orbital and eye disorders Flashcards
whats are the signs of orbital disease in the soft tissue
chemosis- lid swelling/ odeam
ptosis
lid retraction
whats are the signs of orbital disease in the globe
proptosis
endopthalmos
dystopia- displacement of globe
whats are the signs of orbital disease in the muscles and nerves
nerve palsy
restrictive myopathy
muscle entrapment
whats are the signs of orbital disease in the posterior segment
ON swelling/atrophy
vasular congestion
choroidal folds
Initial questions to ask for an orbital disease
WHERE is the disease located- mechanical displacement of orbital structures
HOW had the disease developed-
what abnormal changes occur in an orbital disease
- inflammation- redness/swelling/warmth/pain/loss of function
- mass effect- displacement- something growing out of orbit
- infiltrative changes- impairment of ocular movements or neurosensory function
- vascular changes; venous dilation, exudation, heommahrage, proptosis
how do u examine an orbital px
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
what are the acute orbital inflammations:
Orbital cellulitis
Orbital periostitis
Orbital osteomyelitis
Tenonitis
whats orbital cellulitis
penetrating microbial infection
inflammation of post-septal aspect of eyelids
sx- lid odeama, redness, proptosis, pain, diplopia, opthalmolegia, vision loss, px ill, high fever
how do u assess for orbital cellulitis
h&s va fundus examination ocular motility any neurological signs their temperature
what do u have to differentially diagnose orbital cellulitis with-
pre-septal cellulitis- which lacks the opthalmegia, severe pain, vision loss and fever.
also with tumours, thyroid eye disease, allergic reaction
whats the management for orbital cellulitis
EMERGENCY refer
treat in hosp
what occurs in a Chronic orbital inflammation
Granuloma- inflammation of tissues
Pseudotumours- enlargement resembling a tumour
Myositis- inflammation of the muscles
Parasitic infestations- stings and bites from infections
Causes of exophthalmia
Thyroid disease Orbital tumours - lymphoma, metastic, lacrimal gland Inflammation Vascular disorders Orbital anomalies - heommarages, odeama Intermittent exophthalmos Pulsating exophthalmos Lateral displacement of the globe
what’s exophthalmia
PROPTOSIS
Endocrine exophthalmia
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
Clinically diagnostic ocular signs in thyroid orbitopathy
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
Positive diagnosis and management
bilatteral, symmetrical hyperthyroidism with lid retraction
edocroogist
u axes eye, give lubricants, teat keratopathy, VF
surgery for diplopia, lids?
Deformity of the orbit
due to surgery / trauma
bones disease/ cranial facial defomality
atrophy
hypertelorism
Enophthalmos
posterior displacement of eye
primary and secondary enopthalmos
Primary (congenital) and secondary to bone grow arrest, orbital fracture, surgery, severe infection/inflammation, phthisis bulbi
Pseudoenophthalmos:
unilateral ptosis, Horner’s syndrome, contralateral exophthalmos, buphthalmos or eyelid retraction
Orbital trauma
Penetrating Blow-out fracture Foreign body
Blow-out fracture
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
summary of stuff that can happen to the eyelids
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
Tricahiasis
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
itchy eyelid?
contact dermitits - Soreness
Burning Itching
we see -Well defined Scaling- Erythema -Thickening- Oedema -Hyper-/
hypopigmentation
WHY could u get contact demritits
Eye cosmetics Topical medicines Metals Nail polish Hair dye Soap Water
HOW would u diagnose contact dermatitis
u take detailed H+S
ask px to bring all products to test on skin
PATCH TEST
Treatment for contact detmitits
Avoid the substance duh
coll compress
cortiocsteroids
topical immunomodulators
atopic eczema
simialr to contact dermitis
in childhoood
atopic dermatitis
normally top of lids
constantly rubbed by back of hands
complication of atopic dermatitis
blephorirtis keratoconus uveitis subcapsular catract rd keratoconjuctivitis
lid swelling-
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
differential diagnosis of the swollen eyelid
Contact dermatitis Atopic dermatitis Rosacea Angioedema Blepharitis Cellulitis
Herpes simplex HZO
Tumours Systemic disease
Seborrheoic dermatitis
redness and greasy scaling sebacious glands dandruffy lid margins- usally- couldd lead to blepharitis u need lid hygiene
rosacea
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
Ocular rosacea
MGD blepharitis chalaia corneal infiltrates- ulceration? conjuctivitis episcleritis iritis
how would u manage rashes
avoid extreme temps, spicy food, excessive sunlight, alcohol
orl tetracycline,
lid hygiene, ointments
herpes zoster
Mr. HUTCHINSON has herpes and has something on his nose
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
symptoms and signs
pain
burning
unilateral
vesicles, crusting
use antivirals, neuralgia- therefore pain killers
herpes simplex
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
Molluscum contagiosum
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
viral wart
human papilloma virus passed by contact rough, scaly projection small black dot on surface can get multiple difficult to treat
Blepharitis
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.
anterior blepharitis
staphylococcal- triachrisis, tiny abscesses, scars
sebhorris- associated with seborrrheic dermatitis
treatment with lid hygiene-
posterior belepahritis
due to MGD
how to tell if bacterial infection
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
treatment for blepharitis
lid scrubs warm compress massage the lids Anti-biotics 4-5weekk treatment with doxcycline
when would u refer mk/ blepharitis
Ophthalmological referral in case of severe/recalcitrant marginal keratitis
GP referral in patients with recurrent/chronic blepharitis; they may need a dermatologist
Stye
infection/inflammation of eyelid margin- involving hair follicles of lashes or mgd
painful nodule of eyelid with subacute onset
painful, red, pointed nodule
differential diagnosis of stye, chalazion and tumour
..
how would u manage a stye
warm compress
antibiotics
incision and draiange
