Oculoplastics Flashcards
What etiologies should you consider for preseptal cellulitis?
sinus, dacryadenitis, skin, hematogenous
Most common cause of preseptal historically vs now?
h. influenza before. Now g+ cocci
choice of therapy for preseptal cellulitis
celaphalexin if anterior, augmentin if sinus source, bacterium if worried about MRSA, vans or ceftriaxone if refractory
also do warm compresses, nasal decongestants
hospital acquired MRSA are sensitive to what
vanc, linezolid
most common source of infection for orbital cellulitis
chronic bacterial sinusitis
signs of orbital cellulitis
leukocytosis, fever, erythema, proptosis, chemises, ptosis, restriction/pain with EOMs, decrease in vision, impaired color, restricted fields, pupil Abel
what are the differences in organisms in adult and children with orbital cellulitis
adults usually mixed flora including G+C and anaerobes
Children usually one single organism and less likely need surgical intervention
what kind of orbital wall fracture is at highest risk of subsequent orbital cellulitis
medial wall
subperiosteal abscess may NOT be need to be drained in what circumstances?
isolated media/inferior abscess in children <9 years with isolated ethmoid sinusitis, intact vision, mild proptosis… can keep trying medical therapy
what medicine is particularly good for nec fasc involving group A strep?
Clindamycin
signs of orbital TB
proptosis, EOM Abnl, bone destruction, draining fistulas
what stains is used for asperillus? whats the path finding
Grocott-Gomori methenamine-silver nitrate. shows septet branching hyphae with uniform width.
what stain is used for zygomycosis (mucor/rhizopus)? what’s the finding?
stain is hematoxylin eosin. finding of nonseptated large branching hyphae.
what are the forms of aspergillosis?
acute aspergillosis- fulminant sinus infection that invades the orbit
chronic aspergillosis-indolent infection with slow destruction of surrounding structures
Chronic localized noninvasive aspergillosis–fungal ball without destruction of bone/no inflammation
Allergic aspergillus sinusitis: immunocompetent patients with nasal polyposis and chronic sinusitis. –has elevated eosinophils/IgE bone remodeling and inflammation but no over invasion.
what are the three most common parasitic orbital conditions?
trichinosis, ecchinococcosis, cysticerocosis (taenia solium)
what are the signs of TED?7
proptosis, lid retraction, lid lag, restrictive extra ocular myopathy, compressive optic neuropathy, exposure keratopathy, conjunctival injection/chemosis.
what is Von Graefe sign?
lid lag
most common sign of TED?
lid retraction.
is TED only seen in Graves?
no, it’s also in Hashimotos, or euthyroid circulating thyroid antibodies (TSHR ab, thyroid binding inhibitory abs, TSH Its, antimicrosomal)
what are the diagnostic criteria for TED?
2/3 of the following:
current/recent thyroid dysfunction (graves, hash, or circulating abs), any eye findings consistent with TED, radiographic evidence of fusiform enlargement of any of these IR, MR, LR, SR/levator.
pathophys of TED?
orbital fibroblasts (from neurocrest cells, some become adipose and some fibroblast) have CD40 (usually seen on B cells) thats actively involved in inflammatory states up regulating glycosaminoglycan and can also be associated with fat hypertrophy. Insulin-like growth factor IgG’s may stimulate these receptors.
how to treat mild TED
life style education, AT’s, selenium
How to treat moderate TED
mod dose corticosteroids, cyclosporin, taping lids, moisture chambers
How to treat severe TED
high dose IV steroids, surgical decompression, radiotherapy