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Disease 1 > Lecture 1 - Orbit to TED > Flashcards

Lecture 1 - Orbit to TED Flashcards

1
Q

First step of embryogenesis, multiplying (mitosis)

A

Proliferation

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2
Q

Second step of embryogenesis- movement and changes in shape of cells

A

Motility

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3
Q

Third step of embryogenesis- role assignment of cells

A

Determination

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4
Q

Fourth step of embryogenesis- some genes will be expressed in only certain parts of the body

A

Differentiation

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5
Q

part of the 3 layered gastrula that becomes the mouth

A

Blastopore

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6
Q

part of the 3 layered gastrula that becomes the digestive tube

A

archenteron

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7
Q

Fertilized egg- 2 cell- 4 cell- 8- cell- 16 cell - WHAT?- blastula- 2 layered gastrula- 3 layered gastrula

A

Morula

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8
Q

Lung, Thyroid, Digestive/ Pancreatic cells are formed by which embryonic layer?

A

Endoderm (internal layer)

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9
Q

Cardiac, skeletal, and smooth muscle cells, Tubule cells of kidney, and RBC’s are formed by which embryonic layer?

A

Mesoderm (middle layer)

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10
Q

Skin and pigment cells and Brain Neurons are formed by which embryonic layer?

A

Ectoderm (external layer)

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11
Q

ocular component developed at 2.5 mm stage

A

optic pit depressions

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12
Q

ocular components developed at 4 mm stage

A

optic stalk, vesicle, lens plate

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13
Q

ocular component developed at 5 mm stage

A

optic cup by invagination

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14
Q

ocular component developed at 9 mm stage

A

Lens vesicle - separated from surface ectoderm

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15
Q

ocular components developed at 13 mm stage

A

choroidal fissures close, posterior lens grows forward

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16
Q

ocular components developed at 65 mm stage, after 3 months

A

all basic components of eye are now present

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17
Q

ocular muscles derived from the Neuroectoderm

A

Iris sphincter and dilator

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18
Q

ocular tissues derived from neuroectoderm

A

RPE, PCE, NPCE, pigmented iris epithelium,

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19
Q

lens, conjunctive, and gland tissue are derivatives of which embryonic tissue

A

Surface Ectoderm

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20
Q

ocular blood vessels, EOMs, temporal sclera are derivatives of which embryonic tissue?

A

Mesoderm

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21
Q

Embryonic tissues that derive the vitreous

A

Mesoderm, Surface Ectoderm, Neuroectoderm

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22
Q

Age of gestation when orbital bones fuse and ossify

A

6-7 months

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23
Q

angle between orbits in stages of early development

A

180 degrees

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24
Q

angle between orbits at time of birth

A

70 degrees

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25
Q

angle between orbits at adulthood

A

68 degrees

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26
Q

At what age does the orbit reach adult size

A

16 years old

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27
Q

Approximate volume of the adult orbit

A

30 ml

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28
Q

Effect of a maxillary sinus carcinoma on the orbit

A

roof of maxillary sinus is orbital floor, a carcinoma can invade upward and displace the orbit upward

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29
Q

infections of these sinuses can erode the lamina papyracea and involve the orbit.

A

ethmoid and sphenoid sinuses

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30
Q

infection of this sinus is often the cause of orbital cellulitis

A

Ethmoid sinus

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31
Q

defects in this orbital wall such as neurofibromatosis may result in visible globe pulsations transmitted from cerebrospinal fluid from brain

A

Defects in Orbital Roof

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32
Q

Structures passing through superior orbital fissure ABOVE the annulus of zinn

A

Lacrimal Nerve, Frontal Nerve, Trochlear Nerve, Superior Ophthalmic Artery

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33
Q

Structures passing through superior orbital fissure that pass THROUGH the annulus of zinn

A

Sup Division of Oculomotor Nerve, Nasociliary Nerve, Inferior Division of Oculomotor Nerve, Abducent Nerve

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34
Q

Structure passing through inferior orbital fissure

A

Inferior Ophthalmic Vein

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35
Q

Structures passing through Optic Canal and through annulus of zinn

A

Optic Nerve and Ophthalmic Artery

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36
Q

Internal carotid artery branches into the ophthalmic artery, that has more branches to supply blood to superficial face areas and the orbit. What are the branches of the Ophthalmic artery?

