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Ocular Disease (Orbit) > Inflammatory/Infections of Orbit > Flashcards

Inflammatory/Infections of Orbit Flashcards

1
Q

bony cavities that contain the globes, extraocular muscles, nerves, fat, & blood vessels

A

Orbits/Bony Orbit

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2
Q

pear shaped, tapering posteriorly to the apex & the optic canal

A

Bony orbit

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2
Q

_______approximately parallel and are separated by ___mm in the average adult

A

Medial orbital walls; 25mm

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3
Q

widest dimension of orbit is approximately __cm behind anterior orbital rim

A

1cm

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4
Q

allows the eye to rotate & move forward without damaging the nerve

A

The normal redundancy of optic nerve

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4
Q

segment of the optic nerve that is slightly “S-curved” and moves with the eye

A

Intraorbital segment

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5
Q

What are the 7 orbital walls

(EFLMPSZ)

A

Ethmoid
Frontal
Lacrimal
Maxilla (Maxillary)
Palatine
Sphenoid
Zygomatic

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6
Q

The evaluation of an orbital disorder should distinguish orbital from _______ and ________ lesions

A

Periorbital & intraocular lesions

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6
Q

5 categories of basic clinical patterns

A
  1. Inflammatory (acute, subacute, & chronic)
  2. Mass effect (causing globe displacement w/ axial/non-axial proptosis0
  3. Structural (congenital or acquired change in bony orbital structure)
  4. Vascular (venous or arterial lesions with characteristic dynamic changes
  5. Functional (sensory & motor dysfunction of neuro vascular structures)
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7
Q

What is the importance of the 5 basic clinical patterns

A

The classification provides a framework for development of a differential diagnosis. The evaluation begins with a detailed history.

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8
Q

What are the 6 Inflammatory/Infections of the Orbit

A
  1. Orbital cellulitis
  2. Orbital tuberculosis
  3. Zygomycosis
  4. Acute aspergillosis
  5. Nonspecific Orbital Inflammation (NSOI)
  6. Thyroid Eye Disease (TED)
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8
Q

involves structures posterior to the orbital septum

A

Orbital cellulitis

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9
Q

occurs as a secondary extension of acute or chronic bacterial sinusitis (majority of cases)

A

Orbital cellulitis

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10
Q

Clinical findings of Orbital cellulitis (FLEPCPRPDIRP)

A

a. Fever
b. Leukocytosis (75% of cases) - increased WBC
c. Erythema (redness)
d. Proptosis (exophthalmos, protrusion of the eye)
e. Chemosis (swelling)
f. Ptosis
g. Restriction upon ocular movement
h. Pain with ocular movement
i. Decreased vision
j. Impaired color vision
k. Restricted visual fields
l. Pupillary abnormalities

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11
Q

Clinical findings of Orbital cellulitis which suggest optic neuropathy that demands immediate investigation & aggressive management

A

Decreased vision,
Impaired color vision,
Restricted visual fields,
Pupillary abnormalities

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12
Q

Delay in treatment of Orbital Cellulitis may result in (BCCBD)

A

a. Blindness
b. Cavernous sinus thrombosis
c. Cranial neuropathy
d. Brain abscess
e. Death

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13
Q

Management of Orbital Cellulitis

A

ANTIBIOTIC THERAPY provide broad-spectrum coverage

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14
Q

(Orbital Cellulitis) What are the organisms involved in infections in adults

A

Gram-positive cocci
H influenzae
Moraxella catarrhalis
Anaerobes

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15
Q

occurs most commonly as a result of hematogenous spread from a pulmonary focus

A

Orbital tuberculosis

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16
Q

spread occurs from adjacent tuberculous sinusitis

A

Orbital tuberculosis

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17
Q

Clinical findings of Orbital Tuberculosis (PMBC)

A

Proptosis
Motility dysfunction
Bone destruction
Chronic draining fistulas

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17
Q

this disease is usually unilateral

A

Orbital tuberculosis

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18
Q

skin testing & fine-needle aspiration biopsy with culture early in course of disease may help establish diagnosis

A

Orbital tuberculosis

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18
Q

Treatment/Management of Orbital tuberculosis

A

ANTITUBERCULOUS THERAPY is usually curative

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19
Q

What are the other names for Zygomycosis

A

Phycomycosis, Mucormycosis

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19
Q

What are the the most common & most virulent fungal disease involving the orbit

A

Mucor & Rhizopus

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20
Q

The fungi invade blood vessel walls, producing _________

A

“Thrombosing vasculitis”

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21
Q

Who are the at risk of Zygomycosis

A

Older adults - relatively immunosuppressed therefore at risk of virulent infections

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21
Q

The resultant tissue necrosis promotes further _______

A

fungal invasion

22
Q

Diagnosis: _______ of the necrotic-appearing tissues in the nasopharynx or involved sinus or orbit

A

Biopsy

23
Q

Treatment of Zygomysocis: ____________ should be given via IV administration of ___________ or _________

A

Antifungal therapy; amphotercin B, liposomal amphotericin B

23
Q

fungal disease characterized by fulminant sinus infection with secondary orbital invasion

A

Acute aspergillosis

23
Q

Clinical Manifestations of Acute aspergillosis

(SDP)

A

Severe periorbital pain
Decreased vision
Proptosis

24
Q

Diagnosis for Acute aspergillosis

A

Biopsy

25
Q

Management of Acute aspergillosis

A
  • Therapy of aggressive surgical excision of all infected tissues.

