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Abnormal Ocular Conditions > Lacrima and orbit > Flashcards

Lacrima and orbit Flashcards

1
Q

What is a congenital lacrimal fistula?

A

abnormal duct which connects the lacrimal drainage system with the skin

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2
Q

What are the sxs of congenital lacrimal fistula?

A

asx
epiphora
soreness
mucous discharge
swelling of punctum/fistula

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3
Q

What are the signs of congenital lacrimal fistula?

A

extra punctum (usually inferior or nasal to inferior punctum)
usually unilateral
mucous discharge from punctum or fistula

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4
Q

What are the causes/risks of congenital lacrimal fistula?

A

idiopathic
abnormal gestational development
approx 1 in 2000 (rare)

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5
Q

What is the management of congenital lacrimal fistula?

A

none if asx
if sx, HES referral for cauterization or excision

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6
Q

What is a lacrimal sac mucocele?

A

enlargement of lacrimal sac due to combined obstructions of common canaliculi opening and nasolacrimal duct

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7
Q

What are the sxs of a lacrimal sac mucocele?

A

epiphora
irritation
nasal lump

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8
Q

What are the signs of a lacrimal sac mucocele?

A

non-tender enlarged area at lacrimal sac location

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9
Q

What are the causes/risks of a lacrimal sac mucocele?

A

inflammation
trauma
tumour
nasal surgery
dacryocystitis sequelae (previous hx of dacryocystitis)

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10
Q

What is the management for lacrimal sac mucocele?

A

sxs - lubrication and warm compresses/massage
Routine referral for imaging/diagnosis, poss syringing/surgery to remove obstruction

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11
Q

What is a lacrimal sac mass?

A

tumour
potentially life threatening
v rare

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12
Q

What are the sxs of a lacrimal sac mass?

A

epiphora
irritation
nasal lump (hard mass)
persistent infections
bleeding from nose/punctum

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13
Q

What are the signs of a lacrimal sac mass?

A

painless hard mass at lacrimal sac location
if extends above medial canthus - tumour suspect

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14
Q

What are the causes/risks of a lacrimal sac mass?

A

Younger = more likely to be benign
Over 50 = generally malignant
Tumours usually epithelial (60-94%)

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15
Q

What is the management for lacrimal sac mass?

A

Urgent HES referral for diagnosis and tx

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16
Q

What is varix?

A

enlargement of a vein or artery

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17
Q

What is valsalva action?

A

an action which causes increased pressure e.g. heavy lifting

18
Q

What is a carotid cavernous fistula?

A

abnormal anastomosis between arterial and venous circulation which causes abnormal flow between internal or external carotid and cavernous sinus, producing increased vascular pressure/resistance, impeding venous drainage - leading to vascular congestion in areas drained by cavernous sinus

19
Q

What are the causes of carotid cavernous fistula?

A

congenital
head trauma (most)
intracranial surgery
spontaneous due to aneurysm

20
Q

What are the sxs of carotid cavernous fistula?

A

vision loss
diplopia
redness
orbital/retro-orbital pain
swelling
swishing or buzzing sounds
headache
pulsatile tinnitus

21
Q

What are the signs of carotid cavernous fistula?

A

RAPD
pulsatile proptosis
orbital oedema
distinct tortuous corkscrew blood vessels on conj converging at limbus
chemosis
raised IOP
ophthalmoplegia
retinal vein engorgement
anterior segment ishchemia
disc swelling
CN palsies

22
Q

What is the management for carotid cavernous fistula?

A

mild - urgent HES referral
severe - emergency HES referral

23
Q

What is the mechanism of a lacrimal gland tumour?

A

abnormal epithelial and non epithelial cell division

24
Q

What are the sxs of a lacrimal gland tumour?

A

hard mass/swelling on upper lid
soreness
frequent infections

25
Q

What are the signs of a lacrimal gland tumour?

A

lid mass
S-shaped lid due to blocked lacrimal gland
later in progression: facial asymmetry, diplopia, ptosis, limited EOMs

26
Q

What are the causes/risks of a lacrimal gland tumour?

A

most secondary to dacryoadenitis

27
Q

What is the management for a lacrimal gland tumour?

A

Urgent referral to HES for imaging/biopsy

28
Q

What is an optic nerve glioma or meningioma?

A

tumour of the optic nerve
glioma - uncontrolled glial cell growth (usually under 10s, slow growing, benign or malignant)
meningioma - tumour in meningies (rarely under 20s, benign)

29
Q

What are the sxs of an optic nerve glioma or meningioma?

A

gradual painless reduction in vision
bulging eye

30
Q

What are the signs of an optic nerve glioma or meningioma?

A

reduced VA and CV
compressive field loss
RAPD
optociliary shunt vessels
proptosis if severe

31
Q

What are the causes/risks of an optic nerve glioma or meningioma?

A

Glioma - linked to neurofibromatosis 1 (nerve cancer, malignant)
Meningioma - ionising radiation. women 3x risk. linked to neurofibromatosis 2 (nerve cancer, benign)

32
Q

What is the management for an optic nerve glioma or meningioma?

A

Urgent referral to HES for extensive imaging/biopsy
Can be monitored or excised, or treated with radiation or chemo

33
Q

What is a lymphoma?

A

WBC cancer

34
Q

What are the sxs of metastases or lymphoma in the eye?

A

bulging eye
blur
diplopia
pain
varies dependent on tumour location

35
Q

What are the signs of metastases or lymphoma in the eye?

A

proptosis
reduced VA
field loss
RAPD
suspicious retinal lesions

36
Q

What are the causes/risks for metastases or lymphoma in the eye?

A

metastases - breast/lung/prostate cancer/melonoma
lymphoma - idiopathic. most non-Hodgkins (develops in lymphatic system)

37
Q

What is the management for metastases or lymphoma in the eye?

A

Urgent HES referral for extensive imaging/biopsy
Can be monitored or excised, or treated with radiation or chemo

38
Q

What is rhabdomyosarcoma?

A

rare childhood cancer (90% cases U16, average 5-7 years)
tumour in orbital fat

39
Q

What are the sxs of rhabdomyosarcoma?

A

Proptosis
lid swelling
orbital mass
ptosis
orbital pain

40
Q

What are the signs of rhabdomyosarcoma?

A

proptosis
lid oedema
nasolacrimal duct obstruction (if more nasal)
If towards posterior pole: choroidal folds, disc swelling, retinal detachment

41
Q

What is the management for rhabdomyosarcoma?

A

Call HES and speak to ophthalmologist - same day or 2 weeks

Abnormal Ocular Conditions (4 decks)

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