Orbit Flashcards
What is this?
Preceptal Cellulitis
What things are shown here?
Eyelid and periocular edema
Chemosis
Epibulbar injection
What is shown here?
Proptosis
What is shown?
Dystopia: Displaced eye
What is shown?
Ophthalmoplegia: Misalignment of the eyes due to muscle innervation problems
What might orbital pulsation be caused by?
Cavernous sinus fistula
Defect in orbital roof transmitted via CSF
What is orbital pulsation?
Subtle pulsing at slit lamp or exaggeratied IOP “pulse”
What might be causes of bruit?
Carotid-cavernous fistula
Carotis stenosis in CVA
A-V malformations
What is imaged here?
Choroidal Folds
What is imaged here?
Disc edema
What is shown here?
Optic Atrophy
What is ocular auscultation?
Using the bell of a stethoscope over the closed eye to listen for higher pitced sound in one eye than in the other.
What is a dense fibrous sheath acting as a barrier between orbit and eyelid?
Orbital septum
What does the orbital septum do?
Limits infection
Where does the orbital septum originate?
Periosteum of superior and inferior orbital rims
Where does the orbital septum insert?
Into the levator aponeurosis, just above the superior tarsal border
What is this?
Preceptal cellulitis
Is preceptal cellulitis involved with:
A) Only upper lid
B) Upper and lower lid
C) Lower lid
B) Upper and lower lid
What symptoms coincide with preceptal cellulitis?
Red, tender, edematous lids
What are important symptoms to note are not associated with preceptal cellulitis?
Proptosis, chemosis, vision change, pupillary involvement, fever, EOM restriction
What bacteria usually causes preceptal cellulitis?
Staph aureus
Strep pyogenes
Which bacteria usually causes preseptal cellulitis in children?
H. influenzae
What things causes allow the bacteria inside to cause preseptal cellulitis?
Laceration
Insect bite
Infection spread from hordeolum
Dacrocystitis
Sinusitis
Conjunctivitis
UR or middle ear infection
If any of: proptosis, chemosis, vision change, pupillary involvement, fever or EOM restriction are noted along with red, tender edematous lids, would you suspect preseptal cellulitis, or orbital cellulitis?
Orbital cellulitis
How if afebrile, mild preseptal cellulitis best treated in adults?
Oral antibiotic for 10 days
Ex:
Augmentin 500mg p0 q8h
Cefaclor 250-500mg po q8h
Bactrim or moxifloxacin if allergic to penicillin
How is afebrile preseptal cellulitis treated in children under 5?
Augmentin 20-40 mg/kg/day po
Cefaclor 20-40 mg/kg/day po
Bactrim (trimethoprim/sulfamethoxazole) if allergic to penicillin
With moderate to sever, febrile preseptal cellulitis in a child under 5, what should be done?
Hospital admission for IV antibiotics
What is orbital cellulitis?
A life-threatening infectio of soft tissue behind the orbital septum
Orbital cellulitis is ___ (better, worse) in children than in adults.
Worse
Which bacteria are usually the cause of orbital cellulitis?
S. pneumoniae
S. aureus
S. pyogenes
H. influenzae
What symptoms are commonly seen in orbital cellulitis?
Proptosis
Pain with EOM restriction
Fever
Malaise
Visual imparment (if optic nerve involved)
APD
What are the potential complications of orbital cellulitis?
Meningitis
Brain abscess
Cavernous sinus thrombosis
If orbital cellulitis is deemed emergent, what should be done?
Hospital admission, IV ceftazidime (or vancomycin) + oral metronidazole (anerobes)
What is this?
Chalazion
What is dacryoadenitis?
Most commonly an inflammaotory lacrimal gland disease. May also be an autoimmune disease
Idiopathis dacryoadenitis makes up __% of the leasions.
50%
Comorbidity is frequent with which type of dacryoadenitis?
Autoimmune
Dacryoadenitis is unilateral __% of the time.
80%
Bilateral, painless swelling describes which dacryoadenitis?
Autoimmune dacryoadenitis
Which is the least common type of dacryoadenitis?
Neoplastic dacryoadenitis
What symptomes are associated with neoplastic dacryoadenitis?
Unilateral palpable mass
Dystopia
Proptosis
Low incidence of: pain, redness
Lymphocytic infiltration in elderly
Pleomorphic adenoma in young
Carcinoma - middle age, rare w/ high mortality
What is this?
Dacryoadenitis
What may occur with lymphocytic infiltration of the lacrimal gland?
