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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

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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

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19
Q

What are the causes of carotid cavernous fistula?

A

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

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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

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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

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22
Q

What is the management for carotid cavernous fistula?

A

mild - urgent HES referral
severe - emergency HES referral

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23
Q

What is the mechanism of a lacrimal gland tumour?

A

abnormal epithelial and non epithelial cell division

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24
Q

What are the sxs of a lacrimal gland tumour?

A

hard mass/swelling on upper lid
soreness
frequent infections

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25
What are the signs of a lacrimal gland tumour?
lid mass S-shaped lid due to blocked lacrimal gland later in progression: facial asymmetry, diplopia, ptosis, limited EOMs
26
What are the causes/risks of a lacrimal gland tumour?
most secondary to dacryoadenitis
27
What is the management for a lacrimal gland tumour?
Urgent referral to HES for imaging/biopsy
28
What is an optic nerve glioma or meningioma?
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
What are the sxs of an optic nerve glioma or meningioma?
gradual painless reduction in vision bulging eye
30
What are the signs of an optic nerve glioma or meningioma?
reduced VA and CV compressive field loss RAPD optociliary shunt vessels proptosis if severe
31
What are the causes/risks of an optic nerve glioma or meningioma?
Glioma - linked to neurofibromatosis 1 (nerve cancer, malignant) Meningioma - ionising radiation. women 3x risk. linked to neurofibromatosis 2 (nerve cancer, benign)
32
What is the management for an optic nerve glioma or meningioma?
Urgent referral to HES for extensive imaging/biopsy Can be monitored or excised, or treated with radiation or chemo
33
What is a lymphoma?
WBC cancer
34
What are the sxs of metastases or lymphoma in the eye?
bulging eye blur diplopia pain varies dependent on tumour location
35
What are the signs of metastases or lymphoma in the eye?
proptosis reduced VA field loss RAPD suspicious retinal lesions
36
What are the causes/risks for metastases or lymphoma in the eye?
metastases - breast/lung/prostate cancer/melonoma lymphoma - idiopathic. most non-Hodgkins (develops in lymphatic system)
37
What is the management for metastases or lymphoma in the eye?
Urgent HES referral for extensive imaging/biopsy Can be monitored or excised, or treated with radiation or chemo
38
What is rhabdomyosarcoma?
rare childhood cancer (90% cases U16, average 5-7 years) tumour in orbital fat
39
What are the sxs of rhabdomyosarcoma?
Proptosis lid swelling orbital mass ptosis orbital pain
40
What are the signs of rhabdomyosarcoma?
proptosis lid oedema nasolacrimal duct obstruction (if more nasal) If towards posterior pole: choroidal folds, disc swelling, retinal detachment
41
What is the management for rhabdomyosarcoma?
Call HES and speak to ophthalmologist - same day or 2 weeks
42
What questions should you ask a px c/o watery eyes?
Does it bother you? Is it transient/trivial or disabling? How often do you wipe your eyes? Is it worse in cold weather? Where do the tears spill over? POH - any surgery, trauma or pathology? GH - ENT issues/CN7 palsy/simultaneous runny nose? Meds - anything that is pro-secretory?
43
What are the key clinical assessments for a px c/o watery eyes?
Observation - scars/sag/asymmetry/swelling/MGD/laxity/malposition/puncta position/inflam/infection Tear film - meniscus height/symmetry, TBUT. VA Fluor dye disappearance test Jones test
44
What is the fluorescein dye disappearance test?
Tests drainage If fluor retained after 5 mins, blockage present. Grades 0-1: normal Grades 2-3: abnormal
45
What is the Jones test?
Tests drainage Fluor instilled, cotton bud placed in nostril If no fluor on cotton bud - blockage Repeated after syringing to determine if mechanical obstruction (no fluor on bud) or functional lacrimal pump failure (fluor on bud)
46
What are the signs of lid laxity/malposition?
Lower lid droop (worse nasally) Malposition of puncta Inferior corneal/conj staining Overflow of tears on fluor instillation
