Ocular Disease Flashcards
In orbital blow-out fracture, what are ALL of the findings associated?
trapped IR, damaged infraorbital nerve, periorbital crepitus, (+) forced duction test
Why should a pt. who experienced orbital blow-out NOT blow their nose within 48 hours of accident?
Decrease risk for orbital infection
What is damaged in commotio retinae?
causes disruption of RPE and photoreceptor outer segments
What are the most common ocular infections associated with pre-septal cellulitis?
Hordeolum and dacrocystitis
What are all of the signs of pre-septal cellulitis?
eyelid edema, erythema, ptosis, NO PAIN to mild tenderness, warmth, hard bump on the eyelid
What is one of the leading causes of exophthalmos in children?
Orbital cellulitis
What are some of the most common causes of Orbital cellulitis?
Sinus infection»ethmoid sinus (lamina papricyea), dacroadenitis, dacrocysitits, progression of pre-septal cellulitis, dental infection, or ocular trauma
What are all of the signs and symptoms of Orbital cellulitis?
APD, pain on EOM’s, diplopia, proptosis, red eye, decreased vision, HEADACHE, FEVER, general malaise, reduced color vision, eyelid edema, redness
What can a patient develop if orbital cellulitis is not treated appropriately?
Cavernous sinus thrombosis, brain abscess, and/or meningitis
What are the epidemiological characteristics of thyroid eye disease?
F:M ratio is 8:1, usually in 4th-5th decade, smoking greatest risk factor!
Thyroid eye disease occurs in what % of Grave’s disease patients?
30-70%
What is the most common cause of unilateral or bilateral proptosis in middle-aged patients?
Thyroid eye disease
What is the sign called for unilateral lid retraction in thyroid eye disease?
Dalyrymple’s sign
Upper eyelid lag during upgaze is called what sign?
Von Graefe’s sign
List all the possible ways to diagnose thyroid eye disease…
Forced ductions, CT/MRI for EOM swelling, exophthalmometry, visual fields to detect optic nerve compression, and blood work to measure thyroid activity (TSH)
What is the clinical triad for Carotid Cavernous Fistula?
Pulsatile proptosis, ocular bruit, and chemosis
What is the most common etiology of carotid cavernous fistula? other etiologies?
TRAUMA, followed by ruptured ICA aneurysm, or from cavernous sinus pathology
What is the pathophysiology of carotid cavernous fistula?
High-pressure blood from carotid artery builds up in cavernous sinus»impeding the return of venous blood back to cav. sinus
»therefore, build up of pressure behind the globe causing CCF
What is the most common benign orbital tumor in adults?
Cavernous Hemangioma
What is the most common benign orbital tumor in children?
Capillary hemangioma
What are some of the concern with capillary hemangioma?
Can cause proptosis and form deprivation amblyopia»also has spontaneous resolution
What is Rhabdomyosarcoma?
Rapid bone-destructing tumor that causes progressive unilateral proptosis»average age of onset 7 years old
What genetic disorder is optic nerve glioma associated with?
Neurofibromatosis type 1 in up to 30-50% of patients
What is the most common benign brain tumor?
Meningioma»typically occurs in middle aged women
What is the epidemiology of Orbital Pseduotumor (Idiopathic Orbital Inflammatory Syndrome)?
young to middle-aged patients (20-50 years old), can present like thyroid eye disease, or orbital cellulitis
What are the symptoms of orbital pseudotumor?
acute onset UNILATERAL pain, red eye, diplopia, and/or decreased vision
What are the signs of orbital pseudotomor?
Proptosis, EOM restrictions, periobrbital swelling, chemosis, lacrimal gland enlargement, lid ptosis, hyperopic shift, optic nerve swelling, increased IOP on involved side, reduced corneal sensation
> > Remember, Chemosis is typically associated with allergic symptoms, so if it is UNILATERAL AND it is not associated with allergies…. be sure to include orbital pseudotumor in differentials
What do patients present with in Tolosa-Hunt syndrome?
Acute and painful exophthalmoplegia and diplopia due to ipsilateral palsies of CN 3, 4, and 6.
»may lose sensation from V1 and V2 as well since they all pass through the cavernous sinus and superior orbital fissure
Bilateral orbital pseudotumor in adults should raise suspicion for systemic ________ or _________.
Vasculitis or Lymphoma
What is Evisceration?
Removal of the inner contents of the eye; sclera and other orbital contents remain.
What is Exenteration?
Removal of ALL contents of the orbit, including EOMs and orbital fat.
Who is most affected by Ocular Rosacea?
middle-aged adults of Northern European ancestry mostly, women affected more than men
»affects ~ 10% of the population, including an estimated 50% with acne rosacea
What is the cause/pathophysiology of Ocular Rosacea?
It affects the sebaceous glands (including meibomian glands), resulting in chronic ocular surface disease
What are the symptoms of Ocular rosacea?
Redness, burning, foreign body sensation, and ocular irritation
What are the SIGNS of Ocular Rosacea?
