Orbital Disease Flashcards
what are the bones of the orbit
Frontal Spehnoid zygomatic maxillary palatine lacrimal ethmoid `
what bones make up the roof of the orbit
Frontal bone
Lesser Sphenoid wing
what bones make up the lateral wall of the orbit
zygomatic
greater sphenoid
what bones make up the floor of the orbit
zygomatic
maxillary
palatine
what bones make up the medial wall of the orbit
maxillary
lacrimal
ethmoid
sphenoid
what causes proptosis
thyroid eye disease
tumours
inflammation
infection
what is enopthalmos
globe recession into the prbit
what causes enopthalmos
structural abnormalities - blow out fracture
small globe
atrophy of orbital contents - irridation/scleroderma
what is opthalmoplegia
restriction/disability of ocular muscles
what causes opthalmoplegia
tumours
myopathy
CN3 lesions
Trauma
what is thyroid eye disease
autoimmune disorder where thyroid autoantibodies react with extraocular tissue to cause a variety of symptoms
what are symptoms of thyroid eye disease
exopthalmos (1/3) periorbital odema lid lag diplopia (10%) rarely - CN3 compression, optic neuropathy
what is orbital cellulitis
infection behind orbital septum
whats orbital cellulitis usually secondary to
ethmoiditis
what are symptoms of orbital cellulitis
severe malaise, fever, orbital swelling/redness/ptosis/painful opthalmoplgeia/CN2dysfunction
what are complications of orbital cellulitis
CN2 neuropathy
abscess formation
secondary cranial cavity infection
what is idiopathic orbital inflammatory disease
non-neoplastic non-infectious orbital lesion
20-50%
usually abrupt
causes proptosis, chemosis, periorbital swelling
how do you diagnose idiopathic orbital inflammatory disease
when everything else has been ruled out - diagnosis of exclusion
what type of disease are orbital varicies
congenital
what is a common symptom of orbital varicies
intermittent proptosis accentuated by the valsava
what is a direct carotid-cavernous fistula
abnormalcommunication between the carotid artery and the cavernous sinus (venous dural sinus)
what are features of a direct carotid-cavernous fistula
ptosis opthalmoplgeia chemosis conjunctival injection raised IOP pulsatile proptosis with thrills
what are causes of a direct carotid-cavernous fistula
Trauma
Rupture
what is an indirect carotid-cavernous fistula
abnormal indirect communication between the meningeal branches of the ICA and the carotid sinus
what is the presentation of an indirect carotid-cavernous fistula
dilated eipscleral vessels
raised IOP
occasional opthalmoplegia
mild proptosis
what is encephalocele
herniation of intracranial contents through a congenital skull defect
what are the 4 types of orbital tumours found + their subtypes
vascular - capillary/cavernous haemangioma
lacrimal gland - pleomorphic adenoma
neural - CN2 glioma, CN2 sheath meningoma
misc - mets/invasion from sinus
what is the most common orbital tumour in children
capillary haemangioma
at what point in time do capillary haemoangiomas present in children
30% at birth , 100% by 6 month
what systemic complications are capillary haemoangiomas associated with
high output cardiac failure
maffuci syndrome
what’s the prognosis of capillary haemangiomas
70% resolve by 7 years old
steroids and local resection used when possible
whats the most common orbital tumour in adults
cavernous haemangioma
what is the epidemiology of orbital tumours
F>M 40-60 y/o
how do you treat orbital tumour
Surgical Excision
what are features of pleomorphic lacrimal adenoma
30-40
painless
slow growing
can be surgically removed
what are features of lacrimal carcinoma
30-50
poor prognosis
rapid growing
how do you treat lacrimal carcinoma
surgery/radiotherapy
what are features of CN2 Glioma
F>M
usually young
associated with NF1
7-10 first present with gradual visual loss
slow growing
excision done if affecting vision or cosmetics
what are features of CN2 sheath meningoma
middle aged women
gradual visual loss due to CN2 compression
Tx = excision + radiotherapy
how do you manage orbital cellulitis
Systemic Abx
CN2 monitoring
Surgery
what are the conditions for surgery in orbital cellulitis
antibiotic resistance
abscesses
optic neuropathy
how do you treat idiopathic inflammatory orbital disease
mild = no Tx
prolonged intermittent activity with eventual remissions = steroids, radiotherapy, cytotoxic usage
severe, prolonged = frozen orbit
