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Part 1 > Orbital Adnexa + External Disease > Flashcards

Orbital Adnexa + External Disease Flashcards

1
Q

Prolapsed Fat is what?

A

Orbital septum weakening with age

Fat leaks into LOWER > upper lids

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2
Q

Describe the typical presentation for preseptal cellulitis.

A
  1. Young children/adults
  2. Winter
  3. Develops from OCULAR INFECTION (int/ext hordeolum, dacryocystitis)
  4. Systemic Infection (URI/middle ear)
  5. Skin trauma (insect bite)
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3
Q

What is the leading cause of exophthalmos in kids?

A

Orbital cellulitis

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4
Q

How does orbital cellulitis develop?

A
  1. From a sinus infection (ethmoid)
  2. Orbital infection (dacryoadenitis, progression of preseptal)
  3. Orbital fraction
  4. Dental infection
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5
Q

Symptoms of Orbital cellulitis?

A
  1. DEC VA
  2. *FEVER
  3. *PAIN ON EOMS
  4. (+) FD test
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6
Q

Symptoms of preseptal cellulitis?

A
  1. Erythema
  2. Warmth
  3. (-) GONGESTION/pain on EOM
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7
Q

What is Phthisis Bulbi secondary to?

A

Trauma, infection, Sx, advanced diseases

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8
Q

What is Phthisis bulbi?

A

Shrinking + atrophy of the globe

MAY be painful blind eye!

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9
Q

Which is the only vascular disease of the orbit/ocular adnexa?

A

Carotid cavernous fistula

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10
Q

What is the cause of carotid cavernous fistulas (CFF)?

A

Abnormal communication btwn the arterial and venous systems

MOST commonly caused by HEAD TRAUMA (77%)

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11
Q

Other than head trauma, what else can cause a CFF?

A
  1. Spontaneous ruptured carotid aneurysm

2. High BP from carotid posterior to the globe

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12
Q

What is the triad for CCF?

A
  1. CHEMOSIS
  2. Pulsatile Proptosis
  3. Ocular bruit

NOTE: this is a neuro-surgical urgency

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13
Q

What is the 3rd most common orbital disorder in adults?

A

Orbital Pseudotumor (Idiopathic orbital inflammatory syndrome)

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14
Q

Describe the general findings of orbital pseudotumor?

A
  1. Idiopathic inflammation of soft tissue (EOMs, tendons)
  2. Unilateral
  3. PAIN
  4. Proptosis –> inc IOP
  5. Chemosis
  6. HYPEROPIC

NOTE: appearance can vary sig depending on orbital tissue involved; some present like TED while others look like orbital cellulitis

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15
Q

What ocular disease is rare, idiopathic inflammation of the cavernous sinus + SOF –> leading to acute painful exophthalmoplegia?

A

Tolosa Hunt Syndrome

NOTE: Ipsilateral CN3, 4, and 6. Since V1 & V2 also travel through the cavernous sinus, LOSS of sensory innervation to their areas of distribution may also occur

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16
Q

What should bilateral orbital pseudotumor in adults should raise suspicion for what?

A

Systemic vasculitis (Wegener’s granulomatosis, polyarteritis nodosa)

OR

Lymphoma

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17
Q

TED is more common in 30-40 yo females. What is the pathophysiology of TED?

A

Autoimmune disorder characterized by thyroid-stimulating (TSH) antibodies directed against the EOMs & orbital tissue, causing sig inflammation & thickening of the EOMs –> ONH compression

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18
Q

What is the strongest risk factor for development of TED?

A

Smoking! 2-9X risk

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19
Q

TED occurs in what % of pts w Grave’s Thyroid Disease?

A

30-70%

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20
Q

How do we grade TED?

A

“NO SPECS”

N=no signs/symptoms
O=ONLY signs (Dalrymple’s, Kochler’s, Von Graefe’s)

S=Soft Tissue involvement (lid edema & conj chemosis)
P=Proptosis
E=EOM involvement (diplopia, IR first! –> IMS)
C=Corneal Involvement (i.e. punctate keratitis, SLK, ulceration)
S=SIGHT LOSS due to ONH compression (fibroblast proliferation choking the nerve) –> disc edema, APD, DEC CV, VF loss (5% pts)

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21
Q

What is Von Graefe’s Sign?

A

Upper lid lag during downgaze

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22
Q

What is Kocher’s Sign?

A

Globe lag compared to lid movement when looking UP

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23
Q

What is Dalrymple’s Sign?

A

Lid retraction –> stare appearance

24
Q

What is the MOST COMMON BENIGN orbital tumor in KIDS (<6 months)?

A

Capillary hemangioma

NOTE: almost all cases Dx by 6 months after birth

25
Q

Why are you concerned about Capillary hemangioma in children?

A
  1. Proptosis
  2. Induced astigmatism
  3. Deprivation amblyopia if visual axis is BLOCKED
26
Q

What is Capillary Hemangioma characterized by?

A
  1. Rapid growth & spontaneous involution (70-75% of lesions gradually involute by age 5 or 7)
  2. Strawberry birthmark
27
Q

Management of Capillary Hemangioma?

