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Ocular Disease > Orbit > Flashcards

Orbit Flashcards

1
Q

what are the 3 major signs of orbital issues?

A

proptosis, enophthalmos, and ophthalmoplegia

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2
Q

what is proptosis?

A

protrusion of globe - something is pushing eye forward (often thyroid problems)

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3
Q

what can cause enophthalmos?

A

recession of globe, small globe, structural problem, atrophy/scarring

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4
Q

what are some causes of ophthalmoplegia?

A

(can’t move globe) mass/tumor, myopathy, ocular motor nerve lesions, and trauma

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5
Q

how do you test for ophthalmoplegia?

A

forced ductions

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6
Q

what is inflammatory orbital disease characterized by?

A

occupying lesions in the orbital space

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7
Q

what are 3 inflammatory orbital disease?

A

dacryoadenitis, idiopathic orbital inflammatory pseudotumor and thyroid eye disease

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8
Q

what are some signs and symptoms of idiopathic orbital pseudotumor?

A

pain, red eye, diplopia, proptosis, and eyelid swelling

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9
Q

what are 4 things you do to evaluate orbital pseudotumor?

A

gross observation, slit lamp, CT (r/o tumor) and biopsy (r/o tumor)

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10
Q

what is the treatment/management for orbital pseudotumors?

A

prednisone 80-100 mg qd and radiation if no improvement with steroid treatment

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11
Q

what are the 3 thyrotoxicosis reasons for thyroid eye disease?

A

hyperthyroid (most common), hypothyroid, and euthyroid

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12
Q

where is the thyroid gland and what is it responsible for?

A

endocrine tissue in front of the neck, regulates: heart rate, breathing, metabolic rate, development of cells

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13
Q

what can cause secondary and tertiary thyroid eye disease?

A

secondary = pituitary

tertiary = hypothalamus

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14
Q

what gland directs the pituitary?

A

hypothalamus

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15
Q

what happens after the pituitary releases TSH (thyroid stimulating hormone)?

A

in reponse to TSH - thyroid makes T3 and T4 and circulate throughout the body

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16
Q

why is the orbital tissue affected in thyroid disease?

A

orbital tissue looks like thyroid tissue - auto-antibodies attack the tissue

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17
Q

what are 2 things that orbital disease can occur secondary to?

A

abnormal levels of T3/T4 and antibodies attacking orbital tissue (euthyroid)

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18
Q

what are the signs and symptoms of thyroid eye disease?

A

proptosis and eyelid retraction

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19
Q

what are 3 secondary problems for thyroid eye disease?

A

exposure keratopathy, optic nerve compression, and EOM restriction (diplopia)

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20
Q

what tests can you perform to evaluate thyroid eye disease?

A

gross observation, slit lamp, exophthalmometry, orbit CT, and serology: T3, T4, TSH (if those are normal = auto-antibodies)

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21
Q

what are some treatment/management options for thyroid eye disease?

A

stop smoking, refer to PCP/endocrinologist, ophthalmic ointment for exposure keratopathy, systemic steroids - oral prednisone (80-100mg/day) and may need orbital decompression

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22
Q

what is preseptal cellulitis?

A

infection of subcutaneous tissues anterior to orbital septum

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23
Q

what are some causes of preseptal cellulitis?

A

skin trauma, hordeolum/chalazion, remote infection (URI, ear)

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24
Q

what are some signs/symptoms for preseptal cellulitis?

A

redness, swelling of eyelids, swelling of periorbital area, and tenderness

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25
Q

what are some pertinent negatives for preseptal cellulitis?

A

proptosis, decreased VA, impaired ocular motility

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26
Q

what medication and dose do you give for preseptal cellulitis?

A

oral antibiotic for 10 days (augmentin, ceclor, bactrim or moxifloxicin) and topical antibiotic if there are skin lesions or conjunctivitis

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27
Q

what is orbital cellulitis?

A

infection of soft tissue behind the orbital septum

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28
Q

what are some causes of orbital cellulitis?

A

sinus, spread from facial infection, trauma, and post-surgical

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29
Q

why is orbital cellulitis so severe?

A

can compress other structures in the orbital space and can spread to the brain

30
Q

what are the signs/symptoms of orbital cellulitis?

A

same as preseptal cellulitis - but also has proptosis, EOM restriction (diplopia and pain), if optic nerve is involved (decreased VA, APD, and decreased color vision)

31
Q

what types of tests should you run for orbital cellulitis?

A

vitals, CT (orbit and sinus), CBC with diff, blood cultures, gram stain and culture discharge and lumbar puncture if suspect meningitis

32
Q

how do you treat orbital cellulitis?

A

admit to hospital, IV antibiotic, monitor for spread or orbital compression (VAs), may need to drain orbit (topical antibiotic if needed)

33
Q

what are some differential diagnoses for orbital cellulitis?