Can change from benign hyperplasia to malignant lymphoma
What is a common sign of lymphocytic infiltration of the lacrimal gland?
Subconjunctival salmon patch extension
What is this?
Infectious dacryoadenitis
What are some symptoms of infectious dacryoadenitis?
Pain
Erythema
Edema of lateral upper lid - “S” curve
What age group usually is seen with infectious dacryoadenitis?
Children and young adults, typically
Viral infectious dacryoadenitis is usually caused by which diseases?
Epstein-Barr (mono)
Mumps
Adenovirus
Herpes zoster
Herpes simplex
Rhinovirus
What age group usually gets viral infectious dacryoadenitis? Bacterial?
Viral - under 40
Bacterial - over 40 (rare)
Which bacteria are usually the cause of bacterial infectious dacryoadenitis?
Staph
MRSA
Strep
H. Influenzae
Gonorrhea
What is a primary risk factor for Grave’s ophthalmopathy?
Smoking
What is the etiology of Grave’s autoimmunity?
Attack of TSH receptor by TSH receptor auto-antibodies
Abnormal circulating T3/T4 levels (TSH causes release of these)
What signs are noted here?
Proptosis
Lid retraction
Conjunctival hyperemia
Periorbital edema
All from Graves’ Ophthalmopathy
What is Dalrymple’s Sign?
Lid retraction
What is Von Graefe’s sign?
Lid lag
What is idiopathic orbital inflammatory disease?
Non-infective, non-neoplastic, space-occupying lesions. Generally unilateral
Idiopathic orbital inflammatory disease, though usually unilateral, may be bilateral in ___.
Children
What are some common signs and sypmtoms of idiopathic orbital inflammatory disease?
Periorbital redness, swelling, pain
Proptosis, ophthalmoplegia
May have optic nerve involvement
What is the treatment for mild idiopathic orbital inflammatory disease?
Observation…
What are the treatments for idiopathic orbital inflammatory disease?
Biopsy to rule out neoplasia
NSAID - Ibuprofen 100-400 mg tid
Oral steroids 60-80 mg/day after confirmed Dx
Radiotherapy if no improvement
Antimetabolites (methotrexate) if no improvement
What is this?
Orbital Myositis
What is this?
Idiopathis orbital inflammatory disease (IOID)
What is this?
Orbital myositis
What signs/symptoms are expected in orbital myositis?
Pain exacerbated by eye movement
Diplopia - restricted EOM
Injection over involved muscle
Lide edema, ptosis
Fibrosed muscle enlargement
What are treatments for orbital myositis?
NSAID - Ibuprofen 100-400mg tid 3 weeks
Oral steroids if persisting (40-60mg qd, tapered 1-4 wk)
What is Tolosa-Hunt Syndrome?
Rare, idiopathic, granulomatous inflammation of the cavernous sinus, superior fissure, orbital apex
What may Tolosa-Hunt syndrome cause?
Mild proptosis
Oculomotor nerve palsies, usually with pupil involvement
*Sensory loss of V1, V2 of trigeminal nerve
What is the treatment for Tolosa-Hunt syndrome?
Steroids
What is this?
Carotid Cavernous Fistula
What signs/symptoms are associated with cavernous sinus fistula?
Elevated venous sinus and episcleral venous pressure
Hemorrhagic chemosis
Pulsatile proptosis, whooshing noise in the head, bruit
Increased IOP with exaggerated “ocular pulse”
Vision loss and neuro impact - immediate or delayed; mostly CN VI, some III, IV, V
What is this?
Conjunctivochalasis
What is dacryocystography (DCG) used for?
To identify the site of obstruction of the drainage system
What is this?
Dacryocystitis
What signs/symptoms are associated with dacryocystitis?
Pain
Epiphora
What is the treatment for dacryocystitis?
Warm compresses
Oral antibiotics - Children: augmentin 20-40 mg/kg/day, or cefaclor 20-40 mg/kg/day
Oral antibiotics - adults: cephalexin 500 mg po q6h, or augmentin 500 mg po q8h
Topical antibiotics (in addition) - trimethoprim/polymyxin B qid
For which disease is probing contraindicated?
Dacryocystitis
What is this?
Chronic canaliculitis
What are the signs/symptoms of chronic canaliculitis?
Swelling
Mucopurulent discharge
What are the two congenital conditions?
Nasolacrimal duct obstruction
Dacryocele
What is a dacryocele?
Collection of amniotic fluid or mucus in lacrimal sac, due to imperforate valve of Hasner