A
  1. Central Retinal Artery, 2. Lacrimal Artery, 3. Short Posterior Ciliary Artery, 4. Long Posterior Ciliary Artery, 5. Ethmoidal Artery, 6. Supraorbital Artery, 7. Muscular Artery
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37
Q

Short posterior ciliary arteries branching from the ophthalmic artery form what structure in the optic nerve head?

A

Circle of Zinn

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38
Q

Long posterior ciliary arteries supply blood to what structure?

A

Choroid

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39
Q

two places that blood in the orbit drains into through veins

A

Cavernous sinus and pterygoid venous plexus

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40
Q

3 most common investigative testing scan types for ocular conditions

A

CT scans, MRI, Ultrasound

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41
Q

How does air appear on an x ray?

A

black

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42
Q

How does fat appear on an x ray?

A

dark gray

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43
Q

How does soft tissue and water appear on an x ray?

A

lighter shades of gray

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44
Q

How does bone and metal appear on an x ray?

A

white - more density = more white

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45
Q

CT scans of the orbit are typically done at 3 mm on which planes?

A

Axial - top/botton and Coronal - back/front

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46
Q

Disadvantages of CT scans

A

lack of tissue specificity (cannot distinguish diferent soft tissue masses) and potiential radiation effects

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47
Q

CT scan would be ordered when these 3 types of conditions are suspected

A

neoplasms, inflammatory masses, EOM hypertrophy - Graves

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48
Q

Scan that uses radiofrequency pulses to change movement of protons within of the nucleus of hydrogen atoms, releasing energy when returning to normal equilibrium

A

MRI - magnetic resonance imaging

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49
Q

unit of measurement to quantify the strength of the magnetic field in MRI

A

Tesla (T)

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50
Q

Tesla scale for MRI that provides the best anatomic details of the orbit, air/bone/fluid are hypointense (dark), fat is hyperintense so it is suppressed to eliminate the signal and achieve a better orbital view

A

T1 -weighted images

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51
Q

Tesla scale for MRI that is useful in revealing pathologic conditions (ischemia, inflammation, neoplasms) but not good for anatomic detail. Fluid is hyperintense, used with FLAIR (fluid attenuated inversion recovery) keeps the CSF dark, good for seeing white matter diseases due to periventricular changes

A

T2-weighted images

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52
Q

Form of MRI based on measuring the random motion of water molecules in a tissue, good for strokes and infarcs as it makes them look hyperintense.
Detects ischemia within minutes
Can estimate time of stroke

A

Diffusion Weighted Images

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53
Q

Form of MRI that shows areas of contrast- enchancement from a disturbance of the BBB

A

IV Gadolinium

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54
Q

When is a MRI contraindicated?

A

anything metal in body, pacemaker, life support, obese, claustrophobic

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55
Q

Type of scan where high frequency sound waves are emitted toward the tissue, the sound waves bounce back and are collected by receiver

A

Ultrasound

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56
Q

Type of ultrasound that can quantify the size and growth of a tumor and used to determine the axial length of the eye to determine the power of IOL implant after cataract surgery

A

A scan Ultrasound

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57
Q

Type of ultrasound that is the summation of multiple scans to give a 2D image

A

B scan Ultrasound

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58
Q

For an A scan ultrasound, every 1 mm error, typically caused by corneal compression (shorter than actual length) yields how much refractive surprise?

