Orbit, eyelid, lacrimal Flashcards

1
Q

orbital roof made of

A

frontal bone

lesser wing of sphenoid

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2
Q

lateral wall made of

A

zygomatic bone

greater wing of sphenoid

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3
Q

medial wall made of

A

ethmoid bone
lacrimal bone
maxillary bone
sphenoid bone

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4
Q

floor made of

A

maxillary bone
palatine bone
zygomatic bone

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5
Q

ethmoidal foramina
what goes thru anterior ethnmoidal foramina

posterior?

A

anterior = anterior ethmoidal artery

posterior = posterior ethmoidal artery

root for infection/malignancy

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6
Q

superior orbital fissure
separates?
transmits what?

A

separates greater/lesser wings of sphenoid

transmit CN 3, 4, 6, CN V part
superior ophthalmic vein

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7
Q

nasolacrimal canal
houses

extends from where to where

A

houses nasolacrimal duct which allows tears to drain nasally

from lacrimal sac to inferior meatus of nose

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8
Q

7 layers of eyelid

A

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

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9
Q

what is the lacrimal canaliculi/ducts

what is the lacrimal puncta

A

small channels in each eyelid which conduct tears

puncta = minute orifices where lacrimal ducts comence

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10
Q

what are meibomian glans

what are lacrimal glands

A

meibomian = sebaceous gland in eyelid; prevent rapid tear evap

lacrimal = superior, lat orbi; secrete aqueous part of tear

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11
Q

what are glands of zeiss

what is the whitnall’s ligament

A

sepcialized sebacious glands for eyelids in margin

support ligament of rupper eyelid/superior orbit for levator

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12
Q

what is muller muscle

what is lockwood’s ligament

A

help raise upper eyelid; smooth muscle joining levator

supports eye inferiorly and prevents downward displacement; forms hammock below

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13
Q

what are parasinal sinuses

A

1) maxillary
2) frontal
3) ethmoid
4) sphenoid

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14
Q

what is the annulus of zinn

A

ring of fibrous tissue around optic nerve

origin for 5 of the EO muscles

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15
Q

what is blood supply

  • primary?
  • secondary
  • drained by?
A

primary = ophthalmic artery off internal carotid

secondary = facial/maxillary artery = branch of external carotid

drained by ophthalmic vein

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16
Q

what are extraocular muscles

A

( LR6 SO4 ) 3

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17
Q

orbital floor fracture
what is spared?

what if blow out fracture?

presents with ….

A

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)

18
Q

treatment of orbital floor fracture

A

immediate if muscle entrap or oculocardiac reflex

early if diplopia, hypoglobus, large fracture, enophthalmus more than 2 mm

19
Q

pediatric orbital floor fracture
symptoms

what is white eye blow out

treatment

A

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

20
Q

AApediatric orbital teratoma

A

2+ germinal layer

present with proptosis

treat with subtotal exenteration (remove eye and adjacent structures)

21
Q

capillary hemangioma
MOST COMMON!!

appears at what age?
appears how?

treatment

AA

A

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

22
Q

dermoid cyst
made of?

appears?

location?

dermoid vs epidermoid

AA

A

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

23
Q

lymphangioma
age?

location?

what happens with assoc infection

treatment

AA

A

1st 10 years

conjunctiva, eyelid, orbit, oropharynx,

during infections, swelling of lymph and pressure on eye

treat= draining

24
Q

rhabdomyosarcoma
MOST COMMON MALIGNANT PEDIATRIC ORBIT TUMOR

progression as child vs early teen

derived from

treatment

AA

A

child = sudden onset, unilateral proptosis

teen = progressive proptosis

derived from undiff pluripotent mesenchymal cells

treat = radiation/chemo, exentoration for recurrent

25
Q

cavernous hemangioma
MOST COMMON BENIGN ADULT

progression?

age?

symptoms?

treament

AA

A

slow progressing proptosis

middle age women

retinal striae, hyperopia (farsight), optic nerve compression, incr IOP,

lateral orbitomy

26
Q

neural tumors in orbit
meningiomas (orbital)

location?
age?
progresion?
treatment

AA

A

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

27
Q

neural tumors in orbit
meningiomas (sphenoid wing)

location?
treatment

AA

A

lateral wall of orbit with dural tail

treatment = observe until problem, subtotal resection, post-op radiotherapy

28
Q

neural tumors in orbit
schwannoma

location?
age?

AA

A

vestibular nerve from prolif of schwann cells encapsul by perineurium

age = older/younger women

29
Q

lymphoprolif disrodrs
B cell tumor of orbit usu?

4 most common lymphomas to orbit?

treatment?

AA

A

malignant NH lymphoma

MALT, CLL, follicular center lymphoma, high grade lymphoma

treat = radiotherapy, surgery, chemo

30
Q

lacrimal gland tumors usu

AA

A

epith or non epith

31
Q

secondary orbital tumors
extend to involve?

AA

A

globe or eyelid = choroidal melanoma, retinoblastoma, basal and squamous cell carcinoma

sinuses

32
Q

metastatic tumors usu in adults
most common

symptoms

AA

A

breast and lung

pain, proptosis, inflamm, bone destruction

33
Q

congenital nasolacrimal obstruction

symptoms

A

constant tearing with mucopurlence 90% resolve within 1 year

34
Q

congenital nasolacrimal obstruction
dacrocystocele

due to?
problem?

appearance

can get

complications

A

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

35
Q

dacrocystitis
what happens?

what is risk for infection?

what freq infects?

treatment

A

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

36
Q

preseptal cellultiis
what is it?

treatment?

A

infection of skin around eye, anterior or orbital septum

treat = oral antibiotics and nasal decongestants, warm compress

37
Q

orbital cellulitis
infection where?

usu due to?

symptoms?

treat?

A

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

38
Q

thyroid eye disease
assoc with what?

causes what effects?

more common women or men

A

autoimm assoc with Grave’s

eyelid retract, lid lag, proptosis, restrictive myopathy, compressive optic neuropathy

women

39
Q

pathogenesis of thyroid eye disease

A

orbital fibroblast with CD40 induce synth of GAGs

40
Q

treatment of thyroid eye disease

A

treat thyroid problem so normal thyroid level

quit smoking
orbital decompression if affect nerve

41
Q

symptoms of thyroid eye disease

A

lid retraction

diplopia if infiltration of EOM so eyes can’t move together

blindness if enough congestion to choke optic nerve (decompressive surgery)