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Disease > Orbital Disease (Cale) > Flashcards

Orbital Disease (Cale) Flashcards

1
Q

thinnest wall in the orbit

A

medial

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2
Q

ophthalmoplegia

A

restriction of EOM

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3
Q

how can you test for ophthalmoplegia

A

forced ductions

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4
Q

clues to pathology

A

orbital pulsation (cavernous sinus fistula, defect in orbital roof transmitted via CSF), Bruit (carotid-cavernous fistula, carotid stenosis in CVA, A-V malformations, choroidal folds, disc edema, optic atrophy

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5
Q

Orbital septum

A

dense fibrous sheath acting as barrier between orbit and eyelid. Orignates from periosteum of superior and inferior orbital rims. Inserts into levator aponeurosis just above superior tarsal border and inferior lid retractors just below inferior tarsal border

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6
Q

Preseptal cellulitis

A

red, edematous lids, tender. No proptosis, chemosis, vision change, pupillary involvement, fever or EOM restriction. Staph aureous, strep pyogenes most common. Children H influenza

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7
Q

Causes for preseptal cellulits

A

laceration, insect bite. Infection spread from hordeolum, dacryocystitis, sinusitis, conjunctivitis or URI or middle ear

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8
Q

Management preseptal cellulitis

A

treatment (daily followup)
-afebrile, mild: oral antibiotic for 10 days. for child can use augmentin, cefaclor, bactrim. for adult can use augmentin, cefaclor, bactrim or moxifloxacin. Moderate to severe, febrile (no improvement)- hospital admission for IV antibiotics

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9
Q

orbital cellulitis

A

life-threatening infection of soft tissue behind orbital septum, children> adult. Spnemoniae, S. aureus, S pyogenes, H influenzae. Proptosis, pain, fever, malaise

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10
Q

complications of orbital cellulitis

A

meningitis, brain abscess, cavernous sinus thrombosis

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11
Q

orbital cellulitis emergency case

A

hospital admission, IV ceftazidime (vancomycin) and oral metronidazole (anaerobes)

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12
Q

differential Dx of acutely inflammed orbit

A

orbital cellulitis, fungal infection (mucormycosis), dacryocystitis, dacryoadenitis, vascular, neoplasm, thyroid eye disease, idopathic orbital inflammatory dz, myositis, collagen vascular dz or autoimmune, scleritis, conjunctivitis

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13
Q

Lacrimal gland disease

A

dacryoadenitits

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14
Q

dacryoadenitis

A

inflammatory w/ or w/o autoimmune dz, neoplastic (least common), biopsy is gold standard of diagnosis

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15
Q

inflammatory lacrimal gland disease

A

idiopathyc dacryoadenitits. autoimmune comorbidity frequent. acute or subacute with pain, erythema, dry eye,s welling, unilateral (80%)
autoimmunity- primary target of immune system in autoimmune disorders: sarcoid sjogren’s, wegener, IgG4-related older pt, painless swelling often bilateral

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16
Q

neoplastic

A

unilateral palpable mass, dystopia, proptosis, low incidence of pain, redness, lympocytic infiltration (elderly), pleomorphic adenoma (young mild), carcinoma (mid-aged with high mortality)

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17
Q

lymphocytic infiltration of lacrimal gland

A

can run from benign hyperplasia to malignant lymphoma (subconjunctival “salmon patch” extension

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18
Q

Infectious Dacryoadenitis

A

pain, erythema, edema lateral upper lid’s curve (kids), viral typically, bacterial rare

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19
Q

how to treat infectious dacryoadenitis

A

if mild and uncertain etiology follow daily with oral antibiotics, in kids with augmentin 20-40mg/kg/day, in adults augmentin 250-500mg po q8h.
If moderate to severe-hospitilize

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20
Q

viral infectious dacryoadenitis

A

most common epstein-barr virus, mumps, adenovirus, Hzoster, Hsimplex, rhinovirus, bilateral 40%, fever 25%

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21
Q

bacterial infectious dacryoadenitis

A

staph, MRSA, strep, haemophilus, neisseria, gonorrhea. Unilateral typically, afebrile

22
Q

differential not responsive to antibiotics

A

viral (cold compresses, analgesic), idopathic orbital inflammatory disease (CT scan, blood tests, improves with oral steroid), tumor (non-painful, orbital CT scan, biopsy)

23
Q

grave’s ophthalmopathy in hyperthyroidism

A

clinical eye involvement more common in females. majority have increase in orbital fat (younger) or EOM volume (older). Smoking is primary risk factor for GO in Graves. Manifestations largely due to expanding orbital content in unyielding bony orbit

24
Q

grave’s autoimmunity etiology

A

attack of TSH receptor by TSH receptor auto-antibodies. Abnormal circulating T3-T4 levels (TSH cause release of these)

