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Ocular Disease > Ocular Disease: Lecture 1: The Orbit > Flashcards

Ocular Disease: Lecture 1: The Orbit Flashcards

1
Q

Orbit: Anatomy (1)

  1. Roof: Made up of 2 things?
  2. Lateral Wall: Made up of 2 things?
A
  1. Lesser wing of sphenoid and Orbital plate of the frontal bone.
  2. Greater wing of the sphenoid and Zygomatic bone.
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2
Q

Orbit: Anatomy (2)

  1. Medial Wall: 4 things?
  2. Floor: 3 things?
A
  1. Ethmoid, Lacrimal, Maxillary, and Sphenoid

2. Maxillary, Palatine, and Zygomatic bone

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3
Q

Orbit: Review (3)

  1. What Notches are found in the orbit? (2)
  2. What Foramen? (4)
  3. Fissures? (2)
  4. What else?
A
  1. Supraorbital Notch, Trochlear Notch
  2. Optic Canal (foramen), Ant and Post Ethmoidal Foramina, Infraorbital Foramen
  3. Sup and Inf Orbital Fissures
  4. Lacrimal Fossa, Fossa for Lacrimal Sac, Crest of Lacrimal Bone (post lacrimal Crest), Infraorbital Groove
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4
Q

Orbit: Anatomy (4)

  1. What 3 things pass thru the Optic Foramen?
  2. What 4 things pass thru the Inferior Orbital Fissure?
A
  1. a. Optic Nerve (II), Optic Artery, and Sympathetic Fibers

2. Infraorbital Nerve (V2), Zygomatic Nerve, Branches of Pterygopalatine Ganglion, and Inf Ophthalmic Vein

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5
Q

Orbit: Anatomy (5)

  1. What passes thru the Superior Orbital Fissure? (8)?
  2. Which of these are found w/in the common tendinous ring? (6)
A
  1. Abducens Nerve, Frontal Nerve, Lacrimal Nerve, Nasociliary Nerve, Superior Ophthalmic Vein, Trochlear Never, Upper and Lower divisions of Oculomotor Nerve
  2. Optic Nerve, Ophthalmic Artery (Optic Canal), Sup and Inf divisions of Oculomotor Nerve, Abducens Nerve, and Nasociliary Nerve
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6
Q

Orbit: Anatomy (6)

  1. What 2 things pass thru Ant Ethmoidal Foramen?
  2. What 2 things pass thru Post Ethmoidal Foramen?
A
  1. Ant Ethmoidal Artery and Nerve

2. Post Ethmoidal Artery and Nerve

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7
Q

Orbit: Anatomy (7)

  1. What passes thru the Zygomaticofacial Foramen? (1)
  2. What passes thru the Zygomaticotemporal Foramen? (1)
A
  1. Zygomaticofacial Nerve

2. Zygomaticotemporal Nerve

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8
Q

Orbit: Anatomy (8)

  1. What passes thru the Nasolacrimal Canal? (1)
A
  1. Nasolacrimal Duct
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9
Q

Assessing the Orbit (1)

  1. When assessing the Orbit, what 5 things should we be observing?
A
  1. Dystopia, Enophthalmos, Ophthalmoplegia, Proptosis, and Soft tissue complications
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10
Q

Assessing the Orbit (2)

  1. What things should we be looking for in FOLDARQ? (5)
A
  1. Diplopia, Hx of Trauma, Old Photographs, Pain, Vision Loss
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11
Q

Assessing the Orbit (3)

  1. What should we evaluate for? (6)
A
  1. Direct and Indirect Ophthalmoscopy, EOMs, Gross evaluation, Pupils, VAs, Visual Fields
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12
Q

The 6 P’s

  1. What are the Six P’s?
A
  1. Pain, Proptosis, Progression, Palpation, Pulsation, Periorbital Changes
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13
Q

Pain

  1. Pain: What 4 things could it indicate for the Orbit?
A
  1. Infection, Inflammation, Hemorrhage, and Neoplasms

* Need to Quantify the pain…

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14
Q

Proptosis

  1. Define?
  2. Axial: meaning what?
  3. Non Axial: Meaning what?
A
  1. Displacement of the Eye Forward
  2. Retrobulbar: Usually AT or WITHIN the MUSCLE CONE
  3. Outside the Muscle Cone
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15
Q

Progression

  1. Fast (days to weeks): Could indicate what?
A
  1. Cellulitis, Hemorrhage, Metastasis, Pseudotumor, or Thyroid Eye Disease
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16
Q

