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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
Why are you concerned about Capillary hemangioma in children?
1. Proptosis 2. Induced astigmatism 3. Deprivation amblyopia if visual axis is BLOCKED
26
What is Capillary Hemangioma characterized by?
1. Rapid growth & spontaneous involution (70-75% of lesions gradually involute by age 5 or 7) 2. Strawberry birthmark
27
Management of Capillary Hemangioma?
1. Photodocument 2. Re-evaluate 3-6 months 3. Refer to dermatologist if present after adolescence (laser)
28
What do you call a noticeable proptosis, superotemporally on the face?
Dermoid cyst NOTE: often congenital & Dx in early childhood (1st decade) as a result of noticeable proptosis. Benign.
29
MOST common BENIGN orbital tumor in ADULTS 940-50s)?
Cavernous hemangioma F>M
30
What is a Cavernous hemangioma characterized by?
Progressive, painless, unilateral proptosis Tumor most commonly arises POSTERIOR to GLOBE within the muscle
31
What are the tumors that affect the orbit/ocular adnexa?
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
Which ocular tumor is MOST COMMON PRIMARY pediatric orbital MALIGNANCY?
Rhabdomyosarcoma
33
What is Rhabdomyosarcoma?
Rapid bone-destruction tumor that causes progressive unilateral proptosis, EOM involvement
34
Average of age of Dx for Rhabdomyosarcoma? Sex more common in?
7 years Boys > Girls
35
Tx of Rhabdomyosarcoma?
IMMEDIATELY refer to the ER for CT/MRI
36
MOST COMMON 2nd Pediatric Orbital Malignancy?
Neuroblastoma
37
Where does neuroblastoma most commonly arise?
Abdomen, Mediastinum, or Neck (May have associated Horner's Syndrome)
38
What is the MOST COMMON BENIGN brain tumor to invade the orbit (middle-aged women) "BENIGN-gioma"?
Meningioma
39
Where do meningioma arise?
Sphenoid bone
40
What it is MOST COMMON INTRINSIC tumor of the optic nerve - 65%?
Optic nerve glioma (Juvenile pilocytic atrocytoma)
41
What age do you typically see optic nerve glioma and what systemic disease is it associated with?
2 to 6 years old Most commonly associated w NF-1 in up to 30-50%
42
What ocular tumor is a benign tumor of astrocytes?
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
What ocular tumor is a benign tumor of schwann cells?
Schwannoma NOTE: most common in young to middle-aged adults. As the tumor develops w/in 1st division of CN5
44
What are the external diseases of the orbit+ocular adnexa?
1. Rosacea 2. Contact dermatitis 3. Cicatricial pemphigoid 4. SJS
45
Which glands are affected by rosacea, hypersensitivity?
Sebaceous glands Hypersensitivity Type IV NOTE: flush --> erythema/telangiectasia --> papules/pustules --> facial flush --> rhinophyma
46
What lid diseases may you find in pts w rosacea?
1. Hordeola 2. Chalazia 3. Blepharitis 4. MGD
47
Which ocular disease may you find in rosacea?
1. Phlyctenules | 2. Marginal keratitis
48
Telangiectasia is a signature sign in what 3 disease?
1. Rosacea 2. Basal cell carcinoma 3. Coat's disease
49
Contact dermatitis is what kind of hypersensitivity Rxn? When does it typically develop?
Type 4 24-72 hours after exposure Itchy/red/periorbital edema/chemosis
50
Which medications can cause contact dermatitis?
1. Aminoglycosides 2. Cycloplegics/mydriatics 3. Preservatives 4. Glaucoma medications
51
Tx for contact dermatitis?
Steroids
52
Which drugs can induce ocular cicatricial pemphigoid (OCP)?
1. Timolol 2. Epinephrine 3. Pilocarpine
53
OCP is what kind of hypersensitivity?
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
What are the late stage findings of OCP?
1. Corneal ulceration 2. Neovascularization 3. Keratinization
55
How long does SJS take to self resolve in the acute phase?
2-4 weeks
56
Tx for ocular SJS?
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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