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3P: Neuro > Orbital Disease > Flashcards

Orbital Disease Flashcards

1
Q

Orbital roof

A

Frontal bone

Lesser wing of the sphenoid

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2
Q

Lateral wall of the orbit

A

Greater wing of the sphenoid bone

Zygomatic zone

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3
Q

Medial wall of the orbit

A

Ethmoid bone
Lacrimal bone
Lesser wing of the sphenoid
Tip of maxilla

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4
Q

Orbital floor of the orbit

A

Maxilla
Zygomatic
Palatine

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5
Q

Things that pass through the optic canals

A

Optic nerve and the ophthalmic artery

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6
Q

Things that pass through the superior orbital fissure

A

CN III, IV, VI, superior ophthalmic vein, ophthalmic nerve (frontal and lacrimal),

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7
Q

Inferior orbital fissure things

A

Maxillary nerve (V2)

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8
Q

SO muscle origin

A

Lesser wing of sphenoid

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9
Q

Only muscle that originates from the anteiror orbit

A

IO

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10
Q

IO origin

A

Anteiror portion of the orbit on the maxilla

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11
Q

Symptoms of neuro-ophthalmology of orbital disease

A

Vision loss, double vision, non-comitant strab, swelling, ptosis, proptosis, enophthlamos, facial hypesthesia (CN V), loss of VF

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12
Q

Optic disc findings of neuro-ophthalmology orbital disease

A

Optic nerve atrophy (later stage)

Optic disc swelling

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13
Q

Retinal findings of neuro-op orbital disease

A
  • venous engorgement or impending venous occlusion
  • maybe seen with optic nerve tumors, but us very rare in patients with inflamamtory disease of the orbit
  • choroidal folding
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14
Q

Eye movement abnormalities in neuro-op orbital disease

A

Mixed pattern of eye movement abnormalities

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15
Q

3 major forms of imaging for neuro orbital diseases

A

Echography (A scan/ B scan)
CT scan
MRI scan

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16
Q

Key diffrence between CT and MRI

A

CT used to scan bones

Can only use CT if they have a pace maker

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17
Q

Orbital inflamamtion

A 
Graves orbitopathy 
Idiopathic inflamamtory syndrome (orbital pseudotumor) 
-posterior scleritis 
-diffuse inflammation
-myositis 
-dacryoadenitis 
-perineuritis 
-sclerosing orbital inflamamtion 
Other inflammatory orbital conditions 
-granulomatous orbital inflammation
-sarcoidosis 
-Wagner’s granulomatosis
-Polyarteritis nodosa 
-histiocytic disorders
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18
Q

Onset of idiopathic orbital inflammatory syndrome (orbital pseudotumor)

A

Acute onset of proptosis and eyelid swelling associated with pain and double vision

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19
Q

Signs and symptoms of idiopathic orbital inflammatory syndrome (orbital pseudotumor)

A
  • acute onset proptosis and eyelid swelling associated with pain and double vision
  • usually conjunctival swelling (chemosis), injection, and eyelid erythema
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20
Q

Cause of idiopathic orbital inflammatory syndrome

A

Unknown, maybe include viral, allergic and AI mechanisms

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21
Q

How common is idiopathic orbital inflammatory syndrome

A

Uncommon

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22
Q

Who can get idiopathic orbital inflammatory sybdrome

A

Can occur at any age, with most patients presenting in middle life. No sex/ race predilection

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23
Q

How to confirm idiopathic orbital inflammatory syndrome

A

Echography, MRI or CT
Biopsy usually deferred unless the inflammation is recurrent, atypical in appearance, or primarily involved the lacrimal gland

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24
Q

Treatment for indiopathic orbital inflammatory sybdrome

A
  • corticosteroids (60-100mg of prednisone) slow taper need to be extended for several months
  • NSAIDs may be helpful during the steroid taper
  • immunosuppressant therapies including cyclophosphamide, cyclosporine and methotrexate as well as IV immunoglobulin
  • radiation therapy
25
Q