Progression

  1. Slow (Months to Years): Could indicate what?
A
  1. Cavernous Hemangiomas, Dermoids, Lymphomas, Neurogenic Tumors, Osteomas
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17
Q

Palpation

  1. What are we looking for?
  2. Where do we look?
A
  1. Looking to see if there’s a Palpable Mass

2. Anterior to Equator

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18
Q

Pulsation

  1. Transmission of what?
  2. Abnormal Flow could indicate what?
  3. Bony defect could indicate what 3 things?
A
  1. of Vascular pulse to the eye
  2. Carotid Cavernous Fistula
  3. Sinus Mucocele, Surgery, Trauma
19
Q

Periorbital Changes

  1. The 3 C’s: What are they?
A
  1. Color (and skin position), Changes to Ocular Vasculature, and Changes to normal lid appearance or position
20
Q

Congenital Deformities of the Orbit

  1. Name the 4 we talked about in class. (AMC’S)
A
  1. Anophthalmos
  2. Microphthalmos
  3. Cyclopia
  4. Synophthalmos
21
Q

Anophthalmos

  1. How common is it?
  2. What is it?
  3. How is it confirmed?
A
  1. Extremely Rare
  2. Absence of Ocular tissue
  3. only by Histological Examination
    (r/o existence of extreme Mirophthalmos)
22
Q

Microphthalmos

  1. What is it?
  2. It’s often associated with what?
  3. With or Without what?
A
  1. Developmental Defect resulting in REDUCTION in the size of the globe.
  2. with structural Disorganization
  3. w/or w/o cyst
23
Q

Cyclopia (Synophthalmos)

  1. Is it deadly?
  2. It’s Associated with what 2 types of things?
    a. Examples?
A
  1. Yes. Lethal.
  2. Associated w/dramatic and Symmetric Deformities
    a. Absence of nasal bone and passage, General midline hypoplasia, Holoprosencephalic Brain (non-hemispheric), Hypoplastic Oral Cavity, Proboscis above the eye, and Single Orbit (can have 2 eyes in single orbit)
24
Q

Cranio-Facial Syndromes

  1. It’s a family of conditions involving what?
  2. What are the 3 we talked about? (3 C’s)
  3. Which is the most common?
A
  1. Craniofacial Structures (# of syndromes and malformations is huge)
  2. Craniosynostoses, Cranio-Facial Clefting, Cranio-Orbital Defects
  3. Craniosynostoses
25
Q

Craniosynostoses (1)

  1. What is it?
    a. When does it occur?
    b. What is possible?
A
  1. Premature closure of 1 or more cranial sutures
    a. Embryonic or childhood (compensating growth)
    b. Mental retardation is possible
26
Q

Craniosynostoses (2)

  1. What are the Common Features? (5)
  2. What 3 syndromes are associated with it?
A
  1. Dental and Oral problems, Hypertelorism, Midfacial Hypoplasia, Respiratory difficulty, and Syndactyly
  2. Aperts Syndrome, Crouzon Syndrome, and Pfeiffer Syndrome
27
Q

Craniosynostoses (3): Crouzon Syndrome

  1. What is it?
  2. What are the 3 major features?
A
  1. Premature closure of CORONAL AND Sagittal Sutures
  2. a. Short Anteriorposterior and wide cranium
    b. “Frog-like” facies (midfacial hypoplasia and Parrot-beak nose)
    c. V shaped palate
28
Q

Craniosynostoses (4): Crouzon Syndrome

  1. What are the Ocular Features? (5)
A
  1. a. Hypertelorism
    b. Proptosis
    c. Refractive error and amblyopia common
    d. Sight threatening complications (Exposure keratopathy and Optic Atrophy)
    e. V Pattern Exo
29
Q

Craniosynostoses: Apert Syndrome

  1. What is it?
  2. 9 Major features?
A
  1. Most severe Craniosynostoses
  2. a. Developmental Delay in 30% of cases
    b. Heart, Lung, Kidney Anomalies
    c. High arched palate
    d. Horizontal Groove above supraorbital Ridge
    e. Low set ears
    f. Midfacial Hypoplasia
    g. Parrot beak nose
    h. Steep Forehead
    i. Syndactyly
30
Q

Craniosynostoses: Apert Syndrome (2)

  1. Ocular Features? (5)
A
  1. a. Exotropia
    b. Extorted slant of palpebral apertures
    c. Hypertelorism
    d. Proptosis
    e. Sight threatening complications like those Seen w/Crouzons Syndrome
31
Q

Craniosynostoses: Pfeiffer Syndrome (1)

