Orbit, eyelid, lacrimal Flashcards
orbital roof made of
frontal bone
lesser wing of sphenoid
lateral wall made of
zygomatic bone
greater wing of sphenoid
medial wall made of
ethmoid bone
lacrimal bone
maxillary bone
sphenoid bone
floor made of
maxillary bone
palatine bone
zygomatic bone
ethmoidal foramina
what goes thru anterior ethnmoidal foramina
posterior?
anterior = anterior ethmoidal artery
posterior = posterior ethmoidal artery
root for infection/malignancy
superior orbital fissure
separates?
transmits what?
separates greater/lesser wings of sphenoid
transmit CN 3, 4, 6, CN V part
superior ophthalmic vein
nasolacrimal canal
houses
extends from where to where
houses nasolacrimal duct which allows tears to drain nasally
from lacrimal sac to inferior meatus of nose
7 layers of eyelid
1) skin and subq tissue
2) muscles of protraction = orbicularis oculi/CN 7
3) orbital septum= thin multilayered fibrous tissue protect against infection/trauma
4) orbital fat
5) muscles of retraction upper and loewr eyelid
- upper = levator/superior tarsal
- lower = inferior tarsal, capsulopalpebral fascia
6) tarsus = dense plate of connective tissue
7) conjunctiva= orbit to cover interior eyelid
what is the lacrimal canaliculi/ducts
what is the lacrimal puncta
small channels in each eyelid which conduct tears
puncta = minute orifices where lacrimal ducts comence
what are meibomian glans
what are lacrimal glands
meibomian = sebaceous gland in eyelid; prevent rapid tear evap
lacrimal = superior, lat orbi; secrete aqueous part of tear
what are glands of zeiss
what is the whitnall’s ligament
sepcialized sebacious glands for eyelids in margin
support ligament of rupper eyelid/superior orbit for levator
what is muller muscle
what is lockwood’s ligament
help raise upper eyelid; smooth muscle joining levator
supports eye inferiorly and prevents downward displacement; forms hammock below
what are parasinal sinuses
1) maxillary
2) frontal
3) ethmoid
4) sphenoid
what is the annulus of zinn
ring of fibrous tissue around optic nerve
origin for 5 of the EO muscles
what is blood supply
- primary?
- secondary
- drained by?
primary = ophthalmic artery off internal carotid
secondary = facial/maxillary artery = branch of external carotid
drained by ophthalmic vein
what are extraocular muscles
( LR6 SO4 ) 3
orbital floor fracture
what is spared?
what if blow out fracture?
presents with ….
orbital rim spared
blow out fracture = floor fracture with intact rim herniate into maxillary sinus
present with ecchymosis, emphsema (incr IOP), subconjunctival hemorrhage, enophthalmos (sinking of eye)
treatment of orbital floor fracture
immediate if muscle entrap or oculocardiac reflex
early if diplopia, hypoglobus, large fracture, enophthalmus more than 2 mm
pediatric orbital floor fracture
symptoms
what is white eye blow out
treatment
symptom = nausea/vomiting, pain with eye movement
white eye= no significant trauma; cancellous rubbery bone entrap inferior rectus
treat with surgery; implants to prevent reherniation
AApediatric orbital teratoma
2+ germinal layer
present with proptosis
treat with subtotal exenteration (remove eye and adjacent structures)
capillary hemangioma
MOST COMMON!!
appears at what age?
appears how?
treatment
AA
appear at 1-2 week and enlarge for 6-12 months
superficial = red bump deep = deep blue progressive enlarging
treatment = propranolol and steroids, anti-angiogenic factors, surgery treat strabismus/amblyopia
dermoid cyst
made of?
appears?
location?
dermoid vs epidermoid
AA
made of pinched off skin fill with keratin and rupture
appears as palpable painless enlarging mass
lateral brow
dermoid = keratinizing with dermal appendage; epidermoid = lined by epidermis with keratin
lymphangioma
age?