A

~3D refractive surprise, if compressed cornea and artificially short axial length, surprise will be too positive, causing a myopic surprise of 3 D for every 1mm too short

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59
Q

type of scan used to define the extent of an orbital venous disease, contrast injection can reveal presence of varices (dilated vessels)

A

Venography

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60
Q

type of scan required for detection of aneurysms less than 2 to 3 mm

A

Angiography

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61
Q

scan of choice for evluation of cerbrovascular veno-occlusive diseases such as dural venous or cavernous sinus thrombosis

A

Magnetic Resonance Venography - MRV

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62
Q

Invasive procedure to obtain cytology specimens from a lesion, performed with a CT scan for guidance, can be inconclusive, and risk for hemmorrhave, ocular penetration, tumor seeding along needle tracks

A

Fine - Needle Aspiration

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63
Q

Soft tissue involvement, proptosis, enopthalmos, dystopia, opthalmoplegia, changes in fundus can all indicate what kind of problems?

A

Orbital Problems

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64
Q

Which broad clinical sign of an orbit problem most often occurs in the form of lid and periorbital edema, ptosis, chemosis, and epibulbar injection?

A

Soft Tissue Involvement

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65
Q

3 Causes of soft tissue involvement that will cause orbital problems

A

thyroid eye disease- graves
orbital inflammatory diseases
obstruction to venous drainage - pseudotumor cerebri

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66
Q

Broad clinical sign of orbital problem assessed by estimating the amount of sclera visible above and below the limbus

A

Proptosis

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67
Q

what is assessed by only measuring the among of visible sclera above the limbus?

A

Lid Retraction

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68
Q

instrument that measures distance between front of cornea and orbital rim for each eye, normal is less than 20 mm depending on race and sex, and no more than 2mm should be seen between each eye.

A

Exophthalmometer - (left eye reads 18 and right reads 21, right eye has proptosis)

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69
Q

term for proptosis with lid lag

A

exophthalmos

70
Q

Is exophthalmos congenital, acquired, or both?

A

both

71
Q

is exophthalmos unilateral or bilateral?

A

can be either unilateral or bilateral

72
Q

exophthalmos should be considered when exophthalmometry reads what?

A

greater than 21 mm (bilateral) OR more than 3 mm difference between both eyes (unilateral)

73
Q

if a patient has exophthalmos, should you be able to reposition the globe by pushing in? (retropulsion)

A

No, if exophthalmos, there will be resistance

74
Q

most common cause of unilateral exophthalmos in children

A

orbital cellulitis

75
Q

what things need to be ruled out when searching for the cause of exophthalmos? (7)

A

Graves, space occupying lesions, orbital cellulitis, leukemia, pseudotumor, glaucoma, high myopia

76
Q

What needs to be ruled out when patient has Enophthalmos (retracted globe)

A

contralateral size-reduction disorders

77
Q

when is a condition considered proptosis vs exophthalmos, besides lid lag?

A

exophthalmos is secondary to an endocrine condition while proptosis is secondary to a non-endocrine condition

78
Q

What is the Kanski method for observing asymmetrical proptosis?

A

Patient is looking down and you look from above and behind, or opposite: patient looks up and you look from below and in front of the patient

79
Q

Increase in ORBITAL CONTENT behind or beside the eyeball or EXPANSIVE LESIONS (benign or malignant, arising from bone, muscle, nerve, vessels, or connective tissue) are the two causes of what condition?

A

causes of Proptosis

80
Q

What subtype of proptosis is characterized by expansion within the muscle cone, displacing the eye straight ahead?

A

Axial proptosis - remember that inferior oblique is not considered part of the muscle cone

81
Q

What subtype of proptosis is characterized by a mass outside of the muscle cone, that also causes sideways or vertical displacement of the globe

A

Non-Axial Proptosis

82
Q

What subtype of proptosis is characterized by a pulsation of an orbital malformation or transmission of cerebral pulsations in the absence of a superior orbital roof

A

Pulsating Proptosis

83
Q

What subtype of proptosis is characterized by changes of the Valsalva Maneuver (internal compression) and a sign of orbital varices or meningocele- protrusion of meninges (spina bifida)