  1. How common is it?
  2. Features? (4)
A
  1. Less common than Crouzons or Apert Syndrome
  2. a. Broad thumbs and Great toes
    b. Down slanting palpebral fissure
    c. Midfacial Hypoplasia
    d. Soft Tissue Syndactyly
32
Q

Craniosynostoses: Pfeiffer Syndrome (2)

  1. Ocular Features (similar to Apert syndrome)? (3)
A
  1. a. Hypertelorism (seen in all)
    b. Proptosis
    c. Sight threatening complications as seen with Crouzon
33
Q

Cranio-Facial Clefting

  1. What happens?
    a. How are skeletal arrests are oriented?
    b. How are soft tissue arrests oriented?
  2. What are 4 Clefting Syndromes that affect the eyes and Orbit?
A
  1. Arrest of Normal Development
    a. Around the Orbit and Maxilla
    b. Around the Eyelids and Lips
  2. a. Goldenhar Syndrome
    b. Hallermann-Streiff Syndrome
    c. Pierre Robin Sequence
    d. Treacher Collins-Franceschetti Syndrome
34
Q

Cranio-Facial Clefting: TCF Syndrome (1)

  1. Genetically what?
  2. Involves what?
  3. What types of issues? (4)
A
  1. Autosomal Dominant
  2. Bilateral Involvement of Facial Structures
  3. a. Conductive Deafness
    b. External and Middle Ear Anomalies
    c. Malar and Mandibular Hypoplasia
    d. Microstomia
35
Q

Cranio-Facial Clefting: TCF Syndrome (2)

  1. Ocular Signs? (5)
A
  1. a. Atresia of Lacrimal Passage
    b. Cataract
    c. Coloboma of Lateral 1/3 of Lower Lid
    d. Downward displacement of Lateral Canthus (50%)
    e. Microphthalmos
36
Q

Cranio-Facial Clefting: Goldenhar Syndrome (1)

  1. Genetics?
  2. Considered a spectrum of anomalies including what 3 things?
A
  1. No inheritance pattern
  2. a. Auricular Appendages or Malformations
    b. Epibulbar Dermoids
    c. Skeletal Anomalies
37
Q

Cranio-Facial Clefting: Goldenhar Syndrome (2)

  1. Ocular Features? (4)
A
  1. a. Disc Coloboma
    b. Epibulbar Dermoids (Induced Astigmatism)
    c. Microphthalmos
    d. Upper Lid notching or coloboma’s
38
Q

Cranio-Facial Clefting: HS Syndrome (1)

  1. Etiology?
  2. Characteristics? (5)
A
  1. It’s Sporadic. Unknown.
  2. a. Baldness
    b. “Beaked” Nose
    c. Hypodontia
    d. Mandibular Hypoplasia
    e. Short Stature
39
Q

Cranio-Facial Clefting: HS Syndrome (2)

  1. Ocular Features? (5)
A
  1. a. Bilateral Cataract (up to 90%)
    b. Disc Coloboma
    c. Microphthalmia
    d. Nystagmus
    e. Strabismus
40
Q

Cranio-Orbital Defects

  1. Type of defect where what occurs?
  2. Includes 3 things?
A
  1. skull or orbit allow extra orbital or intracranial content herniation into the orbit
  2. a. Encephalocele
    b. Meningocele
    c. Mucocele
41
Q

Cranio-Orbital Defects: Mucocele

  1. What is it?
  2. When does it present?
  3. What can it erode thru?
  4. 2 of the most common?
  5. What can it do to the Globe?
A
  1. Cystic lesion that comes from the Para Nasal Sinus
  2. In Adult Life
  3. Thru the Bone of the Orbit
  4. Frontal and Anterior Ethmoidal Sinus are most common
  5. Displaces the Globe
42
Q

Cranio-Orbital Defects: Meningocele/Encephalocele

  1. Herniation of what?
    a. Meningocele
    b. Meningoencephalocele
  2. Presents when?
  3. Herniation can be 1 of 2 things?
A
  1. of Intracranial Contents
    a. Dura only
    b. Dura and Brain Tissue
  2. During Infancy
  3. Anterior (Fronto Ethmoidal)
    or
    Posterior (Sphenoid Bone Dysplasia)
43
Q

Cranio-Orbital Defects: Meningoencephalocele

  1. Anterior Signs?
  2. Posterior Signs?
  3. Displacement increases with what 2 things?
  4. What else is possible?
A
  1. Forward and Lateral Displacement of the globe
  2. Forward and Downward displacement of the globe
  3. with Crying and Valsalva
  4. Pulsating Proptosis is possible

Ocular Disease (11 decks)

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