25
Q

clinical signs of thyroid ophthalmopathy

A

lid retraction (dalrymple’s sign), lid lag (von graefe sign), proptosis (measure with exophthalmometer), hyperemia over lateral/medial recti, exposure keratitis, periorbital swelling, chemosis, fat prolapse, EOM restriction and diplopia, optic nerve compression, superior limbic keratoconjunctivitis

26
Q

chief complaints for thyroid ophthalmopathy

A

dry, gritty, blur, tearing, diplopia, pressure sensation behind the eye, other vision loss if optic nerve involved

27
Q

Management of eye in mild disease

A

lubrication of SLK, exposure dryness, topical antiinflammatory agents (Steroid, NSAID, cyclosporin), sleep with head elevated to reduce periorbital edema, tape eyelids shut during sleep

28
Q

management Grave’s

A

endocrinologist (corticosteroids concurrently), treat exposure keratitis, orbital decompression, new approaches designed to avoid the need for orbital decompression (monoclona antibodies to target B and T cell activation and adipogenesis)

29
Q

idopathic orbital inflammatory disease

A

non-infective, non-neoplastic space-occupying lesions. Unilateral (Can be bilateral in kids), F=M middle age to older. Periorbital red, swelling, pain, proptosis, ophthalmoplegia, optic nerve involvement, spontaneous remission, intermittent possible, protracted

30
Q

treatment IOID

A

observation if mild, biopsy to rule out neoplasia, NSAID often effective (Ibuprofen), Oral steroids only after confirmed dx, radiotherapy if no improvement, antimetabolites if no improvement

31
Q

Orbital myositis

A

idiopathic inflammation of one or more EOMs in absence of thyroid orbitopoathy, often spontaneous resolution 3-6wk, etiology unknown

32
Q

Orbital myositis epidemiology

A

F>M young adult, 50% bilateral, acute (single episode lasting), chronic (persistent episode lasting), recurrent result in more chronic disease, fibrosis

33
Q

orbital myositis signs

A

pain exacerbated by eye movement, diplopia (restricted EOM), injection over involved muscle, lid edema, ptosis, fibrosed muscle enlargement

  • NSAID (Ibuprofen)
  • oral steroids if persisting
34
Q

Tolosa-Hunt Syndrome

A

Dx of exclusion, rare, idiopathic, granulomatous inflammation of cavernous sinus, superior orbital fissure, orbital apex, remissions and recurrences, proptosis, mild, oculomotor nerve palsies usually with pupil involvement, sensory loss V1, V2 of trigemina

35
Q

tolosa hunt syndrome treatment

A

steroid

36
Q

cavernous sinus Fistula

A

elevated venous sinus and episcleral venous pressure (signs of orbital arterial and venous stasis), hemorrhagic chemosis, pulsatile proptosis, whoosing noise in head, bruit, increase IOP, vision loss and neuro impact immediate or delayed (Optic nerve and nerves VI, III, IV, V), most not life threatening

37
Q

Cavernous Sinus thrombosis

A

clotting within sinus, high mortality, rapid onset: HA, malaise, nausea/vomiting, proptosis, chemosis, reduced VA, CN III-VI involved

38
Q

what does cavernous sinus thrombosis result from

A

infection (sinusitis), preseptal and orbital cellulitis, otitis

39
Q

epiphora

A

defective drainage
-anatomical: malposition of puncta (ectropion)
-obstruction/stenosis
-lacrimal pump failure (horner’s muscle, lower lid laxity)
hypersecretion secondary to inflammation

40
Q

tests for epiphora

A

fluorescein disappearance test, johns dye, probing and irrigation, dacryocystography, nuclearl lacrimal scintigraphy

41
Q

dacryocystitis

A

pain and epiphora

42
Q

dacryocystitis treatment

A

warm compresses, oral antibiotics follow daily- kids give augmentin or cefaclor, adults give cephalexin or augmentin. can also give topical antibiotics in addition (trimethoprim/polymixin B (Polytrim) qid). probing is contraindicated. Consider CT scan if atypical. Incision and drainage carries risk of developing lacrimal fistula. DCR required after infection resolved

43
Q

chronic canaliculitis

A

swelling and mucopurulent

44
Q

congenital conditions

A

nasolacrimal duct obstruction or dacryocele

45
Q

nasolacrimal duct obstruction

A

common, usually spontaneous resolution. Massage over canaliculus, lid hygiene, erythromycin ung if bacterial conj, probe after 12 months resolved

46
Q

dacryocele

A

collection of amnionic fluid (noninflammatory) or mucus in lacrimal sac, due to imperforate hasner valve

47
Q

inflammatory disease

A 
chalazion
idiopathic orbital ID
Orbital myositis
tolosa-hunt syndrome
dacryoadenitis
48
Q

infectious disease

A 
dacryoadenitis
preseptal cellulitis 
orbital cellulitis 
dacrocystitis 
chronic canaliculitis
49
Q

autoimmune disease

A

graves thyroid ophthalmopathy

50
Q

congenital conditions

A

nasolacrimal duct obstruction

dacryocele

Disease (11 decks)

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