A

Positional Proptosis

84
Q

What subtype of proptosis may result from sinus meningocele - protrusion of meninges into a sinus cavity

A

Intermittent Proptosis

85
Q

Symptoms of proptosis in relation to EOM movements

A

Dissociation causing extension to be asymmetrical between eyes, and cause Diplopia

86
Q

Possible situations of proptosis that cause pain as a symptom

A

rapid expansion, inflammation, infiltration

87
Q

How can proptosis cause pupillary reflexes or color vision as symptons, physiologically

A

ON nerve compression/involvement BEFORE dramatic Visual Acuity Loss (VAL)

88
Q

When does proptosis cause Visual Acuity Loss as a symptom?

A

not UNTIL the lesion affects the optic nerve or if arises from the optic nerve

89
Q

Syndrome occurring when the superior orbital fissure is involved in trauma or contains a tumor, diplopia occurring due to cranial nerve 3, 4, 6 involvement, and anesthesia of cornea and fascial anesthesia caused by Nasolacrimal nerve (V1) involvement

A

Orbital Fissure Syndrome

90
Q

Syndrome occurring when an expanding lesion at the apex of the orbit, can cause axial or non axial proptosis and optic nerve compression, sometimes causes diplopia, facial and corneal anesthesia

A

Orbital Apex Syndrome

91
Q

in Orbital Apex Syndrome, what does it mean if the eye is turned down and out when the lid is retracted and has complete ophthalmoplegia?

A

complete CN3 Palsy

92
Q

In Orbital Apex Syndrome, what does it mean if there is pupil involvement?

A

Aneurysm of posterior cerebral artery

93
Q

an Axial Direction for Proptosis is an indication of what? (2)

A

cavernous hemangiomas (benign blood vessel tumor), optic nerve tumors

94
Q

an Eccentric, non axial Direction for proptosis is an indication of what?

A

extraconal lesions

95
Q

Mild grading with Hertel exophthalmometer

A

Mild - 21 to 23 mm

96
Q

Moderate grading with Hertel exophthalmometer

A

Moderate - 24 to 27 mm

97
Q

Severe grading with Hertel Exophthalmometer

A

Severe - 28 mm or more

98
Q

Name for condition that can be present if proptosis is severe enough that the palpebral aperture (fissure) cannot be closed completely

A

Lagophthalmos - inability to close eyelids

99
Q

backward displacement of the eye in the bony socket, due to loss of function of the orbitalis muscle, loss of supraduction is common, can be caused by blow out fracture to orbital floor

A

Enophthalmos- opposite of proptosis

100
Q

How can Enopthalmos be caused by structural abnormalities

A

trauma like blowout fracture can cause eye to shift backward, or congenital abnormality

101
Q

What are some causes of atrophy of orbital contents that lead to Enophthalmos

A

radiation, scleroderma, eye poking in blind infants (blind infants press on their own eyes)

102
Q

what diseases can cause Sclerosing orbital lesions that result in Enophthalmos

A

Metastatic cirrhosis carcinoma and chronic inflammatory disease

103
Q

Condition that gives the appearance of enophthamos (pseudo-enophthamos)

A

micropthalmos or phtisis bulbi (non functional, shrunken eye)

104
Q

Displacement of the globe in the Coronal plane, vertical or horizontal, usualy due to an extraconal orbital mass- lacrimal gland mass, may co- exist with proptosis or enophthalmos, usually congenital

A

Dystopia

105
Q

When is dystopia a major cause for concern?

A

if it is acquired and not congenital - indicates extraconal tumor or orbital fracture

106
Q

Malposition of the ocular globe and orbit due to a mono or bilateral asymmetry and distortion of the bony structure

A

Orbital Dystopia

107
Q

What can cause orbital dystopia in the form of downward displacement of the superior orbital margin and roof, or infero-laterally with associated nasoethmoidal injuries

A

Craniofacial Injury

108
Q

Inability to move the eye, 1. due to a muscle restriction effecting EOMS (myopathic) or 2. affecting the nerve pathways of EOMs are affected due to poor innervation weak movement due to poor innervation, (Neurogenic), or 3. paralysis/weakness of one or more of the EOMs

A

Ophthalmoplegia

109
Q

In myopathic Ophthalmoplegia, if the eye is turned Eso, which muscle is affected?