-Administration of ampotericin B, flucytosine, rifampin, voriconazole, caspofungin, or combination of these

25
Q

Management of Acute aspergillosis: Administration of what 5 antifungal
(AFRVC)

A

amphotericin B,
flucytosine,
rifampin,
voriconazole,
caspofungin,
or a combination of these

26
Q

benign inflammatory process of orbit characterized by a polymorphous lymphoid infiltrate with varying degrees of fibrosis

A

Nonspecific Orbital Inflammation (NSOI)

27
Q

no known local or systemic cause

A

NSOI

28
Q

diagnosis of exclusion that should only be used after all specific causes of inflammation have been eliminated

A

NSOI

28
Q

NSOI is also known as

A

-Orbital pseudotumor
-Idiopathic orbital inflammation
-Idiopathic orbital inflammatory syndrome

28
Q

Pathogenesis of NSOI: _______
-generally believed to be an ___________ because it is often associated with SYSTEMIC IMMUNOLOGIC DISORDERS

A

Controversial/unknown; immune-mediated process

29
Q

Systemic immunologic disorders related to NSOI (CSRDMA)

A

-Crohn disease
-Systemic lupus erythematosus
-Rheumatoid arthritis
-Diabetes mellitus
-Myasthenia gravis
-Ankylosing spondylitis

29
Q

Symptoms & findings of NSOI (dictated by degree & anatomical location of inflammation)

A

-EOM (Myositis) - pain associated with ocular movement
-Lacrimal gland (Dacryoadenitis) - CT reveals diffuse enlargement of lacrimal gland
-Anterior orbit (Scleritis) - vision may be impaired if optic nerve or posterior sclera is involved
-Orbital Apex - diffuse inflammation throughout the orbit

29
Q

autoimmune inflammatory disorder whose underlying cause continues to be cleared

A

Thyroid Eye Disease (TED)

29
Q

TED is also known as

A

Graves ophthalmopathy
Thyroid ophthalmopathy
Thyroid associated orbitopathy
Thyrotoxic exophthalmos

29
Q

NSOI Treatment/Management

A

-Systemic corticosteroids - rapid & favorable response
-Immunosuppressive agents

30
Q
A
31
Q

Clinical signs of TED (EVPRCECC)

A

-Eyelid retraction
-Von Graefe sign (lid lag)
-Proptosis
-Restrictive extraocular myopathy
-Compressive optic neuropathy
-Exposure keratopathy
-Conjunctival erythema (redness)
-Conjunctival chemosis

32
Q

TED was originally described as part of triad that constitutes

(GHPH)

A

Graves disease
Hyperthyroidism
Pretibial myxedema
Hashimoto thyroiditis (immune-induced hypothyroidism)

33
Q

most common clinical feature of TED ( and TED is the most common cause of ______)

A

Eyelid retraction

34
Q

most common cause of unilateral or bilateral proptosis

A

Thyroid Eye Disease (TED)

35
Q

TED may be markedly ______

A

asymmetric

36
Q

TED is associated with ______ in 90% of patients, 6% of patients may be ________

A

Hyperthyroidism; euthyroid

37
Q

True/False: Severity of TED usually does not parallel serum levels of T$or T3

A

True

38
Q

TED is 6 times as common in _______ as in ________

A

women; men

39
Q

______ is associated increased risk & severity of TED. Urgent care may be required for optic neuropathy or severe proptosis with corneal decompensation

A

Smoking

40
Q

(TED) If surgery is needed what is the usual order of procedures

A

Orbital decompression
Strabismus surgery
Eyelid retraction repair

40
Q

TED Diagnosis: Concurrent or recently treated immune-related thyroid dysfunction:

(GHP)

A
  • Graves hyperthyroidism
  • Hashimoto thyroiditis
  • Presence of circulating thyroid antibodies
40
Q

TED Diagnosis: Radiographic evidence- unilateral/bilateral fusiform enlargement of one or more of the following:

A

-Inferior rectus muscle
-Medial rectus muscle
-Superior rectus & or levator muscle complex
-Lateral rectus muscle

40
Q

TED Diagnosis: Typical ocular signs one or more of the following:

A
  • Unilateral/bilateral eyelid retraction with typical temporal flare (w/ or w/o lagophthalmos)
    -Unilateral/bilateral proptosis
    -Restrictive strabismus in typical pattern
    -Compressive optic neuropathy
    -Fluctuating eyelid edema & or erythema
    -Chemosis & or caruncular edema
40
Q

Treatment & prognosis of TED

A

TED is a self-limiting disease
- last 1 year in non-smokers
- between 2-3 years in smokers

41
Q

therapy usually is directed toward either decreasing orbital congestion & inflammation

A

Severe Orbital inflammation

41
Q

Treatment & prognosis:
Severe Orbital inflammation
To prevent:

A

Corneal exposure
Globe subluxation
Optic neuropathy

42
Q

Treatment & prognosis:
Severe Orbital inflammation

A
  1. Periocular corticosteroids
  2. Systemic corticosteroids
  3. Periocular radiotherapy
  4. Surgical orbital decompression - expanding orbital bony volume
43
Q

____% of px with TED undergo surgical treatment

A

20%

44
Q

13% of patients underwent______

A

eyelid surgery

44
Q

9% of patients underwent __________

A

Strabismus surgery

45
Q

7% of patients underwent _______

A

Orbital decompression

46
Q

only _____% required all 3 types of surgery

A

2%

47
Q

Elective orbital decompression, strabismus surgery, & eyelid retraction repair are delayed until a _________ has been maintained & ophthalmic signs have been confirmed stable for ______ months

A

“Euthyroid state”; 6-9 months

47
Q

Consideration of that delay until euthyroid state:

A

Unless urgent intervention is required to reverse vision loss due to compressive optic neuropathy or corneal unresponsive to maximal medical measures.

Ocular Disease (Orbit) (2 decks)

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