Orbital Disease Flashcards
Non-infectious causes of Inflammatory Orbital Syndromes (7)
- TED
- IOIS
- Immunoglobulin 4 Related Disease
- Sarcoidosis
- Wegener Granulomatosis
- Giant Cell Arteritis
- Polyarteritis Nodosa
IOIS is likely mediated by what immune cells?
T and B cells
IOIS: lacrimal involvement in ___% of cases
25
How to distinguish TED from IOIS
IOIS involves pain and rapid onset
T/F: imaging is required to confirm dx of IOIS
TRUE
CT scan of IOIS shows…
Ill-defined orbit opacity + loss of definition of contents
IOIS demographics
No clear predilection
5 Categories of IOIS
- Anterior
- Diffuse
- Apical
- Lacrimal Gland
- Myositis
IOIS: What is the mechanism that causes GLC from Posterior Scleritis?
Scleritis causes choroidal effusion pushing anterior structures forward and blocking the angle
IOIS:
T/F — Posterior Scleritis is dramatically responsive to steroid therapy
TRUE
What is the most common form of IOIS in children?
Posterior Scleritis
IOIS: Posterior Scleritis manifests uni- or bi-laterally?
Either
Myositis
IOIS affected EOMs
How to differentiate between Myositis and TED
Tendon involvement noted on CT/MRI and A/B Scan
Course of IOIS
- Spontaneous remission
- Intermittent episodes
- Severe prolonged inflammation (leads to fibrosis — “frozen orbit”)
IOIS: What is an effective and common treatment prior to initiating steroids?
NSAIDs
T/F: in mild causes, observation is the treatment for IOIS
TRUE
Management for IOIS: (6)
- Biopsy to r/o neoplasm
- NSAIDs
- Systemic steroids (oral prednisolone)
- Radiotherapy
- Anti metabolites
- Systemic infliximab (tumor necrosis factor inhibitor)
Granulomatous Orbital Diseases
- Wegener’s
- Sarcoidosis
- Polyarteritis Nodosa
- Histocytic Disorders (overproduction of WBCs)
What signs/symptoms suggest sarcoidosis in orbital inflammation?
- Lacrimal gland enlargement
- Perineuritis
- EOM enlargement
- Proptosis
- Pain
Wegener’s is also referred to as
Granulomatosis with Polyangiitis
Wegener’s Granulomatosis
Granulomatous inflammation and necrotizing vasculitis
Wegener’s is mediated by
T-cells
Wegener’s presents uni/bi-laterally?
Bilaterally
What tests are useful in confirming Wegener’s?
cANCA serology or biopsy
Involvement of what other system/body part is particularly associated with orbital inflammation, 2º to Wegener’s?
Sinus involvement (esp paranasal sinuses or nasopharynx)
Treatment for Wegener’s
Steroids and immunosuppressants (cyclophosphamide)
Polyarteritis Nodosa
Vasculitis of medium and small nerves
Involves heart, kidney, liver, GI, and occasionally orbit
Acute onset of orbital inflammation is likely associated with
Infectious etiology
Insidious onset of orbital inflammation is usually associated with…
Neoplasm or TED
(Unless spreading from sinus)
CT of Preseptal Cellulitis shows
Opacification anterior to orbital septum
Preseptal Cellulitis
Lid erythema with periorbital edema
Tx for Preseptal Cellulitis
IV antibiotics (augmentin)
Common causes of Preseptal cellulitis
- skin trauma
- Eye infection
- Dacryocystitis
- Sinusitis
- Spread of remote infection (URI, ear, etc) spread by blood
T/F: sinus congestion can be used to differentiate Preseptal cellulitis and orbital cellulitis
FALSE
Why can Cavernous Sinus Thrombosis appear like orbital syndrome?
Impaired venous drainage —> orbital congestion
Common causative agents for Orbital Cellulitis
- S. Pneumoniae
- S. Aureus
- S pyogenes
- H influenza
Orbital Cellulitis CT scan will show
Orbital opacity posterior to orbital septum
Which is more urgent: Preseptal or orbital cellulitis?
Orbital ☠️
Cavernous Sinus Thrombosis is usually a complication of severe ____, ____, or ____ infection
Facial, sinus, or orbital
T/F: patients with Preseptal cellulitis will often present with malaise and fever
FALSE
What are two non-infectious cavernous sinus disorders that can imitate orbital inflammation?
Cavernous Sinus Fistula and Orbital Varix
Cavernous Sinus Fistula should be considered in all patients with (3)
- Elevated IOP
- Mild HAs
- Bruit + Red eye, esp in elderly women
Orbital varix should be considered when
- Eye bulging in crying infant
- Proptosis during valsava maneuver
- Orbital ecchymosis
Describe orbital lymphomas
Painless
Grow slow
Conform to shape of orbital tissue
What conj lesion is indicative of Orbital Lymphoma?
Salmon Patch
Origin of lymphomas
B cells
Anterior lymphomas have what type of consistency?
Rubbery
T/F: lymphomas generally have good prognosis
TRUE
Lacrimal tumors cause a lack of sensation where?
Region of orbit supplied by lacrimal nerve
T/F: lacrimal tumors are typically malignant
FALSE; 50/50
Half of lacrimal tumors are ____ in nature
Epithelial
T/F: lacrimal tumors have a high mortality rate
TRUE
Neurogenic Tumor examples
Glioma
Schwannoma
Meningioma
Most benign tumor of periorbital areas in children
Capillary Hemangioma
how do you treat capillary hemangioma?
- Laser
- Steroid (IV + po)
- BB
- Resection
- Peds work up
Gender preference for capillary hemangioma
Girls
Capillary hemangiomas should be treated if…
- Amblyopia
- Compression of ON
- Exposure keratopathy
- Severe blemish, necrosis, or infections
After _____, the orbit is the most common site for metastatic invasion
Choroid
Most common primary tumor?
Second?
Most — breast
2nd — Melanoma
From where can non-metastatic tumors spread to orbit?
Paranasal cavities or maxillary sinus
Silent Sinus Syndrome aka
Chronic Maxillary Atelectasis
T/F: Silent Sinus Syndrome is not a tumor
TRUE
Silent Sinus Syndrome
Painless onset of enophthalmos + vertical DV in upgaze, 2º to resorption of orbital floor bones (from chronic maxillary sinusitis)
CT scan of Silent Sinus Syndrome
Bowing of maxillary sinus
