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OHADM1 > Orbit > Flashcards

Orbit Flashcards

1
Q

What is thyrotoxicosis and its risk factors

A
  • autoimmune disorder which presents in 30-40s

Risks:
- smoking
- female
- radioactive iodine used to treat hyperthryroidism

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2
Q

What are the clicical manifestations of TED

A
  • soft tissue involvement
  • lid retraction
  • proptosis
  • restrictive myopathy
  • optic neuropathy
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3
Q

What are the two stages in the development of the disease

A

congestive
- inflammatory stage

Fibrotic
-Quiescent stage (inactive stage)

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4
Q

Symptoms of soft tissue involvement (TED)

A
  • Grittiness
  • photophobia
  • lacrimation
  • retrobulbar discomfort
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5
Q

Signs of soft tissue involvement (TED)

A
  • epibulbar hyperaemia
  • periorbital swelling
  • superior limbic keratoconjunctivitis
  • keratoconjunctivitis sicca (dry eyes)
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6
Q

Mangaement for soft tissue involvement (TED)

A
  • lubircants for superior limbic conjunctivitis, corneal exposure and dryness
  • head elevation with three pillow during sleep to reduce perioorbital oedema
  • eyelid taping during sleep may alleviate mild exposure keratopathy
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7
Q

What are the signs of lid retraction (TED)

A

upper lid retraction- when lid margin is lvl with or above limbus, showing scerla

lower lid retraction- scerla shows below limbus

may occus in isolation. w proprtosis which exaggerates severity

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8
Q

What is the management for lid retraction (TED)

A
  • mild lid retraction requires no treatment, improves spontaneously
  • consider surgery for significant but stable lid retraction
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9
Q

What is proptosis (TED) and how to determine it

A
  • Abnormal protrusion of the globe, detected by looking down at patient from above and behind
  • measure using exophthalmometer/ frm lateral orbital margin w plastic ruler
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10
Q

What are the signs of proptosis

A
  • is axial, uni/bilateral, a/symmetrical n freq. permanent
  • sever proptosis may comprimise lid closure. W resultant exposure keratopathy, corneal ulceration and infection
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11
Q

What is the management of proptosis

A
  • systemic steroids (maybe used in rapidly progressive and painful proptosis)
  • radiotheraphy (maybe used in addition to steroids or when steroids are contraindicated/ ineffective)
  • surgical decompression ( aims to increase the volume of the orbit by removing the bony walls and may be combined with removal of orbital fat to increase the retroplacement of the globe)
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12
Q

What is restrivtive myopathy (TED) and its different type of defects

A
  • ophthalmoplegia (paralysis of muscles within or surrounding the eye)

where ocular motility is restrited intially by inflammatory oedema, and later fibrosis

Ocular motility defects:
- elevation (freq)
- adduction (freq)
- abduction
- depression

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13
Q

What is the mangament for restrictive myopathy

A
  • surgery if dilopia is present in primary/ reading position of gaze. If disease is quiescent n angle of deviation has been stable for at least 6 months
  • If not, diplopia may be alleviated with prisms
  • Botox injection into affect muslce may be useful in some cases
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14
Q

What is optic neuropathy (TED) caused by

A

compression of optic nerve or its blood supply at the orbital apex by congested and enlarged recti muscle

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15
Q

What could optic neuropathy (TED) lead to and what is its presentation with

A
  • Severe permanent but preventable visual impairment
  • presentation is with impairment of central vision
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16
Q

How to detect optic neuropathy (TED)

A
  • Advise patients to self monitor visual function
  • occulde each eye, read small print and asses the intensity of colours
17
Q

What is the sign of optic neuropathy (TED)

A
  • reduced visual acuity, with RAPD, colour desaturation, diminished light brightness appreciation
  • visual field defects may be centeral or paracentral, maybe combined with nerve fibre bundle defects
  • optic disc is usually normal, occasionally swollen
18
Q

What is the mangament for optic neuropathy (TED)

A

refer for systemic steriods. Surgical decompression may be considered

19
Q

Name the infections of the orbit

A

preseptal cellulitis

bacterial orbital cellulitis

20
Q

What is preseptal cellulitis

A

An infection of subcutaneous tissues anterior to orbital septum

Occasionally rapid progression to orbital cellulitis may occur

21
Q

What are the causes of preseptal cellulitis

A
  • skin trauma from lacerations or insect bites
  • spread of local infection such as acute horeolum or dacryocystitis
  • from remote infection of upper respiratory tract or middle ear by haematogenous spread
22
Q

What are the signs of preseptal cellulitis

A
  • unilateral, tender, red periorbital oedema
  • CT shows opacification anterior to orbital septum
23
Q

what is the management for preseptal cellulitis

A

refer to opthalmologist for antibiotics therapy

24
Q

What is bacterial orbital cellulitis

A

Life threatening infection of the soft tissues behind the orbital septum (more common in children)

25
Q

What are the causes of bacterial orbital cellulitis

A
  • Sinus related
  • Extension of preseptal cellulitis
  • Local spread
  • Haematogenous spread
  • Post- trauma
  • Post- surgery
26
Q

What are the signs and symptoms of bacterial orbital cellulitis

A
  • rapid onset of severe malaise, fever, pain and visual impairment
  • Unilateral, tender, warm, red periorbital and lid oedema
  • Proptosis is often obscured by lid swelling
  • painful opthalmoplegia (paralysis of EOM)
  • optic nerve dysfunction
  • CT scan shows opacification posterior to the orbital septum
27
Q

What is the management of bacterial orbital cellulitis

A
  • refer to the emergency department
  • Hospital admission with otolaryngological assessment and frequent ophthalmic review is mandatory. (antibiotic therapy n monitoring of optic nerve function via every 4h test pupillary reactions, VA, colour vision and light brightness appreciation)
28
Q

What is capillary haemangioma

A

Common tumour of the orbit and periorbital area in childhood

Girls affected more commonly

29
Q

What are the signs of capillary haemangioma

A
  • usually in first few months of life
  • Unilateral, raised, red lesion
  • typically blanches on pressure may swell with crying
  • characterized by rapid growth 3-6 mths after diagnosis, followed by a slower phase of natural resolution
30
Q

What is the managment of capillary haemangioma

A
  • treatment is inficated principally for amblyopia secondary to induced astig, ansiometropia, occlusion, strabismus (eyes dont line up)
31
Q
A

OHADM1 (5 decks)

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