Orbital Disease

Question 1

what are the bones of the orbit

Answer 1

Frontal 
Spehnoid
zygomatic 
maxillary
palatine
lacrimal
ethmoid
`

Question 2

what bones make up the roof of the orbit

Answer 2

Frontal bone

Lesser Sphenoid wing

Question 3

what bones make up the lateral wall of the orbit

Answer 3

zygomatic

greater sphenoid

Question 4

what bones make up the floor of the orbit

Answer 4

zygomatic
maxillary
palatine

Question 5

what bones make up the medial wall of the orbit

Answer 5

maxillary
lacrimal
ethmoid
sphenoid

Question 6

what causes proptosis

Answer 6

thyroid eye disease
tumours
inflammation
infection

Question 7

what is enopthalmos

Answer 7

globe recession into the prbit

Question 8

what causes enopthalmos

Answer 8

structural abnormalities - blow out fracture
small globe
atrophy of orbital contents - irridation/scleroderma

Question 9

what is opthalmoplegia

Answer 9

restriction/disability of ocular muscles

Question 10

what causes opthalmoplegia

Answer 10

tumours
myopathy
CN3 lesions
Trauma

Question 11

what is thyroid eye disease

Answer 11

autoimmune disorder where thyroid autoantibodies react with extraocular tissue to cause a variety of symptoms

Question 12

what are symptoms of thyroid eye disease

Answer 12

exopthalmos (1/3) 
periorbital odema
lid lag
diplopia (10%) 
rarely - CN3 compression, optic neuropathy

Question 13

what is orbital cellulitis

Answer 13

infection behind orbital septum

Question 14

whats orbital cellulitis usually secondary to

Answer 14

ethmoiditis

Question 15

what are symptoms of orbital cellulitis

Answer 15

severe malaise, fever, orbital swelling/redness/ptosis/painful opthalmoplgeia/CN2dysfunction

Question 16

what are complications of orbital cellulitis

Answer 16

CN2 neuropathy
abscess formation
secondary cranial cavity infection

Question 17

what is idiopathic orbital inflammatory disease

Answer 17

non-neoplastic non-infectious orbital lesion
20-50%
usually abrupt
causes proptosis, chemosis, periorbital swelling

Question 18

how do you diagnose idiopathic orbital inflammatory disease

Answer 18

when everything else has been ruled out - diagnosis of exclusion

Question 19

what type of disease are orbital varicies

Answer 19

congenital

Question 20

what is a common symptom of orbital varicies

Answer 20

intermittent proptosis accentuated by the valsava

Question 21

what is a direct carotid-cavernous fistula

Answer 21

abnormalcommunication between the carotid artery and the cavernous sinus (venous dural sinus)

Question 22

what are features of a direct carotid-cavernous fistula

Answer 22

ptosis
opthalmoplgeia
chemosis 
conjunctival injection 
raised IOP 
pulsatile proptosis with thrills

Question 23

what are causes of a direct carotid-cavernous fistula

Answer 23

Trauma

Rupture

Question 24

what is an indirect carotid-cavernous fistula

Answer 24

abnormal indirect communication between the meningeal branches of the ICA and the carotid sinus

Question 25

what is the presentation of an indirect carotid-cavernous fistula

Answer 25

dilated eipscleral vessels raised IOP occasional opthalmoplegia mild proptosis

Question 26

what is encephalocele

Answer 26

herniation of intracranial contents through a congenital skull defect

Question 27

what are the 4 types of orbital tumours found + their subtypes

Answer 27

vascular - capillary/cavernous haemangioma lacrimal gland - pleomorphic adenoma neural - CN2 glioma, CN2 sheath meningoma misc - mets/invasion from sinus

Question 28

what is the most common orbital tumour in children

Answer 28

capillary haemangioma

Question 29

at what point in time do capillary haemoangiomas present in children

Answer 29

30% at birth , 100% by 6 month

Question 30

what systemic complications are capillary haemoangiomas associated with

Answer 30

high output cardiac failure | maffuci syndrome

Question 31

what's the prognosis of capillary haemangiomas

Answer 31

70% resolve by 7 years old steroids and local resection used when possible

Question 32

whats the most common orbital tumour in adults

Answer 32

cavernous haemangioma

Question 33

what is the epidemiology of orbital tumours

Answer 33

F>M 40-60 y/o

Question 34

how do you treat orbital tumour

Answer 34

Surgical Excision

Question 35

what are features of pleomorphic lacrimal adenoma

Answer 35

30-40 painless slow growing can be surgically removed

Question 36

what are features of lacrimal carcinoma

Answer 36

30-50 poor prognosis rapid growing

Question 37

how do you treat lacrimal carcinoma

Answer 37

surgery/radiotherapy

Question 38

what are features of CN2 Glioma

Answer 38

F>M usually young associated with NF1 7-10 first present with gradual visual loss slow growing excision done if affecting vision or cosmetics

Question 39

what are features of CN2 sheath meningoma

Answer 39

middle aged women gradual visual loss due to CN2 compression Tx = excision + radiotherapy

Question 40

how do you manage orbital cellulitis

Answer 40

Systemic Abx CN2 monitoring Surgery

Question 41

what are the conditions for surgery in orbital cellulitis

Answer 41

antibiotic resistance abscesses optic neuropathy

Question 42

how do you treat idiopathic inflammatory orbital disease

Answer 42

mild = no Tx prolonged intermittent activity with eventual remissions = steroids, radiotherapy, cytotoxic usage severe, prolonged = frozen orbit