A

If the eye is turned inward, the MEDIAL RECTUS is affected, because it is turned inward due to muscle restriction, preventing the eye from turning back to center gaze- If Exo - Lateral Rectus etc.

110
Q

An orbital mass would cause which type of ophthalmoplegia?

A

Myopathic ophthalmoplegia

111
Q

A cranial mass would cause which type of ophthalmoplegia

A

Neuropathic ophthalmoplegia

112
Q

Thyroid disease or orbital myositis causes which type of ophthalmoplegia?

A

Restrictive - Myopathic

113
Q

Which nerve is associated with lesions in the cavernous sinus, posterior orbit (carotid cavernous fistula, Tolosa-Hunt syndrome and malignant lacrimal tumors) as cause for ophthalmoplegia

A

Oculomotor Nerve

114
Q

Common injury that can restrain EOM’s or fascia resulting in myopathic ophthalmoplegia, typically seen as the Eye looking Down because of Inferior Oblique Restriction

A

Blowout Fracture

115
Q

What happens as a result of a meningioma making eye movements very painful?

A

Splinting - holding eyes still to prevent pain causes muscle rigidity. DeJesus discussed using a balloon to inflate lungs with a broken rib to prevent lung collapse from shallow breaths

116
Q

If an eye cannot be moved (positive result) by the forced duction test, what kind of ophthalmoplegia does the patient have?

A

Myopathic ophthalmoplegia if cannot be moved

117
Q

If an eye can be moved (negative result) by the forced duction test, what kind of ophthalmoplegia does the patient have?

A

Neurological ophthalmoplegia if eye can be moved

118
Q

after performing Differential IOP test, if an increase in IOP of 8 mmHg is seen, what kind of ophthalmoplegia is suggested?

A

Myopathic ophthalmoplegia if >6 mmHg- not a safe bet

119
Q

after performing Differential IOP test, if an increase in IOP of 4 mmHg is seen, what kind of ophthalmoplegia is suggested?

A

Neurological ophthalmoplegia, if

120
Q

How does myopathic ophthalmoplegia effect saccades?

A

normal velocity with a sudden halt

121
Q

How does neurological ophthalmoplegia effect saccades?

A

decreased velocity

122
Q

Major fundus changes seen in patients with ophthalmoplegia (5) FACCS

A

Optic Disc Swelling, Optic Atrophy (palor-whitening), Cupping, Collaterals (optociliary shunt vessels), Choroidal folds

123
Q

one of the fundus changes from ophthalmoplegia, anastomosis of vessels to reroute blood from an obstructed vein, typically caused by retinal vein occlusion, optic nerve glioma or sheath meningioma, or chronic papilledema

A

Collaterals - optociliary shunt vessels

124
Q

One of the major fundus changes from ophthalmoplegia, can occur in cases of intraocular hypotony, retinal detachment, or orbital mass, not associated with severe VAL, typically caused by orbital tumors, dysthyroid opthalmopathy, mucoceles

A

Choroidal folds

125
Q

RVO, optic nerve glioma or sheath meningioma, and chronic papilledema can cause what in the fundus?

A

Collaterals- optociliary shunt vessels- associated with ophthalmoplegic fundus changes

126
Q

Hypotony, retinal detachment, orbital mass/tumor, dysthyroid ophthalmopathy, mucoceles and no severe VAL are signs of what in the fundus area?

A

Choroidal folds - associated with ophthalmoplegia

127
Q

Proptosis in the absence of orbital disease, caused by high myopia, globe is not pushed forward, but gives the appearance due to a small vacity, enlarged globe, retracted lid, recessed globe or droopy lid of opposite eye- good case hx needed to provide clues for cause

A

Pseudoproptosis

128
Q

How does irregular facial asymmetry give the appearance of proptosis (psuedoproptosis)

A

smaller cavity can cause the eye to look like it is protruding outward

129
Q

If the globe is severely enlarged, it can appear to bulge outward like proptosis, but instead, it can be caused by?