location?
what happens with assoc infection
treatment
AA
1st 10 years
conjunctiva, eyelid, orbit, oropharynx,
during infections, swelling of lymph and pressure on eye
treat= draining
rhabdomyosarcoma
MOST COMMON MALIGNANT PEDIATRIC ORBIT TUMOR
progression as child vs early teen
derived from
treatment
AA
child = sudden onset, unilateral proptosis
teen = progressive proptosis
derived from undiff pluripotent mesenchymal cells
treat = radiation/chemo, exentoration for recurrent
cavernous hemangioma
MOST COMMON BENIGN ADULT
progression?
age?
symptoms?
treament
AA
slow progressing proptosis
middle age women
retinal striae, hyperopia (farsight), optic nerve compression, incr IOP,
lateral orbitomy
neural tumors in orbit
meningiomas (orbital)
location?
age?
progresion?
treatment
AA
along arachnoid of optic sheath
30-40 y/o women
gradual unilat vision loss, painless
treatment = observe, radiation if in orbit, surgery if vision loss
neural tumors in orbit
meningiomas (sphenoid wing)
location?
treatment
AA
lateral wall of orbit with dural tail
treatment = observe until problem, subtotal resection, post-op radiotherapy
neural tumors in orbit
schwannoma
location?
age?
AA
vestibular nerve from prolif of schwann cells encapsul by perineurium
age = older/younger women
lymphoprolif disrodrs
B cell tumor of orbit usu?
4 most common lymphomas to orbit?
treatment?
AA
malignant NH lymphoma
MALT, CLL, follicular center lymphoma, high grade lymphoma
treat = radiotherapy, surgery, chemo
lacrimal gland tumors usu
AA
epith or non epith
secondary orbital tumors
extend to involve?
AA
globe or eyelid = choroidal melanoma, retinoblastoma, basal and squamous cell carcinoma
sinuses
metastatic tumors usu in adults
most common
symptoms
AA
breast and lung
pain, proptosis, inflamm, bone destruction
congenital nasolacrimal obstruction
symptoms
constant tearing with mucopurlence 90% resolve within 1 year
congenital nasolacrimal obstruction
dacrocystocele
due to?
problem?
appearance
can get
complications
enlargement of nasolacrimal sac at birth –> obstruct duct prox and nasal valve of Hasner distal
fluid trapped in sac = tears + amniotic fluid
large blue, cystic
can get intranasal cyst (problem in baby because nose breather)
preseptal cellulitis
orbital cellulitis
intranasal cyst
dacrocystitis
what happens?
what is risk for infection?
what freq infects?
treatment
complete nasal obstruction from infection of lacrimal sac
chronic stasis risk for infection
staph strep diphtheroid infect
gram neg in diabetic and immune compromised
insert prosthetic drain via bypass
preseptal cellultiis
what is it?
treatment?
infection of skin around eye, anterior or orbital septum
treat = oral antibiotics and nasal decongestants, warm compress
orbital cellulitis
infection where?
usu due to?
symptoms?
treat?
infection posterior to orbital septum
due to sinusitis
fever, leukocytosis, proptosis, chemosis, ptosis, decr visual acuity, color
treat aggressively!!!!!!!
may spread to brain, cause blindness, abscess
thyroid eye disease
assoc with what?
causes what effects?
more common women or men
autoimm assoc with Grave’s
eyelid retract, lid lag, proptosis, restrictive myopathy, compressive optic neuropathy
women
pathogenesis of thyroid eye disease
orbital fibroblast with CD40 induce synth of GAGs
treatment of thyroid eye disease
treat thyroid problem so normal thyroid level
quit smoking
orbital decompression if affect nerve
symptoms of thyroid eye disease
lid retraction
diplopia if infiltration of EOM so eyes can’t move together
blindness if enough congestion to choke optic nerve (decompressive surgery)
