Orbit/Lids/Adnexa Flashcards
<p>What are the dimensions of the adult orbit?</p>
<p>40mm W x 35mm H x 45mm D</p>
<p>What orbital bones make up the roof of the orbit?</p>
<p>Frontal andSphenoid (lesser wing)</p>
<p>What orbital bones make up the lateral wall?</p>
<p>Zygomatic andSphenoid (greater wing)</p>
<p>What orbital bones make up the floor?</p>
<p>Palatine, Maxillary, Zygomatic</p>
<p>What orbital bones make up the medial wall?</p>
<p>Sphenoid (lesser wing), Maxillary, Ethmoid, Lacrimal</p>
<p>Orbital length of the optic nerve? Intracanalicular length of the optic nerve? Intracranial length?</p>
<p>25-30mm, 9mm,16mm</p>
<p>What structures pass through the superior orbital fissure outside the annulus of Zinn?</p>
<p>Lacrimal (V1)</p>
<p>Frontal (V1)</p>
<p>Trochlear n. (CN IV)</p>
<p>Superior ophthalmic vein</p>
<p>"LFTS"</p>
<p></p>
<p>What structures pass though the superior orbital fissure within the annulus of Zinn?</p>
<p>Sup. division of CNIII</p>
<p>Nasociliary (V1)</p>
<p>Inf. division of CNIII</p>
<p>Abducens (CNVI)</p>
<p>"3N3 is6"</p>
<p>What structures pass through the optic canal?</p>
<p>Optic Nerve (CNII)</p>
<p>Ophthalmic artery</p>
<p>What structures pass through the inferior orbital fissue</p>
<p>Infraorbital neurovascular bundle</p>
<p>Inferior ophthalmic vein</p>
<p>Zygomatic nerve</p>
<p>Ganglionic branches (from pterygopalatine ganglion to maxillary n.)</p>
<p>What is the arcus marginalis?</p>
<p>Fusion of the orbital septum and periosteum at the orbital rim, fuses with dura covering ofoptic nerve</p>
<p>How many fat pads are in the upper eyelid?</p>
<p>2 - nasal fat pad (smaller and paler), and central</p>
<p>How many fat pads are in the lower eyelid? Which fat pads are separated by the inferior oblique?</p>
<p>3 - the IO separates nasal and middle fat pads; the lateral fat pad is smaller and more inferior</p>
<p>What is the innervation of the lacrimal gland?</p>
<p>Secretomotor - superior salivary nucleus of CN7</p>
<p>Sensory - CNV</p>
<p>Sympathetic - fromsuperior cervical ganglion</p>
<p>Whereare the glands of Wolfring found?</p>
<p>At the superior edge of tarsus</p>
<p>Where are the glands of Krause found?</p>
<p>In the fornices</p>
<p>Name the 3 anatomic parts of the orbicularis oculi</p>
<p>Pretarsal</p>
<p>Preseptal</p>
<p>Orbital</p>
<p>Where does the orbital septum fuse in non-Asian eyelids?</p>
<p>To the levator aponeurosis 2-5mm above the superior tarsal border</p>
<p>Where does the orbital septum fuse in Asian eyelids?</p>
<p>To the levator aponeurosis between the eyelid margin and the superior border of the tarsus</p>
<p>How long are the muscular and aponeurotic portions of thethe levator palpebrea?</p>
<p>Muscular = 40mm</p>
<p>Aponeurotic = 14-20mm</p>
<p>Where is Whitnall's tubercle located and what structures are attached to it?</p>
<p>11mm inferior to the FZ suture and 4-5mm posterior to the orbital rim;</p>
<p><strong>4 L's:</strong></p>
<p><strong>L</strong>ockwood suspensoryligament</p>
<p><strong>L</strong>ateral rectus check ligament</p>
<p><strong>L</strong>ateral palpebral ligament</p>
<p><strong>L</strong>evator aponeurosis</p>
<p>(Whitnall's ligament does NOT attach to the Whitnall's tubercle; actually inserts to trochlea medially and the FZ suture temporally)</p>
<p></p>
<p></p>
<p>From where does Muller's muscle originate? Where does it insert? What is it's length? How much does it raise the eyelid?</p>
<p>Origin: undersurface of levator at level of Whitnall's ligament</p>
<p>Insertion: superior border of tarsus</p>
<p>Length: 12-15mm</p>
<p>Action: raises eyelid 2mm</p>
<p>What are the lower eyelid retractors?</p>
<p>Capsulopalpebral fascia (analogous to levator aponeurosis), inferior tarsal muscle (analogous to Muller's), Lockwood's suspensory ligament</p>
<p>What are the heights of the superior and inferior tarsal plates?</p>
<p>10mm and 4mm respectively</p>
Which limb of the medial canthal tendon is more important for appearance and function?
