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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
Classes of graves
``` 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
Posterior scleritis
- 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
Diffuse inflammation
- 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
Myositis
- 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
Dacryoadenitis
- 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
Perineuritis
- 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
Sclerosing orbital inflammation (sclerosing orbital pseudotumor)
- 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
Granulomatous orbital inflamamtion
Prestn with mild (compared to the more painful and acute IOIS) inflammatory symptoms
33
Sarcoidosis
Uncommon in orbital disease
34
Wagner’s granulomatosis
Ophthalmic manifestations occur in 50-60% of patients and involves the orbit in about 1/4 of those with eye findings
35
Polyarteritis nodosa
Occasionally presents with a nonspecific orbital inflammatory sydnrome
36
Histiocytic disorders
Erdheim-chester disease (a systemic xanthogranulomatous disorder)
37
Which has mor epain, thyroid orbitopathy or IOIS
IOIS
38
Laterality of thyroid orbitopathy and IOIS
Thyroid-bialteral | IOIS-almost always unilateral
39
Onset of thyroid orbitopathy and IOIS
Thyroid: gradual IOIS: acute (hours or days)
40
Vision in thyroid and IOIS
Thyroid: usually good unless orbital apex compromised IOIS: impaired with posterior scleritis, perineuritis, and optic neuritis
41
Eye movements and thyroid/OIOS
Thyroid: restrictive IOIS: impaired in field of inflamed muscle
42
Eyelid in thyroid and IOIS
Thyroid: retraction IOIS: ptosis
43
Imaging for thyroid vs IOIS
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
Repsosne to steroids: thyroid vs IOIs
Thyroid: slow and moderate IOIS: immediate and often complete
45
Orbital lymphoma
- 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
Neurogenic tumors
- 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
Lacrimal tumors
- 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
Metastatic tumors
- 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
Secondary orbital tumors
- 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
Orbital extension of intracranial tumors
- 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
Vascular tumors
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
Clinical presentations of orbital infection
- 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
Mucoceles
- paranasal sinus mucoceles are cystic, expanding lesion that can arise in any of the paranasal sinuses - non-axial proptosis, double vision
54
Silent sinus sydnrome
-painless onset of enophthlamos and vertical double vision worse in upgaze secondary of the bone of the orbital floor by chronic maxillary sinusitis
55
Phycomycosis (mucormycosis)
- 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
Aspergillosis
- fungal - invasive - slower course compared to mucor
57
Allergic fungal sinusitis
Noninvasize
58
Orbital truama
Retrobulbar hemorrhage Floor fracture Other fractures

3P: Neuro (11 decks)

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