Classes of graves

A 
Graves 
Class I: eyelid retraction 
class II: eyelid and conjunctival invovlemt (chemosis, eyelid swelling, red eye)
Class III: double vision  (EOM invovlemt)
Class IV: proptosis 
Class V: severe corneal conditions
• aggressive treatment 
Class VI: optic nerve involvement

These dont go in order, they could have eyelid retraction and optic nerve invovlened and nothing else. They can be mixed together too

26
Q

Posterior scleritis

A
  • inflamamtion focused on eye wall and surrounding tenons capsule
  • pain, proptosis, ptosis, lid swelling, chemosis and injection of conjunctiva, decrease vision
  • choroidal folds, exudative RD, papillitis and uveitis
  • echography may be demonstrate sclerotenonitis with edema or widening of tenons space (T sign)
27
Q

Diffuse inflammation

A
  • inflammation involving the entire orbit
  • pain, proptosis, ptosis, lid swelling, chemosis and injection of conjunctiva, occasionally EOM involvement and double vision
  • maybe pupillary defects
  • exudative RD, papillitis and uveitis
  • CT scan shows that the entire orbit is involved by the irregular infiltrate that often obscures normal orbital anatomy
  • treatment is oral steroids
28
Q

Myositis

A
  • inflammation of the muscles
  • pain on eye movements, double vision, proptosis, ptosis, eyelid swelling, chemosis, and injection of conjunctiva
  • CT or MRI scan shows diffuse invelemtn of the muscle and tendon
  • A and B scan show muscle enlargement with tendon involvement and low reflectivity consistent with edema
  • the most common muscles involved are SR/levator complex and MR
29
Q

Dacryoadenitis

A
  • inflamamtion of the lacrimal glands
  • the most common form of IOIS
  • could be typical acute and subacute or chronic (painless)
  • pain, swelling of the temporal portion of the eyelid (S shaped deformity), the globe may be displaced downward and inferiorly
  • rarely have double vision or decreased vision
  • scan shows inflammatory mass lesion in the ST orbit
  • biopsy needed
30
Q

Perineuritis

A
  • nonspecific orbital inflammation
  • vision loss from either optic nerve sheath inflamamtion or mass effect on the optic nerve
  • enhancement of the sheath no the nerve itself
  • optic disc edema and mild venous obstruction
31
Q

Sclerosing orbital inflammation (sclerosing orbital pseudotumor)

A
  • chronic scarring orbitopathy with fibroblastic proliferation with formation of dense fibrous CT and severe orbital dysfunction
  • vision loss from either optic nerve dysfunction and thickening
  • proptosis, pain with eye movement, and double vision
  • onset at any age and often simulates a tumor
  • the compressive inflammatory mass may result in a venous obstructive appearance
32
Q

Granulomatous orbital inflamamtion

A

Prestn with mild (compared to the more painful and acute IOIS) inflammatory symptoms

33
Q

Sarcoidosis

A

Uncommon in orbital disease

34
Q

Wagner’s granulomatosis

A

Ophthalmic manifestations occur in 50-60% of patients and involves the orbit in about 1/4 of those with eye findings

35
Q

Polyarteritis nodosa

A

Occasionally presents with a nonspecific orbital inflammatory sydnrome

36
Q

Histiocytic disorders

A

Erdheim-chester disease (a systemic xanthogranulomatous disorder)

37
Q

Which has mor epain, thyroid orbitopathy or IOIS

A

IOIS

38
Q

Laterality of thyroid orbitopathy and IOIS

A

Thyroid-bialteral

IOIS-almost always unilateral

39
Q

Onset of thyroid orbitopathy and IOIS

A

Thyroid: gradual
IOIS: acute (hours or days)