Posterior limb (attaches to posterior lacrimal crest), maintains apposition to the globe
What does the grey line demarcate?
Muscle of Riolan aka border of pretarsal orbicularis
What is the arterial supply to the upper eyelid?
ICA --> ophthalmic artery --> superior marginal arcade
What is the arterial supply to the lower eyelid?
External carotid artery --> facial artery --> angular artery --> inferior marginal arcade
What is the pretarsal venous drainage pathway?
Medially: Angular vein
Temporally: superificial temporal vein
What is the post-tarsal venous drainage?
orbital vein, facial vein, pterygoid plexus
What aspect of the face drain to the submandibular nodes?
Medial 1/3 of upper lid
Medial 2/3 of lower lid
What aspect of the face drains to the preauricular nodes?
Lateral 2/3 of upper lid
Lateral 1/3 of lower lid
What are the lengths of the canalicular system?
Pucta: 2mm
Canaliculus: 8mm
Lacrimal Sac: 10mm
Nasolacrimal duct: ~15mm
Where is the weakest area of the orbit?
Posterior medial floor (blow out fracture)
What is a tripod fracture?
Fracture of the zygomaticomaxillary suture, zygomaticofrontal suture, and the zygomatic arch + the orbital floor
What bone is involved in all LeFort fracture?
Pterygoid plate
What is a LeFort I fracture?
Low transverse fracture of the maxillary bone above teeth, no orbital involvement
"floating palate"
What is a LeFort II fracture?
Pyramidal fracture of nasal, lacrimal and maxillary bones, involves superior medial wall or maxilla (orbital floor)
"Floating maxilla"
What is a LeFort III fracture?
craniofacial dysjunction, through ZF suture, orbit, nose, ethmoids
"Floating face"
What are the stages of globe degeration?
1. atrophia bulbi without shrinkage
2. atrophia bulbi with shrinkage
3. Phthisis bulbi (disorganization)
increased risk of malignancy, get bscan annually
Most common fungal orbital infection?
Phycomycetes
What are the findings of mucormycosis?
non-septae, large branching hyphae;
invasion of blood vessels w/ thrombosis and necrosis
What is the treatment for mucormycosis?
Surgical debridement, IV amphotericin B
Aspergillosis findings & treatment?
Septate, branching hyphae
Disseminated vs Local forms
Treat with surgical debridement, amphotericin B, flucytosine, rifampin
What causes dengue fever and how does it present?
Flavivirus
75% present with eye soreness and pain with movements
What are the most common presentations/locations of orbital pseudotumor?
1. Myositis (involves muscle AND tendon)
2. Dacryoadenitis
3. Scleritis
4. Orbital Apex
5. Diffusely thoughout orbit
What are the laboratory findings for orbital pseudotumor?
1. Eosinophilia
2. Elevated ESR
3. +ANA
4. CSF pleocytosis
Treatment for orbital pseudotumor?
steroids 1mg/kg prednisone, slow taper due to chance of recurrence; if no response, can consider radiation or immunomodulatory therapy (cyclosporine, MTX, cyclophosphamide)
When does orbital pseudotumor warrant work-up for systemic vasculitis or lymphoproliferative disordersz/
Simultaneous bilateral orbital inflammation in adults
(In children, ~1/3 are bilateral and rarely associated with systemic disorders)
What are the histological findings for orbital pseudotumor?
pleomorphic cellular infiltrate consisting of lymphocytes, plasma cells, and eosinophils with variable degrees of reactive fibrosis
When to biopsy for orbital inflammation?
Isolated inflammation of the lacrimal gland
How does sclerosing orbital pseudotumor differ from NSOI?
Fibrosis of orbit and lacrimal gland
Slow insidious onset, pain less common, eye white and quiet
Less responsive to steroids
A-scan: low reflectivitiy (both lymphoma and orbital pseudotumor)
associated with retroperitoneal fibrosis
What is the most common cause of proptosis?
Thyroid eye disease
What is the most common clinical manifestation of thyroid eye disease?
Lid retraction
What is von Grafe's sign?
