Oculoplastics Flashcards
The most common cause of lacrimal drainage failure
Punctal abnormality
Fluroscein dissappearance test (BKZ)
High meniscus >= 0️⃣.6️⃣ mm
N= 0️⃣.2️⃣-0️⃣.4️⃣ mm
The most common causes of primary punctal stenosis
Chronic blepharitis
Idiopathic stenosis
Ptosis measurements
KRM=4-5 mm
KA= 🚺8-12 mm, 🚹7-10 mm
LF= >15 mm; good:12-14, fair:5-11, poor:>5mm
Kapak cizgisi= 🚺10 mm, 🚹8 mm
Surgery in ptosis
LF is good=>10➡️KJM
LF is fair=>5➡️levator advancement
LF is poor=<4➡️frontalis suspension
Entubation in canalicular obstruction
Left in situ for 6weeks to 6 months
FOS
Cranium➡️orbita
Superior: CN5(1): lacrimal, frontal; CN4, VOS
Inferior: CN3, CN6, n.nasociliaris, sympathic fibers from the cavernous plx
FOI
Orbit➡️pterygopalatine and infratemporal fossa
CN5(2), branches of the pterygopalatine ganglion, VOI
Hertel
> 20 mm ➡️ proptosis
(Upper limit for white men:22)
Difference of >2-3 mm btw the eyes is suspicious
Thyroid eye disease-clinical activity score
Treatment if >3️⃣/7️⃣
- Spontaneous orbital pain
- Gaze evoked orbital pain
- Eyelid swelling
- Eyelid erythema
- Conjunctival redness
- Chemosis
- Inflammation of caruncule
Thyroid eye disease treatment
IV metilprednisolone
500mg once weekly - 6 weeks
250mg once weekly - 6 weeks
Preseptal cellulitis and Bacterial orbital cellulitis-patogens and treatment
Preseptal: S.aureus, S.pyogenes ➡️ ORAL co-amoxiclav
Orbital:➕S.pneumoniae, H.influenza [ethmoid sinus]
➡️ IV ceftazidime, metronidazol—continue till the patient has been apyrexial for 4 days, followed by 1-3 weeks of oral treatment
BCC
Most common: LOWER eyelid
Differentiation from SCC: surface vascularization, slowly growing
Blepharitis-anterior vs posterior
Anterior: staph or seborrheic
Posterior: MGD
Chalazion vs Ext.Hordoleum
Chalazion: Meibomian,retained sebasous secretions
Ext.hordoleum: Zeis, staph
Angular blepharitis-cause and treatment
Moraxella lacunata/S.aureus ⬇️ Topical chloramphenicol(gemysetin) bacitracin erythromicin
Where is the nasolacrimal duct obstruction in congenital obstruction?
Valve of Hasner
Chronic canaliculitis-cause
Actinomyces Israelii
*sulfur granules
Thyroid eye disease-signs
Dalrymple:lid retraction in primary gaze
Kocher:frightened appearence in attentive fixation
The von Graefe:retarded decent of the upper lid in downgaze
Thyroid eye disease-Orbital myositis diff diagnosis
TED: always tendon sparing
OM: with or without involvement of the tendons
Acute dacryocystitis vs Acute dacryoadenitis
Cystitis: staph/strep➡️oral flucloxacilin/co-amoxiclav
Adenitis: EBV/rarely bacterial➡️treatment not required in many cases (or according to the cause)
⭐️S-shaped ptosis
Congenital causes of watering eye-diff diagnosis
Nasolacrimal duct obstruction Punctal atresia Congenital glaucoma Chronic conjunctivitis (chlamydia) Keratitis Uveitis
Carotid-cavernous fistula-triad
1️⃣pulsatile proptosis(with bruit)
2️⃣conjunctival chemosis
3️⃣whooshing noise in the head
Carotid-cavernous fistula-the most frequently affected CN
CN 6 (due to its free-floating location within the cavernous sinus)
Carotid-cavernous fistula-investigation
CT/MR: prominence of the VOS
Varices and Lymphangioma-the most frequent site
Upper nasal
⭐️Lymphangioma:bluish
The most common tumour of the orbit and periorbital area in childhood
Capillary haemangioma
Capillary haemangioma-visceral involvement
Can lead to serious complications: thrombocytopenia(Kasabach-Merritt syndrome), high-output cardiac failure
⚠️systemic investigation should be considered
Capillary haemangioma-treatment
Rapid growth 3-6months after diagnosis
Slower phase of natural resolution
30% resolve by age 3
75% resolve by age 7
The most common orbital tumor in the adults
Cavernous haemangioma
Cavernous haemangioma-treatment
Asymptomatic: observation alone
Symptomatic: surgical excision (well encapsulated and relatively easy to remove unlike capillary h.)
The most common epithelial tumour of the lacrimal gland
Pleomorphic adenoma=benign mixed tumour
✳️No pain
✳️Treatment:surgical excision
❗️NO BIOPSY prior to surgery in order to prevent seeding
The most common peripheral neural tumour of the orbit
Plexiform neurofibroma
NF-1
Iris hamartomas=Lisch nodules Optic nerve glioma Plexiform neurofibroma Encephalocoele Glaucoma
NF-2
Optic nerve sheath menengioma
The most common soft tissue sarcoma of childhood
The most common primary orbital malignancy in children
Rabdomyosarcoma
Evisceration
Sclera and extraocular muscles remain intact
❗️if malignancy➡️do enucleation
Evisceration
Sclera and extraocular muscles remain intact
❗️if malignancy➡️do enucleation
The most common cause of both unilateral and bilateral proptosis in adults
Thyroid eye disease
The most common cause of unilateral proptosis in children
Orbital cellulitis
Orbital walls-the strongest and the weakest
Strongest: lateral
Weakest: medial
The volume of the average human orbit
30 mL
MR-T1 and T2
T1: fat brighter
T2: vitreous brighter
Optic nerve glioma-radiography
⭐️pathognomonic: Kinking of the optic nerve
The most common malignant neoplasm of the lacrimal gland
Adenoid cystic carcinoma
✳️perineural invasion➡️pain
✳️Biopsy is necessary for histological diagnosis
Wolfring and Krause
10% of production (basal tear secretion) (lacrimal➡️reflex tear secretion)
Wolfring: in tarsus
Krause: in the conjunctival fornices
Upper and lower eyelid-analogs
Levator aponeurosis↔️capsulopalpebral fascia
Whitnall’s ligament(condensation of levator muscle sheath)↔️Lockwood’s suspensory ligament(condensation of capsulopalpebral fascia)
Müller muscle↔️inferior tarsal muscle
Meibomian, Zeiss, Moll
Meibomian: within tarsus
➡️chalazion
Zeis: near lid margin
➡️external hordeolum
Moll: near lid margin