Telangiectasia, rhinophyma (sebaceous gland hyperplasia of the nose), Facial flushing (butterfly rash that is usually triggered by alcohol, or spicy foods)
What type of reaction is Contact Dermatitis? What are the signs and symptoms?
Type 4 hypersensitivity reaction–delayed T lymphocyte
»Symptoms include periorbital swelling, redness, itching, tearing
»Signs include unilateral or bilateral erythema and crusting of the lid and periorbital tissues and significant conjunctival chemosis
What type of reaction is Cicatricial Pemphigoid? What is the epidemiology?
Type II reaction involving autoantibodies directed against the conjunctival basement membrane
»F>M, average age of diagnosis is 65 years old, 10-30 years after bilateral blindness
What is this pathophysiology of Cicatricial Pemphigoid?
Chronic, systemic, idiopathic mucous membrane disorder that commonly affects the oral and ocular mucous membranes
»can also be drug induced from Timolol, Epinephrine, and Pilocarpine
What are the signs and symptoms of Cicatricial Pemphigoid?
redness, dryness, foreign body sensation, decreased vision
»Conjunctival fibrosis and scarring, bilateral SYMBLEPHARON,
»PROGRESSION: results in destruction of goblet cells, meibomina glands, glands of Krause & Wolfring, and ducts of main lacrimal gland–causing SEVERE ocular surface disease
What type of reaction is Stevens-Johnson syndrome? What is the pathophysiology?
Type 3 sensitivity reaction that affects mucous membranes (typically oral and ocular)»commonly drug induced (sulfonamide) or from an infectious agent
What are the ocular signs and symptoms of Stevens-Johnson syndrome?
Prodrome of fever, malaise, headache, nausea, and vomiting
»skin lesions, severe bilateral diffuse conjunctivitis associated with PSEUDOMEMBRANES, also bacterial conjunctivitis
»Chronic signs include SYMBLEPHARON, entropion, ectropion, trichiasis, corneal ulcers, neovascularization
What are the 2 main types of Blepharitis?
- Staphylococcal
2. Seborrheic
How does Seborrheic differ from Staphylococcal blepharitis?
Seborrheic is associated w/ less lid inflammation, more oily, greasy scales with flaking, and more eyelash loss.
Chalazion is often associated with which 2 skin conditions?
Acne Rosacea and Seborrheic dermatitis
What is the pathophysiology of Chalazion as well as signs and symptoms?
Chronic, sterile inflammation of a Meibomian gland due to retention of normal secretions
»Hard, painless, immobile nodule without redness, asymptomatic
»Recurrent chalazia warrant an evaluation for possible malignancies (i.e. sebaceous gland carcinoma)
What can be used to treat Demodex infections in the meibomian glands?
Tea tree oil
What drug can be used to treat Staph Blepharitis infections?
Maxitrol (tobramycin, neomycin, and dexamethasone)
What drug can be used to treat Sebhorric blepharitis?
Dandruff shampoo, Hypochlor, or Havanova
Why is Ectropion most commonly caused by old age?
Loss of muscle tone of the orbicularis oculi
|»_space;other causes are mechanical (tumor), cicatricial (scar tissue), paralytic (facial nerve palsy), and congenital (rare)
If a patient had Exposure Keratopathy due to Bell’s palsy what would you prescribe them?
Antibiotic ointment
What is Trichiasis? Distichiasis? Tristichiasis?
- Eyelashes grow posteriorly from their site of origin
- A second row of lashes arise from the meibomian gland openings
- A third row of lashes growing
How most commonly has floppy eyelid syndrome? What are possible reasons that it occurs?
Obese men w/ obstructive sleep apnea
|»_space;Possible correlation with NAION and LT glaucoma
What is Benign Essential Blepharospasm? Who is affected by it?
Women 2X more common than men, ages 50-70, Spasms of orbicularis oculi, procerus, and corrugator musculature
What is Meige’s syndrome?
characterized by BEB AND lower facial abnormalities (diff. chewing, opening mouth, jaw spasms)
What is the most common pre-cancerous skin lesion and is a precursor to squamous cell carcinoma?
Actinic Keratosis
Which is more aggressive SCC or BCC?
SCC»13-24% of SCCs undergo metastasis to nearby lymph nodes
What is the most common eyelid cancer?
Basal cell carcinoma
|»_space;affects males more than females
What are the signs of Basal cell carcinoma? Where is it most commonly located?
shiny, firm, pearly nodule with superficial telangiectasia (ocular rosacea)
»most commonly located on lower eyelid and medial canthus
Who is affected by Squamous cell carcinoma? Signs?
more common in males (2:1), variable presentation, often appears similar to BCC but WITHOUT telangiectasia
»rough, scaly, ulcerated and may be flat or elevated
What is Keratoacanthoma? Is it dangerous?
similar to BCC and SCC, often a central plaque or ulcer that grows very quickly to a large size (1-2 cm) before slowly shrinking and often spontaneously resolve.