Lid lag on downgaze in thyroid eye disease
What would you find on pathology in thyroid eye disease?
patchy infiltrates of lymphocytes, monocytes, mast cells and fibroblasts; enlargement of muscles
What muscles are typically involved in thyroid eye disease?
IMSLO = Inferior > medial > superior > lateral > obliques
(tendons are usually spared)
In what order do you perform surgery for thyroid eye disease?
Orbital decompression --> strabismus --> eyelid surgery
Requirements before strabismus surgery in TED?
stability for 6 months
avoid if anterior inflammation is present
Prefer recession over resection
What are the common findings of sarcoidosis (in the eye)?
Panuveitis (often bilateral)
Thickened Descemet's membrane, band K, nummular keratitis, deep stromal vacuoles
pars planitis
chorioretinitis
orbital apex syndrome
ptosis
conjunctivitis
dacryoadenitis
Pathology for sarcoid
Non-caseating granulomas
Langhans' Giant Cells
Granulomatosis w/ Polyagniitis findings
painful proptosis
reduced motility
chemosis
scleritis
keratitis
optic nerve edema
NLDO
GPA pathology
triad of vasculitis, granulomatous inflammation, and tissue necrosis
Differences between direct carotid-cavernous fistula vs dural-sinus fistula?
Direct c-c fistula: high flow, associated with head trauma; dilated corkscrew scleral/episcleral vessels, chemosis, elevated IOP, pulsatile proptosis, orbital bruit, dilated retinal veins; may develop ischemic maculopathy or RAO, enlarged C/D, CN6 palsy, anterior seg ischemia, blood in Schlemm's
Dural-sinus fistula: low-flow communication between meningeal branches of carotid artery and dural walls of cavernous sinus; often asymptomatic, associated with HTN, atherosclerosis, connective tissue diseases, may close spontaenously, need MRI/MRA
Dilated superior orbital vein on CT along with dilated corkscrew episcleral/scleral vessels, chemosis, orbital bruit, recent history of head trauma; diagnosis?
Carotid-cavernous fistula
Hamartoma vs Choristoma
Hamartoma = growth arising from tissue normal found in that site (nevus, neurofibroma, neurilemmoma, schwannoma, glioma, hemangioma, hemangiopericytoma, lymphangioma, trichoepithelioma)
Choristoma = growth arising from tissue not normally found in that site (dermoid, dermatolipoma, ectopic lacrimal gland)
Most common benign orbital tumor in adults?
Cavernous hemangioma
Pathology: blood-filled cavernous spaces, lined by epithelial cells
Findings: slowly progressive proptosis, may induce hyperopia, retinal striae, IOP elevation, strabismus, ON compression
Imaging findings for cavernous hemangioma?
US: high internal reflectivity
CT: well-demarcated, encapsulated intraconal mass
MRI: hypointense to fat on T1; hyperintense to fat on T2, equivalent to vitreous
Treatment of hemangiopericytoma?
Complete excision (concern for metastasis)
Most common benign orbital tumor in children?
Capillary hemangioma
Pathology: numerous blood-filled channels lined by epithelium; unencapsulated
Location: superonasal orbit, medial upper eyelid
Often regresses spontaneously by age 5-8 in 80% of cases
Most common location for Neurilemmoma (Schwannoma)
Superior orbit, causing progressive proptosis and globe dystopia
Schwannoma pathology stain and types?
S-100 stain
Antoni A: spindle cells arranged in cords/whorls/palisades, Verocay bodies
Antoni B: loose, myxoid; stellate cells w/ mucoid stoma
Optic nerve sheath meningioma spenser's triad?
optociliary shunt vessels, optic atrophy, optic nerve meningioma
Pathology: sheets of cells or whorls, Psammoma bodies in center
Treatment: observation, excision to prevent ON or chiasm involvement
bilateral lacrimal gland enlargement, limitation of EOMs, visual disturbance, diagnosis?
Benign reactive lymphoid proliferation
Pathology: mature lymphocytes with reactive germinal centers; T-cells, 60-80% w/ scattered polyclonal B-cells, high degree of endothelial cell production
Atypical lymphoid hyperplasia findings
low-grade lymphoma, no mitotic activity
Path: follicles and polymorphous response
40% develop systemic disease within 5 years
Orbital Lymphoma findings
EOM limitation, painless lacrimal gland swelling, salmon patch, visual changes, 17% bilateral
Orbital Lymphoma Pathology
atypical immature lymphocytes with mitoses; diffuse or follicular; monoclonal b-cells 60-90% w/ scattered reactive T-cells
Risk of systemic involvement of orbital lymphoma by location?
eyelid (67% have systemic) > orbita (35%) > conjunctiva (20%)
Ossifying fibroma
Occurs 2nd and 3rd decades, more common in women
well-circumscribed, slow growin, monostotic lesion
Pathology: vascular stroma containing lamellar bone with rim of osteoid and osteoblasts
Where do osteomas originate from?
frontal and ethmoid sinuses
Pathology: lamellar bone with variable amounts of fibrous stroma
What is the most common mesenchymal orbital lesion in adults?