A

contact dermatitis, ptosis, cellulitis, hordeolum/chalazion, herpes zoster, viral conjunctivitis with eyelid swelling

34
Q

what is the most common tumor type that affects the lacrimal gland?

A

most are benign - Pleomorphic adenoma (mixed cell)

35
Q

how do you diagnose and manage a lacrimal gland tumor?

A

diagnose = CT scan

manage = excision

36
Q

how do nasal/paranasal sinus tumors affect the eye?

A

nasolacrimal duct and orbit (through lamina papyracea)

37
Q

what are some signs/symptoms of orbital tumors?

A

proptosis/globe displacement, periorbital/eyelid swelling or other signs

38
Q

what is the management for orbital tumors?

A

refer to oncologist for = chemotherapy and radiation also refer to ophthalmology = excision/biopsy

39
Q

what is a dermoid cyst?

A

benign, superficial-congenital and occurs deep-adolescence or adult

40
Q

what is the treatment for a dermoid cyst?

A

excise - prevent globe malposition and leakage of fluid (inflammation)

41
Q

what is a mucocele?

A

sinus drainage is obstructed and debris erodes walls of sinuses

42
Q

what is an encephalocele?

A

herniation of intracranial contents through defect in base of skull - congenital

43
Q

what is the treatment for mucocele/encephalocele?

A

excise

44
Q

what is a capillary hemangioma?

A

hemangioma = isolated lesion of rapid growth of blood vessels most common orbital tumor in children

45
Q

what is the treatment for capillary hemangioma?

A

observe, resect, steroids, radiotherapy - treat only if there is a threat to visual impairment or risk of cardiac failure

46
Q

who typically gets cavernous hemangioma’s?

A

adults = most common benign orbital tumor

47
Q

what is the treatment for cavernous hemangioma’s?

A

excise - usually required to prevent vision threatening complications

48
Q

what is an optic nerve glioma and who typically gets them?

A

slow growing, associated with neurofibromatosis and children and may extend intracranially

49
Q

what is the treatment for optic nerve gliomas?

A

observation, excision and/or radiotherapy - if needed to prevent life or vision threatening conditions

50
Q

what is an optic nerve sheath meningioma and who typically gets them?

A

begnin, characterized by optic nerve dysfunction and may cause proptosis or ophthalmoplegia - middle aged patients

51
Q

what is the treatment for optic nerve sheath meningioma?

A

observation, excise and/or radiotherapy = prognosis is good

52
Q

what type of tumor is in children and starts in the abdomen with a poor prognosis?

A

neuroblastoma (metastic)

53
Q

what are some signs/symptoms for a blow out fracture?

A

pain, epiphora, restricted EOMs, edema/ecchymosis

54
Q

how should you evaluate a blow out fracture?

A

complete exam and CT scan

55
Q

what is the treatment for a blow out fracture?

A

oral antibiotics and refer for repair

56
Q

what are some signs/symptoms of a retrobulbar hemorrhage?

A

proptosis, subconj heme, eyelid ecchymosis, VA loss and APD

57
Q

what is the management for a retrobulbar hemorrhage?

A

refer asap for decompression surgery

58
Q

what is a carotid-cavernous fistula?

A

abnormal communication between blood vessels - affects circulation in (artery) and out (vein)

59
Q

how does a carotid-cavernous fistula occur?

A

vein gets “arterialized” and increases the venous pressure - affects the venous drainage (carotid artery and cavernous sinus vein)

60
Q

what are some causes for a carotid-cavernous fistula?

A

head trauma, rupture of aneurysm and congenital

61
Q

what are some signs/symptoms for a carotid-cavernous fistula?

A

ptosis, red/chemotic conjunctiva, elevated IOP, AC ischemia, pulsatile proptosis, and nerve palsy

62
Q

how do you manage a carotid-cavernous fistula?

A

refer for possible surgery and many recover spontaneously

63
Q

what is phthisis bulbi?

A

a shrunken eyeball - globe starts to atrophy until no vision is left

64
Q

what are some causes of phthisis bulbi?

A

trauma, inflammation, widespread ocular disease

65
Q

what is anophthalmos?

A

lack of a globe

66
Q

what are the causes of anophthalmos?

A

usually congenital or it can be acquired (trauma or enucleation)

67
Q

what should you look for when evaluating a patient with phthisis or anophthalmos?

A

infection, inflammation or tumors

68
Q

what is the management for phthisis bulbi?

A

B-scan annually, if painful (topical steroids or cycloplegic), prosthetic shell

69
Q

what is the management for anophthalmos?

A

infection = topical antibiotic

inflammation = topical steroid

tumor = refer for excision

prosthetic = clean and evaluate

70
Q

what is this condition?

A

orbital cellulitis

71
Q

what is this condition?

A

preseptal cellulitis

72
Q

what is this condition?

A

idiopathic orbital pseudotumor

Ocular Disease (10 decks)

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