ORbital disease Flashcards
Orbit bones
-Roof
Lesses wing of sphenoid
Frontal bone
Lateral wall of orbit
Greater wing of sphenoid
Zygomatic bone
Floor or orbit
Zygomatic bone
Maxillary
Palatine
Medial wall of orbit
Maxillary bone
LAcrimal bone
Ethmoid bone
Sphenoid bone
What is proptosis
ABnormal protrusion of the globe
What is pseudoproptosis
When it looks like there is proptosis but there isn’t. Due to: high myopia or enophthalmos in the other eye
Causes of proptosis
Thyroid eye disease
Tumours
Inflammation
Infection
causes of enopthalmos
Small globe
Blow out fractures
Atrophy of orbital content (scleroderma)
What is ophthalmoplegia
Causes
Disability or restriction of extra ocular muscles
Tumour, Restrictive myopathy (TED, myositis) and trauma (blow out fractures)
Why can visual acuity be dysfunctional
Corneal exposure
Optic nerve compression (also causes changes in colour vision)
Choroidal folds
When can pulsations be seen in the eye
AV communication - can be with or without bruit
Defect in the orbital roof (CSF pulsation)- no bruit
What is a bruit a sign of
Carotid-cavernous fistula. Heard with bell of stethoscope
What fundus changes can be seen in orbital disease
Optic disc swelling
Optic disc atrophy
Choroidal folds- seen in thyroid eye disease and orbital tumours
Thyroid eye disease clinical manifestations
Eyelid retraction + periorbital oedema (most common)
Exophthalmos (proptosis)
Diplopia
Exposure keratopathy
soft tissue involvement
What is the cause if diplopia in thyroid eye disease
Oedema in active stage and fibrosis in late stage
Complications of orbital cellulitis
Optic neuropathy
Abscess formation
What is idiopathic orbital inflammatory disease
Non-neoplastic, non infectious orbital lesion.
Abrupt painful onset
Unilateral
Periorbital swelling and chemosis
Proptosis
Opthalmoplegia
management: steroids, radiotherapy, cytotoxics
Manifestation of orbital venous anomalies (varices)
Usually unilateral
Demonstrate intermittent proptosis when doing valsalva manoeuvres
What is a direct-cavernous fistula
Causes: head trauma, spontaneous rupture.
Ptosis, ophthalmoplegia, raised IO pressure
Can hear a bruit but when compress the carotid on the same side of the face then the bruit disappears
What is indirect cavernous carotid fistulas
Indirect communication between meningeal branches of internal or external carotids and cavernous sinus
Due to: congenital malformations, spontaneous rupture.
Manifestation of indirect cavernous carotid fistulas
Dilated episcleral vessels
Raised IO pressure with wide pulsation
Occasional opthalmoplegia and mild proptosis
What are encophalaceles
Herniation of intracranial contents through congenital skull defects
Causes pulsating proptosis without a bruit
Types of tumours which can affect the orbit
VAscular
LAcrimal gland
Neural
Miscellaneous
What are the commonest tumours in children
Capillary haemangiomas - may enlarge on coughing or straining.
Treatment of capillary haemangiomas
Steroid injections
Local resection
What are the most common adult benign orbital tumour
cavernous haemangiomas
Prognosis and presentation of pleomorphic lacrimal gland adenoma
Painless and slow growing. Good prognosis as well encapsulated
Presentation of lacrimal gland carcinomas
Painful and fast frowing
poor prognosis
What is optic nerve glioma
Treatment
Typically affects young girls. Associated with neurofibromatosis
Presents with gradual visual loss
OBservation- no growth, good vision and good cosmoses
Excision- poor vision and poor cosmesis
radiotherapy- intracranial extension
what is optic nerve meningioma . treatment
Middle aged women
GRadual vision loss due to optic nerve compression
Observation- slow growing tumours
Excision- aggressive tumours and poor vision
Radio- slow growing and good vision
Common primary sites of tumours which can affect the eye
Breast, bronchus, prostate, skin, GI and kidney