Fibrous histiocytoma
distinguishable form hemangiopericytoma only on biopsy
storiform (cartwheel/spiral), nebullar pattern (fibroblasts)
image: histocytes on left, fibrous on right
Most common epitheloid tumor of the lacrimal gland?
Pleomorphic adenoma (Benign mixed tumor)
Firm mass, painless proptosis
CT: well-circumscribed, may be nodular, may indent bone
Path: ductal structures, osteoid and cartilaginous metaplasia
What is the preferred treatment for pleomorphic adenoma?
Complete surgical resection, incomplete excision may lead to recurrence and malignant transformation into pleomorphina adenocarcinoma
Rapidly progressive, painful lacrimal gland tumor in elderly with long history of lacrimal mass?
Pleomorphic adenocarcinoma (malignant mixed tumor)
Treat with radical orbitectomy w/ bone removal
Most common malignant lacrimal gland tumor?
Adenoid cystic carcinoma
4th decade of life
rapid progression, painful proptosis due to perineural spread
Highly malignant
Swiss chess appearance on path
CT may show bony erosion, poorly circumscribed
Treat with resection including bone, radiation
Poor prognosis
Which sinus tumor is associated with cystic fibrosis? Most common location?
Sinus mucocele (must rule out encephalocele/meningocele)
Frontoethmoidal sinus (most common): above medical canthal tendon, displaces globe down and out
Sphenoid and posterior ethmoid sinus: retrobulbar pain, 50% have nasal symptoms, cranial nerve palsies
Maxillary sinus: globe displaced upward, erosion of orbital floor may cause enophthalmos
What type of cancer is most common in sinus carcinomas?
Squamous cell carcinomas, most commonly from maxillary sinus
How do mets to orbit differ in pediatrics vs adults?
peds tumors metastasize more commonly to orbit than to uvea
Most common source of orbital mets in women?
Breast cancer
Most common source of orbital mets in men?
Lung cancer
Orbital mets causing enophthalmos and ophthalmoplegia?
Breast cancer
Orbital mets mimicking pseudotumor?
Prostate cancer
Closure for small eyelid lacerations?
Closure for 25-50% eyelid defect?
Closure for >50% eyelid defect?
Small: direct closure
Moderate: Tenzel rotational flap
Large: Cutler-Beard (upper); Hughes (lower)
External hordeolum origin?
Glands of Zeiss
Internal hordeolum origin?
Meibomian gland
Organism associated with angular blepharitis?
Moraxella
Type of hypersensitivity in acne rosacea?
Type IV
Findings and treatment of contact dermatitis?
Erythematous, scaling lesions, may have vesicles or weeping lesions
Treat with elimination of inciting agent, mild topical steroid or tacrolimus 0.1%
Organism responsible for this lesion?
Poxvirus MCV (molluscom contagiosum virus)
Treat with excision, cryo, curettage
Organism, findings, treatment of Leprosy?
Mycobacteria leprae
loss of lashes, trichiasis, ectropion, exposure keratitis
dapsone, rifampin
Blepharospasm vs hemifacial spasm
BEB: bilateral, not present during sleep, unclear etiology but potentially basal ganglia
HFS: usually unilateral due to CN7 compression, or CPA tumor
recurrent attacks of transient, painless eyelid edema resulting in atrophy, wrinkling, and redundancy of eyelid skin; usually women, familial
blepharochalasis
Testing for ptosis:
Normal palpebral fissure height?
Normal MRD-1?
Normal levator function?
Muller muscle contribution?