A

High myopia (longer axial length), Buphothalmos (enlarged eye, can be caused by congenital glaucoma)

130
Q

What condition is suggested by lid retraction (psuedoproptosis cause) when there is also upward movement of the eye?

A

Congestive dysthyroid disease

131
Q

What condition is suggested by lid retraction (psuedoproptosis cause) when there is a deficiency in upward gaze?

A

weakness of superior rectus after an operation on a rectus muscle

132
Q

What condition is suggested by lid retraction (pseudoproptosis cause) when there is excessive stimulation of levator muscles in Bells phenomenon (up and out when eye closed?

A

Seventh nerve palsy

133
Q

Lid retraction causing pseudoproptosis with upward eye movement can be caused by what muscle receiving excessive stimuli from nerve fiber of superior rectus

A

Levator muscles

134
Q

What syndrome causes lid retraction with upward movement as a cause of pseudoproptosis, and is caused by pretectal or periaqueductal lesion in midbrain

A

Dorsal Midbrain Syndrome

135
Q

Lid retraction with downward eye movement caused tumor trauma, or stroke effect are caused by ?

A

aberrant regeneration to CNIII

136
Q

syndrome involving the superior oblique tendon sheath that causes lid retraction with downward movement of the eye

A

brown syndrome

137
Q

parkinsonian-like disease that causes lid retraction with downward movement of the eye

A

progressive supranuclear palsy

138
Q

A patient with a scar on the eye lid could prevent the levator muscle from doing what?

A

relaxing when looking down, causing the upper lid to retract

139
Q

lid lag during downward gaze ( graefe sign) is typical in what kind of exophthalmos?

A

noncongestive type of dysthyroid exophthalmos

140
Q

retraction syndrome with underaction of lateral rectus muscle and spillover to levator causing widening

A

Duane syndrome (remember brown is retraction when looking down, this is retraction when the levator muscle is not working

141
Q

History, External Examination, Ocular examination, vital signs with temp, orbital CT scan, MRI or ultrasound, lab tests, consider excision or biopsy

A

Work up for unknown etiology of proptosis

142
Q

What lab results would be shown if hyperthyroidism is the cause of the proptosis?

A

T3, T4 elevation and TSH decrease

143
Q

condition caused by excessive quantities of thyroid hormones due to overproduction, ectopic overproduction (paraneoplastic syndrome) loss of storage function - leak from gland, usually presents in 30 - 40 y/o women

A

Thyrotoxicosis

144
Q

Most common causes of hyperthyroidism

A

Thyroid Eye disease or Graves

145
Q

condition caused by IgG antibodies producing inflammation of the EOMs, inflammatory cells infiltrate vascularized fibro-fatty orbital tissue

A

Thyroid Eye Disease

146
Q

If a 35 year old female smoker comes into your office with complaint of lid retraction, proptosis, taking radioactive iodine for thyroid tx, and showing signs of optic neuropathy and restrictive myopathy, what is the most likely diagnosis?

A

Thyroid Eye Disease

147
Q

Thyroid eye disease often presents with systemic hyperthyroidism (rapid pulse, hot dry skin, goiter, weight loss ) and can also be present with what condition marked by muscle weakness in addition to double vision and ptosis, sometimes in patients with thymus tumors

A

Myasthenia Gravis

148
Q

What disease is classified like this?

