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Eyes > Orbital Diseases > Flashcards

Orbital Diseases Flashcards

1
Q

What are the signs of orbital disease?

A
  • soft tissue involvement
  • proptosis
  • enophthalmos
  • ophthalmoplegia
  • visual dysfunction
  • dynamic changes
  • fundus changes
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2
Q

What are the symptoms of orbital disease?

A
  • double vision
  • pain
  • discomfort
  • decreased vision
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3
Q

What is soft tissue involvement?

A
  • lid and periorbital oedema
  • ptosis
  • conjunctival swelling (chemosis) and injection
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4
Q

What causes soft tissue involvement?

A
  • Inflammation

- Vascular abnomalies

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5
Q

What is proptosis?

A
  • Abnormal protrusion of the globe

- direction of protrusion can be intraconal or extraconal

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6
Q

What causes proptosis?

A

thyroid eye disease
tumours
inflammation
infection

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7
Q

What is enophthalmos?

A

It is a condition in which the globe is recessed within the orbot

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8
Q

What causes enophthalmos?

A
  • small globe
  • structural bone abnormalities
  • atrophy of orbital content
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9
Q

What is opthalmoplegia?

A

paralysis or weakness of the eye muscles

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10
Q

What are the causes of opthalmoplegia?

A
  • tumour
  • restricted myopathy
  • ocular motor nerve lesions
  • trauma (long standing bone fractures)
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11
Q

What is visual dysfunction?

ie what are the problems

A
  • visual acuity (corneal exposure, ON compression, choroidal folds)
  • colour vision
  • visual field defects
  • decreased brightness sensitivity
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12
Q

What are the dynamic changes seen?

A
  • Increased venous pressure
  • Pulsation (AV communication or defect in the orbital roof)
  • Bruit (sign of carotid-cavernous fistula)
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13
Q

What are fundus changes?

A

Optic disc changes

  • optic disc swelling
  • optic disc atrophy
  • opticociliary shunt

Choroidal folds

Retinal vascular changes

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14
Q

What investigations should be carried out in orbital disease?

A

CT
MRI
Plain radiograph
Fine needle biopsy

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15
Q

What are the ocular manifestations of thyroid eye disease?

A
  • eyelid retraction/lag
  • periorbital oedema
  • exophthalmos
  • compression of the optic nerve
  • exposure keratopathy
  • soft tissue involvement
  • restrictive myopathy (50% will have permanent diplopia
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16
Q

What are the infections/inflammatory orbital diseases?

A

Orbital cellulitis

Idiopathic Orbital Inflammatory Disease

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17
Q

What is orbital cellulitis?

A

Infection behind orbital septum

usually second to ehtmoiditis

18
Q

How does orbital cellulitis present?

A

sever malaise, fever and orbital signs

19
Q

What are the orbital signs in orbital cellulitis?

A

severe eyelid odema and redness
proptosis - most frequently lateral and down
painful opthalmoplegia
optic nerve dysfunction

20
Q

What are the complications of orbital cellulitis?

A 
raised intraocular pressure 
retinal vasculature occlusion 
optic neuropathy 
orbital/brain/ sunperiosteal abscess 
meningitis 
cavernous sinus thrombosis
21
Q

How is orbital cellulitis treated?

A

Hospital admission
Systemic antibiotic therapy
Monitoring of optic nerve function

22
Q

When is surgery indicated for orbital cellulitis?

A

resistance to antibiotics
orbital or subperiosteal abscess
optic neuropathy

23
Q

What is idiopathic orbital inflammatory disease (IOID)?

A

Non-neoplastic, non-infectious orbital lesion (pseudotumour)

Involves any or all soft tissue components

24
Q

How does idiopathic orbital inflammatory disease (IOID) present?

A

In 2nd to 5th decades of life with abrupt painful onset

Usually unilateral
Periorbital swelling and chemosis
Proptosis
Opthalmoplegia

25
Q

What is the treatment of idiopathic orbital inflammatory disease (IOID)?

A

Anti-inflammatory druga
NSAIDS
Steroids
Cytotoxic (steroid sparing drugs)

26
Q

What are the vascular orbital disorders?

A

Orbital venous anomalies (varices)

Carotid-cavernous fistula

27
Q

What are orbital varices?

A

congenital enlargements of pre-existing venous channels
usually bilateral
may bleed or get thrombosed

28
Q

What is a carotid-cavernous fistula?

A

abnormal communications between carotid and cavernous sinus

can be direct/ indirect/ encephalocele

29
Q

What are the causes of direct carotid-cavernous?

A
  • head trauma

- spontaneous rupture in hypertensive females

30
Q

How does a direct carotid-cavernous fistula present?

A

pulsatile proptosis with a bruit and thrill

abolished by ipsilateral carotid compression

31
Q

What are the causes of indirect carotid-cavernous?

A

congenital malformations

spontaneous rupture

32
Q

What is an encephlocele?

A

herniation of intracranial contents through congenital skull defect

transmission of CSF pulsation causes pulsating proptosis without a bruit

33
Q

What are the 4 types of orbital tumours?

A

Vascular tumours
Lacrimal gland tumours
Neural tumours
Miscellaneous tumours

34
Q

What is the most common orbital tumour in children?

A

capillary haemangioma

may resolve spontaneously, treatment is with steroids

35
Q

Which orbital tumour, presents most commonly in adults (70% females) in the 4th-5th decades of life?

A

cavernous haemangiomas

36
Q

Which orbital tumour presents in the 4th-5th decade, is painless and slow growing and is treated via surgical excision?

A

pleomorphic lacrimal gland adenoma

37
Q

Which tumour presents in the 4th -5th decade of life with a very poor prognosis?

A

lacrimal gland carcinoma

38
Q

Which tumour affects young girls and presents at the end of the first decade with a gradual visual loss?

A

optic nerve glioma

39
Q

Which tumour affects middle aged women and can be slow/fast growing?

A

optic nerve sheath meningioma

excision if aggressive and poor vision
radiotherapy if slow growing

40
Q

Where are the common primary sites for adult metastatic tumours?

A 
breast 
bronchus
prostate
skin 
GIT
kidney

Eyes (11 decks)

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