PF normally 10-11mm
MRD-1 ~4mm
LF: normal >12mm, fair 6-11mm, poor if <5mm
Muller's muscle raises lid about 2mm
Most common cause of eyelid retraction
Thyroid eye disease
Types of ectropion
Involutional
Paralytic
Cicatricial
Mechanical
Types of entropion
Spastic
Involutional
Cicatricial
Congenital (very rare, epiblepharon or tarsal kink)
Floppy eyelid sydrome findings
Chronic papillary conjunctivitis
associated wtih obesity, keratoconus, sleep apnea
Differential Dx for madarosis
eyelid neoplasm, chronic blepharitis, trauma, burns, trichotillomania, alopecia, seborrheic dermatitis, chemotherapy, malnutrition, leprosy, lupus
Conditions associated with poliosis/vitiligo
VKH
Sympathetic ophthalmia
Wardenburg syndrome
Tuberous sclerosis
Radiation
Dermatitis
Virus associated with this eyelid lesion?
HPV - Squamous papilloma
Most common benign eyelid lesion
Papillomatous proliferation of suprabasalar (prickle cells)
Seborrheic keratosis
Single-lumen, round/oval lesion lined by keratinized, stratified squamous epithelium and filled with cheesy keratin debris
Epidermal inclusion cyst (epidermoid cyst)
lined by keratinized, stratified, squamous epithelium and dermal appendages such as hair shafts and sebaceous glands
Dermoid cyst
Fluid-filled lesipons near lateral canthus
Hydrocystoma, most often eccrine (can be apocrine if arising from glands of Moll)
Muir-Torre Syndrome
multiple sebaceous neoplasms, keratoacanothomas, and visceral tumors (esp GI)
waxy, yellow nodules on lower lid, usually in young women, benign proliferation of eccrine ductal structures
Syringoma
Benign adnexal tumor of hair follicle origin; firm flesh-colored/yellowish dome-shaped papule
Trichoepithelioma
Mean age 45ys, more common in women
Will increase in size and number
Histopathology: basaloid cells surrounding a keratin center
Treatment: excision, dermabrasion, cryo, laser
Hamartoma of hair follicle tissue; solitary, small, dome-shaped, flesh-colored papule or nodule w/ a diagnostic central keratin killed pore, may have wisps of hair
Trichfolliculoma
No malignent potential, simple excision
Cowden's disease
Multiple trichilemmomas, marker for breast (40%) or thyroid cancer
crusty lesion with rough surface, may mimick BCC/SCC/sebaceous CA
Calcifying epithelioma of Malherbe
Pilomatrixoma
solitary, firm deep nodule with overlying normal pink or bluish skin
Common in children
associated with Myotonic Dystrophy and Gardner's sydrome
Percentage of actinic keratosis that evovle into SCC?
12% (25% will resolve spontaneously)
Elastoic degeneration, overlying hyperkeratosis, focal parakeratosis, clefts in dyskeratotic areas
Actinic Keratosis
Benign pigmented lesion from neural crest cells?
Nevus
Type of nevus with greatest malignant potential?
Junctional nevus
Pigmented skin lesion
Compound nevus
Both intradermal and junctional components, malignant potential from junctional component
Most common type of nevus?
Intradermal nevus
most bening, can be amelanotic, can be papillomatous, flat or dome-shaped
Congenital nevus secondary to fusion of lids during embyonic development? involves upper and lower lids?
Kissing nevus
Nevus with no malignant potential?
Spindle cell nevus
compound nevus of childhood
Melanotic Freckle of Hutchinson
aka Lentigo Maligna
cutaneous version of PAM
melanoma arises in 30%
may have conj but no episcleral pigment
Freckles, scaling in young patient due to defect in DNA repair?
Xeroderma pigmentosa
AR inheritence
UV light endonuclease defect
3% incidence of malignant melanoma
Pathology: Basaloid blue cells arranged in nests and cords, peripheral palisading commonly seen
Basal Cell Carcinoma
most common malignancy of the eyelid (40x more common than SCC)
Site of BCC with poorest prognosis?
Medial canthus, often extends deeper into lacrimal system
Location in order of frequency:
lower lid > medial canthus > upper lid > lateral canthus
Most common form of BCC?
Nodular
More aggressive form of BCC?
Morpheaform
Firm, flat lesion with indistinct borders
Penetrates into dermis, pagetoid spread
Pathology: thin cords of basal cells
Dome-shaped squamous lesion, rapid onset, usually elderly patients, may involute spontaneously
Keratoacanthoma
central keratin-filled crater and elevated rolled edges, resembles BCC
Pathology: cup-shaped lesion with keratin core
Treatment: observation, excision, local steroid injection
2nd or 3rd most common malignancy of the eyelid, may mimick chronic blepharitis
Sebaceous gland carcinoma
Highly malignant, lethal (5 yr mortality = 30%)
Argument over whether more common than SCC
origin of sebaceous gland carcinoma
Meibomian gland
Can arise from Zeis glands or caruncle
Orange-yellow nodule
Pathology: large foamy, lipid-laden tumor cells, vacuolated cytoplasm
Treatment for sebaceous gland carcinoma
wide excision, send for frozen section, conj map biopsy
exenteration for pagetoid spread or orbital involvement
palliative radiation
Most common form of melanoma?