No signs or symptoms
Only signs - lid lag, lid retraction

Soft tissue involvement- kertoconjuctiv, perioribital swell
Proptosis
Extraocular involvment
Corneal ulceration
Sight loss
A

Dysthyroid Ophthalmoplegia

149
Q

Lid presents with one of these four conditions could be a sign of what disease: mild left lid retraction, mild bilateral lid retraction w/o proptosis, severe bilateral lid retraction, right lid lag on down gaze

A

Thyroid Eye Disease

150
Q

cause of lid retraction in TED in only the levator palpebrae

A

fibrotic contraction

151
Q

cause of lid retraction in TED that happens in response to hypotropia produced by fibrosis and tethering of the inferior rectus

A

secondary overaction of levator-superior rectus complex

152
Q

cause of lid retraction in TED that occurs as a result of sympathetic overstimulation secondary to high levels of thyroid hormones

A

Humorally-induced overaction of Muller muscle

153
Q

name of the sign marked by lid retraction in primary gaze

A

Dalrymple’s Sign

154
Q

name of the sign marked by a staring, frightening, and scary look

A

Kocher Sign

155
Q

name of the sign marked by lid lag on downward gaze

A

Von Graefe

156
Q

how do we treat mild lid retraction?

A

May not need treatment because it can spontaneously improve

157
Q

how do we treat lid retraction by decreasing vertical dimensions of the wide palpebral fissures, after the proptosis and strabismus have been addressed (lids treated last)

A

Surgery - last treatment because orbital decompression will affect the motility and eyelid positions

158
Q

3 surgeries that can be done for lid retraction:

A

mullerectomy, lower lid retractor recession, botulin injection

159
Q

30 - 40% of patients with TED develop ophthalmoplegia secondary to muscle fibrosis, what are the 4 most common ocular motility defects: EADA

A

Elevation- IR
ABduction-MR
Depression- SR
ADduction-LR

Fibrosis means the muscle loses contractility, so for example, eye cannot elevate because the IR is stiff and scarred, not restrictive but unable to lengthen

160
Q

uncommon but serious complication of compression of the ON or blood supply to orbital apex by congested and enlarged recti, may lead to severe visual impairment

A

Optic neuropathy

161
Q

If optic neuropathy does occur in response to thyroid eye disease causing congested muscles to compress the optic nerve, what signs might be noticed?

A

Central vision loss- reduced VA, positive APD, decreased CV, VF defect, increased IOP

162
Q

What is the treatment for optic neuropathy in the case of thyroid eye disease?

A

intravenous methylprednisolone, orbital decompression if medication is ineffective or contraindicated

163
Q

Clinical Pearl: why should you never assume that disproportionate vision loss is nothing more than a minor corneal complication?

A

You will miss optic neuropathy!

164
Q

primary Differential diagnosis for Graves disease-TED

A

3rd nerve palsy with aberrant regeneration

165
Q 
How do you treat TED/ Graves?
1 keratitis
2 eyelid edema
3 proptosis and corneal ulcer
4 diplopia w/ inflammation
5 vision loss due to optic neuropathy
A

1 treat exposure keratitis with Refresh (eyes dont close)
2 Elevate head at night if pt has eyelid edema
3 prednisolone then orbital decompression
4 prednisolone, taper off quickly if no improvement, EOM sx may be needed
5 Predinosolone, radiation, orbit decompression

166
Q

TED proptosis Management Considerations
1 congestive phase for progressive and painful proptosis
2 when steroids are not effective
3 combination therapy
4 when non invasive methods are ineffective, for cosmetics, or as primary tx

A

1 oral or intravenous prednisolone
2 radiation therapy
3 irradiation, azathiprine (immune suppression), prednisolone
4 surgical decompression

167
Q

TED Follow up- how often should you see a patient with no exposure problems and mild to moderate proptosis

A

every 3-6 months

168
Q

TED follow up- why should a patient with TED and fluctuating diplopia or ptosis be given the Tensilon test (edrophonium chloride)

A

to rule out myasthenia gravis

169
Q

TED follow up- is optic nerve compression a serious condition?

A

REQUIRES IMMEDIATE ATTENTION

170
Q

TED follow up- besides optic nerve compression, what possible symptoms require prompt attention?

A

advanced exposure keratopathy and severe proptosis

Disease 1 (8 decks)

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