40
Q

Vision in thyroid and IOIS

A

Thyroid: usually good unless orbital apex compromised

IOIS: impaired with posterior scleritis, perineuritis, and optic neuritis

41
Q

Eye movements and thyroid/OIOS

A

Thyroid: restrictive
IOIS: impaired in field of inflamed muscle

42
Q

Eyelid in thyroid and IOIS

A

Thyroid: retraction

IOIS: ptosis

43
Q

Imaging for thyroid vs IOIS

A

Thyroid: multiple muscles enlarged; regular borders and tendon sparing; does not extend to fat

IOIS: multiple muscles enlarged with irregualr borders and extension to the orbital fat, enhancement around globe

44
Q

Repsosne to steroids: thyroid vs IOIs

A

Thyroid: slow and moderate
IOIS: immediate and often complete

45
Q

Orbital lymphoma

A
  • maybe primary or secondary as manifestation of a systemic lymphoma
  • can be difficult to distinguish form IOSI clinically
  • a visible subconjunctival component or “Salmon patch” may be present
  • biopsy needed
46
Q

Neurogenic tumors

A
  • most orbital peroperhal nerve sheath tumors, such as schwannomas and neurofibromas, originate from the sensory branches of the first division of the trigeminal nerve
  • neurofibromas due to NF type 1 may manifest with proptosis and massive outgrowth of the eyelid skin
47
Q

Lacrimal tumors

A
  • rare
  • adenoid cystic carcinoma of the lacrimal gland is the most common malignant lesion
  • mass lesion, non axial proptosis, the eye is usually white and quiet, and the pain is no exacerbated by eye movements
  • only about 70% of all patients with adenoid cystic carcinoma are alive at 5 years
48
Q

Metastatic tumors

A
  • few patients survive for more than 1 year
  • double vision is often an early manifestation of metastatic disease
  • Capone and slamovits study: 16 cases arose from the breast, 6 cases arose from melanoma
49
Q

Secondary orbital tumors

A
  • invovlemt the orbit by direct extension
  • most common setting in which patients require exenteration
  • the majority arises fro the paransal sinus cavity
  • only 25% of patients with sinus tumor and orbital involvement have a 5 year survival rate
50
Q

Orbital extension of intracranial tumors

A
  • rare; mainly occurs with meningioma
  • high grade astrocytoma of the frontal lobe may invade the orbital roof
  • orbital involvement may also occur with the extension of meninges tumors, through the subarachnoid space and along the optic new sheath
51
Q

Vascular tumors

A

Cavernous hemangioma are the most common (lesions ar relatively easily excised)
Lymphangiomas of orbit are congenital benign vascular tumors (acutely due to spontaneously bleeding)
Venous angiomas
Hemangioblastomas

52
Q

Clinical presentations of orbital infection

A
  • pain, redness, fever, and an elevation of WBC
  • ominous sign include loss of vision or worsening of proptosis
  • sinus disease is common
  • staph aureus, Strep species, H. Influenzas are the most commonly encountered pathogenic organisms, and methicillin resistant cellulitis is occurring with increased frequency
53
Q

Mucoceles

A
  • paranasal sinus mucoceles are cystic, expanding lesion that can arise in any of the paranasal sinuses
  • non-axial proptosis, double vision
54
Q

Silent sinus sydnrome

A

-painless onset of enophthlamos and vertical double vision worse in upgaze secondary of the bone of the orbital floor by chronic maxillary sinusitis

55
Q

Phycomycosis (mucormycosis)

A
  • fungal
  • invasive
  • may involve the lungs, GI tract, or the rhino-orbital structures
  • pain, fever, HA, reduced acuity, double vision, facial numbness, and sometimes a seropurulent discharge from the nose
  • orbital infarction syndrome can occur because of the angioinvasive nature
  • mortality rate is 15-35%
  • treatment: compete excision of necrotic tissue and antifungal agents. Amphotericin first line
56
Q

Aspergillosis

A
  • fungal
  • invasive
  • slower course compared to mucor
57
Q

Allergic fungal sinusitis

A

Noninvasize

58
Q

Orbital truama

A

Retrobulbar hemorrhage
Floor fracture
Other fractures

3P: Neuro (11 decks)

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