Superficial spreading
Spreading macule w/ irreg outline, variable pigmentation, invasive phase marked by papules and nodules
Path: pagetoid nests in all levels of epidermis
69% 5-year survival
Most common type of melanoma of the eyelid?
Nodular melanoma
5th decade, more common in men, palpable lesion
more aggressive, with vertical invasion
44% 5-year survival
Treatment and prognosis of malignant melanoma?
wide surgical excision, lymph node dissection if indicated
prognosis depends on depth of vertical invasion
<0.75mm indicates favorable prognosis
Most common site for Merkel Cell tumor?
upper eyelid
rare, vascular red-blue vascular tumor
mets and death in 30% of patients
Treatment: wide excision with immunohistochemical stains, lymph node dissection, radiation
Systemic involvement of Xanthalesma?
Erdheim-Chester disease (lipoid granulomatosis)
lipogranulomas of the liver, heart, kindey, lung, bones
Mycosis fungiodes
Cutaneous T-cell lymphoma
Pathology: Lutzner cells and Pautrier abscesses
What is the dye disappearance test?
Instillation of fluorescein
Wait 5 minutes
Check for clearance of dye from tear meniscus
Jones I test?
Perform Dye Disappearance Test first
Recover dye from nose with cotton tipped applicator
(abnormal test results occurs in 1/3 of individuals)
Jones II test?
After Jones I test, flush residual fluorescine from conjunctival sac
Then irrigate nasolacrimal system with saline
In the Jones II test, what does recovery of dye in the nose after irrigation indicate?
Functional obstruction of the nasolacrimal duct
In the Jones II test, what does recovery of clear saline in the nose represent?
canalicular obstruction or non-functional lacrimal pump
What is a dacryoscintogram?
Instillation of technetium 99 - physiologic test
What is a dacryocystogram?
Injection of Lipiodol (Ethiodol) - outlines drainage system
Correction of canalicular obstruction?
Punctal obstruction - dilation, punctoplasty
Partial Canalicular obstruction - crawford stents, vier rods
Canalicular obstruction <8mm from punctum - Jones tube
Canalicular obstruction >8mm from punctum - DCR
Etiologies for NLDO?
involutional, trauma, chronic sinus disease, nasal polyps, dacryocystitis, granulomatous disease
Treat wtih silicone intubation, DCR
Lacrimal sac obstruction etiology and treatment?
trauma, acute or chronic dacryostitis
Treat with DCR
Typical microrganism in canaliculitis?
Typical findings?
Treatment?
Micro: Actinomyces israelii (most common), also candida albicans, aspergillus, nocardia, HSV, VZV
Findings: pouting punctum, discharge, may have bloody tears, sulfur granules
Treatment: warm compress, probing and irrigation with penicillin, canalicular curettage, incision and debridement
Dacryocystitis organisms?
Staph, strep, pseudomonas, H.flu (children, rare after vaccination), Klebsiella, actinomyces, candida
Dacryocystitis findings and treatment?
Acute: edema, erythema, distention below medial canthal tendon
Chronic: distended lacrimal sac, minimal inflammation
Treatment: warm compress, topical/systemic abx, I&D, avoid probing and irrigation during acute infection, DCR after acute inflammation subsides
Etiology of dacryoadenitis?
Acute: infection (Staph, gonorrhea, mumps, EBV, VZV)
Chronic: inflammation or infection (NSOI, sarcoid, Mikulicz, lympoid, syphilis, TB)
Diagnosis and treatment of dacryoadenitis?
Treatment: CT scan, consider culture, labs, biopsy
Treatment: systemic abx if indicated, treatment of underlying condition, excision, I&D
Findings in lacrimal sac tumors?
Painless mass above the medial canthal tendon, tearing, may have bloody tears (hemolacria), bleeding with probing
dacryocystogram outlines tumor
Most common primary lacrimal sac tumor?
Squamous papilloma
Most common primary malignant lacrimal sac tumor?
Squamous cell carcinoma
Second most common malignant lacrimal sac tumor?
Lymphoma