A
  1. Photodocument
  2. Re-evaluate 3-6 months
  3. Refer to dermatologist if present after adolescence (laser)
28
Q

What do you call a noticeable proptosis, superotemporally on the face?

A

Dermoid cyst

NOTE: often congenital & Dx in early childhood (1st decade) as a result of noticeable proptosis. Benign.

29
Q

MOST common BENIGN orbital tumor in ADULTS 940-50s)?

A

Cavernous hemangioma

F>M

30
Q

What is a Cavernous hemangioma characterized by?

A

Progressive, painless, unilateral proptosis

Tumor most commonly arises POSTERIOR to GLOBE within the muscle

31
Q

What are the tumors that affect the orbit/ocular adnexa?

A
  1. Capillary hemangioma
  2. Dermoid cyst
  3. Cavernous hemangioma
  4. Rhabdomyosarcoma
  5. Neuroblastoma
  6. Meningioma
  7. Optic nerve glioma
  8. Lymphoma
  9. Neurofibroma
  10. Schwannoma
32
Q

Which ocular tumor is MOST COMMON PRIMARY pediatric orbital MALIGNANCY?

A

Rhabdomyosarcoma

33
Q

What is Rhabdomyosarcoma?

A

Rapid bone-destruction tumor that causes progressive unilateral proptosis, EOM involvement

34
Q

Average of age of Dx for Rhabdomyosarcoma? Sex more common in?

A

7 years

Boys > Girls

35
Q

Tx of Rhabdomyosarcoma?

A

IMMEDIATELY refer to the ER for CT/MRI

36
Q

MOST COMMON 2nd Pediatric Orbital Malignancy?

A

Neuroblastoma

37
Q

Where does neuroblastoma most commonly arise?

A

Abdomen, Mediastinum, or Neck (May have associated Horner’s Syndrome)

38
Q

What is the MOST COMMON BENIGN brain tumor to invade the orbit (middle-aged women) “BENIGN-gioma”?

A

Meningioma

39
Q

Where do meningioma arise?

A

Sphenoid bone

40
Q

What it is MOST COMMON INTRINSIC tumor of the optic nerve - 65%?

A

Optic nerve glioma (Juvenile pilocytic atrocytoma)

41
Q

What age do you typically see optic nerve glioma and what systemic disease is it associated with?

A

2 to 6 years old

Most commonly associated w NF-1 in up to 30-50%

42
Q

What ocular tumor is a benign tumor of astrocytes?

A

Neurofibroma

NOTE: it is most common in young to middle-aged adults. You will see S-shaped ptosis, superior orbit, & associated with NF1/2

43
Q

What ocular tumor is a benign tumor of schwann cells?

A

Schwannoma

NOTE: most common in young to middle-aged adults. As the tumor develops w/in 1st division of CN5

44
Q

What are the external diseases of the orbit+ocular adnexa?

A
  1. Rosacea
  2. Contact dermatitis
  3. Cicatricial pemphigoid
  4. SJS
45
Q

Which glands are affected by rosacea, hypersensitivity?

A

Sebaceous glands

Hypersensitivity Type IV

NOTE: flush –> erythema/telangiectasia –> papules/pustules –> facial flush –> rhinophyma

46
Q

What lid diseases may you find in pts w rosacea?

A
  1. Hordeola
  2. Chalazia
  3. Blepharitis
  4. MGD
47
Q

Which ocular disease may you find in rosacea?

A
  1. Phlyctenules

2. Marginal keratitis

48
Q

Telangiectasia is a signature sign in what 3 disease?

A
  1. Rosacea
  2. Basal cell carcinoma
  3. Coat’s disease
49
Q

Contact dermatitis is what kind of hypersensitivity Rxn? When does it typically develop?

A

Type 4

24-72 hours after exposure

Itchy/red/periorbital edema/chemosis

50
Q

Which medications can cause contact dermatitis?

A
  1. Aminoglycosides
  2. Cycloplegics/mydriatics
  3. Preservatives
  4. Glaucoma medications
51
Q

Tx for contact dermatitis?

A

Steroids

52
Q

Which drugs can induce ocular cicatricial pemphigoid (OCP)?

A
  1. Timolol
  2. Epinephrine
  3. Pilocarpine
53
Q

OCP is what kind of hypersensitivity?

A

Type 2 involving autoantibodies against the conjunctival basement membrane (keratinization of conj w loss of goblet cells due to reduced tearing & dryness –> entropion & trichiasis w corneal neo/scarring)

54
Q

What are the late stage findings of OCP?

A
  1. Corneal ulceration
  2. Neovascularization
  3. Keratinization
55
Q

How long does SJS take to self resolve in the acute phase?

A

2-4 weeks

56
Q

Tx for ocular SJS?

A
  1. Antiobiotics (gentamicin, tobramycin, norfloxacin, or ofloxacin drops QID or more frequent)
  2. Polysporin ung QHS
  3. Tx blepharitis
  4. R/O hypersensitivity to Ab

q1h

Part 1 (31 decks)

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