contralateral facial nerve palsy
• retraction of the contralateral lid
• misdirected facial nerve fibers, after CN7 damage (can lead to a rare and peculiar form of facial
asymmetry known as jaw-winking, in which an eye closes in response to opening and closing the mouth

A

unequal palpebral apertures not associated with exophthalmos

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6
Q

• ocular trauma or any surgery in or around an eye,
• also: enophthalmos, in which the palpebral apertures
are actually of different sizes but due to malposition of the globe.
•physiological pseudoptosis (physiological asymmetry
more than normal but not associated with pathology).

A

unequal palpebral apertures not associated with exophthalmos

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7
Q

! Dorsal midbrain syndrome
! Thyroid-related orbitopathy
! Aberrant regeneration syndromes
! Pseudo lid retraction e.g., contralateral ptosis

A

lid retraction

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8
Q
  1. Lid retraction
  2. Palsy of up gaze
  3. “Retraction nystagmus” on attempted upgaze
  4. Tectal pupils
    sluggish, mydriatic, near resp>lite resp
A

dorsal midbrain syndrome

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9
Q

what are the 2 categories of unequal palpebral apertures associated with orbital dz

A
  1. not associated with thyroid dz

2. associated with thyroid dz

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10
Q 
!  orbital mass
!  venous stasis
!  EOM paralysis (external ophthalmoplegia) 
!  orbital cellulitis
!  orbital pseudotumor
!  surgery
!  other (unusual)
A

exophthalmos with equal or unequal palpebral apertures not thyroid related

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11
Q

orbital contents into a sinus, e.g., in blow-out fracture, sinus surgery

A

enophthalmos with equal or unequal palpebral apertures

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12
Q

what can happen when v pressure is too high (mass lesion)

A

venous stasis

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13
Q

what does it mean if all eye muscles are paretic at the same time

A

external ophthalmoplegia

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14
Q

exophthalmos with equal or unequal caucasian palpebral apertures

A

> 20 mm

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15
Q

exophthalmos with equal or unequal african palpebral apertures

A

> 24 mm

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16
Q

exophthalmos with equal or unequal palpebral apertures will have an asymmetry of what?

A

2.0 mm or more

17
Q

what type of pathology accounts for 90% of exophthalmos

A

thyroid related

18
Q

what can be used to find abnormalities even when pt is euthyroid?

A

modern blood tests

19
Q 
!  TRO
!  Thyroid ocular disease
!  Grave's disease / Grave's orbitopathy
!  Grave's ophthalmopathy
!  Dysthroid orbitopathy
!  Dysthroid myopathy
!  Dysthyroid ophthalmopathy
A

thyroid related orbitopathy synonyms

20
Q

name 3 TRO symptoms

A
  1. binocular diplopia
  2. ocular irritation
  3. my eyes look funny
21
Q 
!  exophthalmos
!  stare, lid retraction
!  inferior punctate staining
!  abnormal eye movements
!  sector injection
!  elevated IOP / optic neuropathy
!  lid edema
A

TRO signs

22
Q

what are 3 TRO lab tests

A
  1. TSH
  2. elevated T4 (not T3)
  3. thyroid stimulating antibody (if in doubt)
23
Q 
!  educate the patient
!  exophthalmometry
!  measure palpebral aperture
!  check for corneal staining, TBUT
!  muscle field
!  Take IOP & document ONH
!  communicate with endocrinologist
A

TRO specific procedures

24
Q 
!  Adnexa
!  Lids
!  Bulbar conjunctiva
!  Cornea
!  Eyeball
!  Extraocular muscles
!  IOP
!  Optic nerve
A

TRO checklist tissues

25
Q 
!  Puffiness ( adnexa)
!  Edema, retraction, stare (lids)
!  Sector injection (conj)
!  Exposure keratitis, staining (cornea)
!  Exophthalmos (eyeball)
!  Incomitancy, enlargement (EOMs)
!  Elevation or elevated on up gaze (IOP)
!  Compression, glaucoma (optic nerve)
A

TRO checklist signs

26
Q

during progression what are 3 TRO interventions?

A

tarsorrhaphy
orbital decompression systemic steroids
monocular occlusion

27
Q

when progression has stopped, what are 2 TRO interventions?

A

! lid reconstruction for cosmesis

! alleviate diplopia

28
Q

what are the 4 steps of TRO management

A
  1. co-manage the endocrine disorder
  2. protect the CORNEA (lubricant, tape lids at night)
  3. protect the ON
  4. help the patient cope with diplopia, cosmesis
29
Q

what are 3 cases when prescribing prism?

A
  1. acquired strabismus
  2. spread of comitancy
  3. there is incomitancy
30
Q

what are diagnositc tools for Rxing prism in acquired strabismus? (5)

A
  1. CT
  2. maddox rod
  3. double maddox rod vergences
  4. ARFT
  5. hess lancaster screen
31
Q

where do we put the direction of base when Rxing prism in acquired strabismus?

A

move image to where eye points (apex toward direction of deviation)

32
Q

how much prism do we have an acquired strabismus pt?

A

measure the deviation
trial & error: prism bars, TF

How:
usually must surface, decenter if poss two pairs of glasses

ocular disease 3 (10 decks)

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