47
What are the sxs of lid laxity/malposition?
Epiphora Irritation Redness AM crustiness
48
What is the management for lid laxity/malposition?
Advise normal age related change Manage sxs - lubrication and hygiene No referral
49
What are the sxs of punctal/canaliculi stenosis (blockage)?
Epiphora Irritation Recurring conjunctivitis (lack of drainage)
50
What are the signs of punctal/canaliculi stenosis (blockage)?
Grade 2-3 FDDT Tear regurgitation on palpation of lacrimal sac
51
What are the RFs for punctal/canaliculi stenosis?
Age Scarring Chronic inflam/infection Prostaglandin analogues Chemotherapy (known side effect of 5-FU type)
52
How should punctal/canaliculi stenosis be managed?
Manage sxs - lubrication and warm compress Lacrimal syringing Routine referral for surgery (severe)
53
What are the sxs of incomplete blink?
Epiphora Irritation Dry eye sxs
54
What are the signs of incomplete blink?
MGD (glands not cleared by blink) Smile stain Poor TBUT
55
What are the RFs for incomplete blink?
Prolonged screen time/reading (less blinking) Botox 7th nerve palsy Bell's palsy
56
How should incomplete blink be managed?
Conscious blinking Blinking exercises Artificial tears 20/20/20 Refer if secondary cause
57
How would you instruct a px to complete blinking exercises?
Close eyes: 2 secs Squeeze: 2 secs Open: 2 secs Repeat 5x Every hour for 2 weeks/on computer then 4x per day
58
What are the sxs of congenital nasolacrimal duct occlusion (NLDO)?
Watering Sticky discharge Frequent infections
59
What are the signs of congenital nasolacrimal duct occlusion (NLDO)?
White eyes Increased tear meniscus Sticky/crusty discharge Persistent conjunctivitis FDDT grade 2-3
60
What causes NLDO?
Incomplete canalisation causes obstruction (5-20% newborns)
61
How should NLDO be managed?
Warm compress/massage Lid hygiene (1:10 baby shampoo : water, use cotton bud) Routine referral if unresolved within a year
62
What is dacryocystitis?
Acute bacterial infection of lacrimal sac Usually due to bloackage
63
What are the sxs of dacryocystitis?
Epiphora Nasal swelling Discharge Pain Fever
64
What are the signs of dacryocystitis?
Redness Tenderness Lacrimal sac swelling Mucopurulent discharge on expression (painful) Conjunctivitis Maybe pre-septal cellulitis
65
What are the RFs for dacryocystitis?
Kids with NLDO Over 40s Females 2x as likely Trauma/surgery
66
How should dacryocystitis be managed?
Severe/kids: emergency referral Mild: chloramphenicol warm compress/massage GP referral for oral antibiotics if no response Urgent referral if no further response Follow up in case pre-septal cellulitis develops
67
What does CN7 (facial nerve) innervate?
Orbicularis oculi Lacrimal gland
68
What non-ocular sxs can a CN7 palsy cause?
Ear pain Tinnitus Increased sound sensitivity Facial drooping Impaired taste Numbness
69
What ocular sxs can a CN7 palsy cause?
Unable to fully open or close eye Watering Irritation Red eye
70
What are the signs of a CN7 palsy?
Incomplete blink Corneal/conj staining Conj redness Exposure keratitis
71
What test should be normal in CN7 palsy?
Motility
72
What are the RFs for CN7 palsy?
Bell's palsy Stroke Tumour Virus Inflam
73
How should new cases of CN7 palsy be managed?
Same day referral to GP/HES for corticosteroids/antivirals and diagnosis confirmation
74
How should old cases of CN7 palsy be managed?
Sx management: lubrication, lid taping at night Avoid keratitis
75
What is canaliculitis?
Bacterial infection of canaliculus Acute or chronic
76
What are the sxs of canaliculitis?
Epiphora Mucous discharge Swollen punctum Pain/tenderness Grittiness caused by lumps in canaliculi
77
What are the signs of canaliculitis?
Red/white lump at puncta Punctum turned out/pouting Chronic conjunctivitis Mucopurulent discharge when pressure applied to punctum/canaliculi
78
What are the RFs for canaliculitis?
Age Punctal plugs Immunocompromisation
79
What is the management for canaliculitis?
Chloramphenicol Oral antibiotics Warm compress/massage Monitor - may become pre-septal cellulitis or dacryocystitis
80
What are the 7 P's for history taking when there is suspicion of orbital involvement?
Pain Proptosis Progression Past medical history Perception Palpable mass Periorbital abnormalities
81
What are the 7 P's for examination when there is suspicion of orbital involvement?
Panorama (signs outside of eye) Perception (VA, CV, CS, VF) Pupils Proptosis Palpate Pulsation Periorbital

Abnormal Ocular Conditions (10 decks)

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