Orbital Diseases Flashcards
What are the signs of orbital disease?
- soft tissue involvement
- proptosis
- enophthalmos
- ophthalmoplegia
- visual dysfunction
- dynamic changes
- fundus changes
What are the symptoms of orbital disease?
- double vision
- pain
- discomfort
- decreased vision
What is soft tissue involvement?
- lid and periorbital oedema
- ptosis
- conjunctival swelling (chemosis) and injection
What causes soft tissue involvement?
- Inflammation
- Vascular abnomalies
What is proptosis?
- Abnormal protrusion of the globe
- direction of protrusion can be intraconal or extraconal
What causes proptosis?
thyroid eye disease
tumours
inflammation
infection
What is enophthalmos?
It is a condition in which the globe is recessed within the orbot
What causes enophthalmos?
- small globe
- structural bone abnormalities
- atrophy of orbital content
What is opthalmoplegia?
paralysis or weakness of the eye muscles
What are the causes of opthalmoplegia?
- tumour
- restricted myopathy
- ocular motor nerve lesions
- trauma (long standing bone fractures)
What is visual dysfunction?
ie what are the problems
- visual acuity (corneal exposure, ON compression, choroidal folds)
- colour vision
- visual field defects
- decreased brightness sensitivity
What are the dynamic changes seen?
- Increased venous pressure
- Pulsation (AV communication or defect in the orbital roof)
- Bruit (sign of carotid-cavernous fistula)
What are fundus changes?
Optic disc changes
- optic disc swelling
- optic disc atrophy
- opticociliary shunt
Choroidal folds
Retinal vascular changes
What investigations should be carried out in orbital disease?
CT
MRI
Plain radiograph
Fine needle biopsy
What are the ocular manifestations of thyroid eye disease?
- eyelid retraction/lag
- periorbital oedema
- exophthalmos
- compression of the optic nerve
- exposure keratopathy
- soft tissue involvement
- restrictive myopathy (50% will have permanent diplopia
What are the infections/inflammatory orbital diseases?
Orbital cellulitis
Idiopathic Orbital Inflammatory Disease
What is orbital cellulitis?
Infection behind orbital septum
usually second to ehtmoiditis
How does orbital cellulitis present?
sever malaise, fever and orbital signs
What are the orbital signs in orbital cellulitis?
severe eyelid odema and redness
proptosis - most frequently lateral and down
painful opthalmoplegia
optic nerve dysfunction
What are the complications of orbital cellulitis?
raised intraocular pressure retinal vasculature occlusion optic neuropathy orbital/brain/ sunperiosteal abscess meningitis cavernous sinus thrombosis
How is orbital cellulitis treated?
Hospital admission
Systemic antibiotic therapy
Monitoring of optic nerve function
When is surgery indicated for orbital cellulitis?
resistance to antibiotics
orbital or subperiosteal abscess
optic neuropathy
What is idiopathic orbital inflammatory disease (IOID)?
Non-neoplastic, non-infectious orbital lesion (pseudotumour)
Involves any or all soft tissue components
How does idiopathic orbital inflammatory disease (IOID) present?
In 2nd to 5th decades of life with abrupt painful onset
Usually unilateral
Periorbital swelling and chemosis
Proptosis
Opthalmoplegia
What is the treatment of idiopathic orbital inflammatory disease (IOID)?
Anti-inflammatory druga
NSAIDS
Steroids
Cytotoxic (steroid sparing drugs)
What are the vascular orbital disorders?
Orbital venous anomalies (varices)
Carotid-cavernous fistula
What are orbital varices?
congenital enlargements of pre-existing venous channels
usually bilateral
may bleed or get thrombosed
What is a carotid-cavernous fistula?
abnormal communications between carotid and cavernous sinus
can be direct/ indirect/ encephalocele
What are the causes of direct carotid-cavernous?
- head trauma
- spontaneous rupture in hypertensive females
How does a direct carotid-cavernous fistula present?
pulsatile proptosis with a bruit and thrill
abolished by ipsilateral carotid compression
What are the causes of indirect carotid-cavernous?
congenital malformations
spontaneous rupture
What is an encephlocele?
herniation of intracranial contents through congenital skull defect
transmission of CSF pulsation causes pulsating proptosis without a bruit
What are the 4 types of orbital tumours?
Vascular tumours
Lacrimal gland tumours
Neural tumours
Miscellaneous tumours
What is the most common orbital tumour in children?
capillary haemangioma
may resolve spontaneously, treatment is with steroids
Which orbital tumour, presents most commonly in adults (70% females) in the 4th-5th decades of life?
cavernous haemangiomas
Which orbital tumour presents in the 4th-5th decade, is painless and slow growing and is treated via surgical excision?
pleomorphic lacrimal gland adenoma
Which tumour presents in the 4th -5th decade of life with a very poor prognosis?
lacrimal gland carcinoma
Which tumour affects young girls and presents at the end of the first decade with a gradual visual loss?
optic nerve glioma
Which tumour affects middle aged women and can be slow/fast growing?
optic nerve sheath meningioma
excision if aggressive and poor vision
radiotherapy if slow growing
Where are the common primary sites for adult metastatic tumours?
breast bronchus prostate skin GIT kidney
