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Anterior Eye > orbital and eye disorders > Flashcards

orbital and eye disorders Flashcards

1
Q

whats are the signs of orbital disease in the soft tissue

A

chemosis- lid swelling/ odeam
ptosis
lid retraction

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2
Q

whats are the signs of orbital disease in the globe

A

proptosis
endopthalmos
dystopia- displacement of globe

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3
Q

whats are the signs of orbital disease in the muscles and nerves

A

nerve palsy
restrictive myopathy
muscle entrapment

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4
Q

whats are the signs of orbital disease in the posterior segment

A

ON swelling/atrophy
vasular congestion
choroidal folds

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5
Q

Initial questions to ask for an orbital disease

A

WHERE is the disease located- mechanical displacement of orbital structures
HOW had the disease developed-

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6
Q

what abnormal changes occur in an orbital disease

A
  1. inflammation- redness/swelling/warmth/pain/loss of function
  2. mass effect- displacement- something growing out of orbit
  3. infiltrative changes- impairment of ocular movements or neurosensory function
  4. vascular changes; venous dilation, exudation, heommahrage, proptosis
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7
Q

how do u examine an orbital px

A

OBSERVE: check their facial contours obis not their makeup contours, symmetry, eyelids, peri-ocular structures, changes in colour of the skin
VA
Examine- conjuctiva, eyelids, leavtor function, pupils for thie symmetry and reactions
VF
Ocular motility
other investigations such as MRI. X-rays, CT scans

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8
Q

what are the acute orbital inflammations:

A

Orbital cellulitis
Orbital periostitis
Orbital osteomyelitis
Tenonitis

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9
Q

whats orbital cellulitis

A

penetrating microbial infection
inflammation of post-septal aspect of eyelids
sx- lid odeama, redness, proptosis, pain, diplopia, opthalmolegia, vision loss, px ill, high fever

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10
Q

how do u assess for orbital cellulitis

A 
h&s
va
fundus examination
ocular motility
any neurological signs
their temperature
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11
Q

what do u have to differentially diagnose orbital cellulitis with-

A

pre-septal cellulitis- which lacks the opthalmegia, severe pain, vision loss and fever.
also with tumours, thyroid eye disease, allergic reaction

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12
Q

whats the management for orbital cellulitis

A

EMERGENCY refer

treat in hosp

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13
Q

what occurs in a Chronic orbital inflammation

A

Granuloma- inflammation of tissues
Pseudotumours- enlargement resembling a tumour
Myositis- inflammation of the muscles
Parasitic infestations- stings and bites from infections

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14
Q

Causes of exophthalmia

A 
Thyroid disease 
Orbital tumours - lymphoma, metastic, lacrimal gland
Inflammation
Vascular disorders
Orbital anomalies - heommarages, odeama
Intermittent exophthalmos
Pulsating exophthalmos
Lateral displacement of the globe
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15
Q

what’s exophthalmia

A

PROPTOSIS

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16
Q

Endocrine exophthalmia

A

Thyroid diseasse
most common cause of symmetrical bilateral poroptosis in adults
autoimmune reaction towards orbital fibroblasts
MH
Protosis, lid retraction, diplopia, compressive optic neuropathy, exposure keratopathy, injection, chemosis/ odeama

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17
Q

Clinically diagnostic ocular signs in thyroid orbitopathy

A

von Graefe’s sign: superior lid lag upon down gaze
Dalrymple’s sign: eyelid retraction
Stellwag’s sign : infrequent blinking
Ballet’s sign: palsy of one or more extraocular muscles

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18
Q

Positive diagnosis and management

A

bilatteral, symmetrical hyperthyroidism with lid retraction
edocroogist
u axes eye, give lubricants, teat keratopathy, VF
surgery for diplopia, lids?

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19
Q

Deformity of the orbit

A

due to surgery / trauma
bones disease/ cranial facial defomality
atrophy
hypertelorism

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20
Q

Enophthalmos

A

posterior displacement of eye

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21
Q

primary and secondary enopthalmos

A

Primary (congenital) and secondary to bone grow arrest, orbital fracture, surgery, severe infection/inflammation, phthisis bulbi

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22
Q

Pseudoenophthalmos:

A

unilateral ptosis, Horner’s syndrome, contralateral exophthalmos, buphthalmos or eyelid retraction

23
Q

Orbital trauma

A

Penetrating Blow-out fracture Foreign body

24
Q

Blow-out fracture

A

force of a non-penetrating object bigger tun the orbital entrance- e.g. ball/ dashboard
u see bruises, endothalmos, muscle restrictive movements, pain, dipopia, numbness in cheek and teeth areas

25
Q

summary of stuff that can happen to the eyelids

A

Disorders of the eyelashes The itchy eyelid
Lid swelling
Rashes
Infections
Blepharitis and other inflammations Common eyelid lumps and bumps Ptosis
Ectropion and entropion
Excessive blinking

26
Q

Tricahiasis

A

misdirection of the eyelashes- growing into cornea
secondary to inflammation or trauma
can give pain, foreign body sensation
can result in corneal erosions, ulcers, ocular irritation and pannus
Tretament- epilation, electrolysis, laser, surgery
difffernetialy diagnose with entropian, distichiasis, epiblepharon

27
Q

itchy eyelid?

A

contact dermitits - Soreness
Burning Itching
we see -Well defined Scaling- Erythema -Thickening- Oedema -Hyper-/
hypopigmentation

28
Q

WHY could u get contact demritits

A 
Eye cosmetics 
Topical medicines 
Metals
Nail polish 
Hair dye 
Soap 
Water
29
Q

HOW would u diagnose contact dermatitis

A

u take detailed H+S
ask px to bring all products to test on skin
PATCH TEST

30
Q

Treatment for contact detmitits

A

Avoid the substance duh
coll compress
cortiocsteroids
topical immunomodulators

31
Q

atopic eczema

A

simialr to contact dermitis

in childhoood

32
Q

atopic dermatitis

A

normally top of lids

constantly rubbed by back of hands

33
Q

complication of atopic dermatitis

A 
blephorirtis
keratoconus
uveitis
subcapsular catract
rd
keratoconjuctivitis
34
Q

lid swelling-

A

due to systemuc, dermatologic and ocular conditions
most likely due to renal/endocrine reasons
or could be due to ageing, tiredness
use faso constructers. or treat underlying cause, or avoid the factor that may be causing this

35
Q

differential diagnosis of the swollen eyelid

A

Contact dermatitis Atopic dermatitis Rosacea Angioedema Blepharitis Cellulitis
Herpes simplex HZO
Tumours Systemic disease

36
Q

Seborrheoic dermatitis

A 
redness and greasy scaling
sebacious glands
dandruffy
lid margins- usally- couldd lead to blepharitis
u need lid hygiene
37
Q

rosacea

A 
mostly middle aged, fair women- multifactoria-
over-active facial blood vessels
v common
red papules and pustules, swelling
erythema, telnagictasis
cheeks, nose, chin and forehead
frwquent flushing
ocular involvemnt- MG, chalazion, uvietis, episcleritis

DIFFERNTIALY DIAGNOSIS with- sebhoric dermatitis, lupus, syphilis, periorbital dermatitis, tb, carcinoid syndrome

38
Q

Ocular rosacea

A 
MGD
blepharitis
chalaia
corneal infiltrates- ulceration?
conjuctivitis
episcleritis
iritis
39
Q

how would u manage rashes

A

avoid extreme temps, spicy food, excessive sunlight, alcohol
orl tetracycline,
lid hygiene, ointments

40
Q

herpes zoster

Mr. HUTCHINSON has herpes and has something on his nose

A

rash around eyelid
opghalmic division of trigenimal nerve?
nasocilliary nerve- hutchinsons sign- crusting on tip of nose
skin atrophy- depigmentation and thinning- could lead to tissue destruction

41
Q

symptoms and signs

A

pain
burning
unilateral
vesicles, crusting

use antivirals, neuralgia- therefore pain killers

42
Q

herpes simplex

A 
cold sores
grouped vesicles
atopic suffered more prone
tiny grouped blisters with erythema that pustules and cause a conjuctival inflammation which then crust form ulcers then heal and scar..
Stain using rose bengal
don't usually invoke cornea
-
Eczema herpeticum
43
Q

Molluscum contagiosum

A

dome shaped- central umbilication- flesh coloured lesion
conjuctivitis on lid margin
pox virus
grows with pper layer of skin
spreads by contact- affects children
normally self resolve- can do some curettage stuff- scraping it off

44
Q

viral wart

A 
human papilloma virus
passed by contact
rough, scaly projection
small black dot on surface
can get multiple
difficult to treat
45
Q

Blepharitis

A

binocular red eye
acute/chronic infection
canbe infectious or not
can occur anterior/posterior/mixed
itching/burning/scratchiness/fbs/excessive tearing/crusty debris
signs: lid erythema, collarettes (a fibrin crust encircling an eyelash), madarosis (missing lashes), trichiasis, plugged meibomian glands, conjunctival injection and superficial punctate keratitis on the lower third of the cornea, papillary hypertrophy of the palpebral conjunctiva.

46
Q

anterior blepharitis

A

staphylococcal- triachrisis, tiny abscesses, scars
sebhorris- associated with seborrrheic dermatitis
treatment with lid hygiene-

47
Q

posterior belepahritis

A

due to MGD

48
Q

how to tell if bacterial infection

A

milky exudate when u express the gland- oral antibiotics needed
if u use sterids- check iop
px who have recurrent or don’t respond to meds may be suffering from acne rosaecca

49
Q

treatment for blepharitis

A 
lid scrubs
warm compress
massage the lids
Anti-biotics
4-5weekk treatment with doxcycline
50
Q

when would u refer mk/ blepharitis

A

Ophthalmological referral in case of severe/recalcitrant marginal keratitis
GP referral in patients with recurrent/chronic blepharitis; they may need a dermatologist

51
Q

Stye

A

infection/inflammation of eyelid margin- involving hair follicles of lashes or mgd
painful nodule of eyelid with subacute onset
painful, red, pointed nodule

52
Q

differential diagnosis of stye, chalazion and tumour

A

..

53
Q

how would u manage a stye

A

warm compress
antibiotics
incision and draiange

Anterior Eye (14 decks)

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