Orbital diseases

Question 1

What is ‘soft tissue involvement’ in orbital disease

Answer 1

periorbital oedema, lid involvement, ptosis, conjunctival swelling due to inflammation or vascular abnormalities

Question 2

What is the term for restricted or disability of ocular muscles?

Answer 2

opthalmoplegia

Question 3

Roof of orbit?

Answer 3

Frontal bone and lesser wing of sphenoid

Question 4

What is enopthalmos?

Answer 4

The globe is recessed in the orbit

Question 5

Dynamic changes in the eye?

Answer 5

Pulsation of the eye: AV communication or CSF pulsation (no bruit)
Bruits: carotid-cavernous fistula
Increased venous pressure: thyroid disease or vascular problems

Question 6

Causes of ophthalmoplegia?

Answer 6

CN palsy
Restrictive myopathy (TED or myositis)
Tumour
Trauma

Question 7

Fundal changes in the eye ?

Answer 7

Choroidal folds, optic disc changes, retinal vascular changes

Question 8

Lateral wall?

Answer 8

Zygomatic, greater wing of sphenoid

Question 9

Floor of orbit?

Answer 9

Zygomatic bone, maxillary, palantine

Question 10

What are the ocular manifestations of thyroid eye disease?

Answer 10

Periorbital oedema and lid retraction 
Exopthalmos in 1/3
Soft tissue involvement
Lid lag
Restrictive myopathy
Optic neuropathy 5% of cases

Question 11

Why does restrictive myopathy occur?

Answer 11

Initially due to the inflammation but then due to fibrosis, gives a permanent diplopia
Affects the Inferior rectus, followed by Medial; Superior; Lateral

Question 12

Medial wall?

Answer 12

Ethmoid, Maxillary, Sphenoid bone, Lacrimal

Question 13

What is orbital cellulitis?

Answer 13

It is an infection behind the orbital septum, usually secondary to ethmoiditis
Symptoms and signs: fever, malaise and orbital signs-
Red eye
Orbital oedema
Painful opthalmoplegia
Ptosis
ON dysfunction if advanced
Can complicate to Optic neuropathy and abscess

Question 14

Idiopathic orbital inflammatory (IOID)

Answer 14

Dx of exclusion: non-infectious, non-neoplastic orbital lesion and can involve any soft tissue component. Presentation 20-50s, abrupt painful
Unilateral proptosis, chemosis, periorbital swelling and ophthalmoplegia

Question 15

What is chemosis??

Answer 15

Chemosis is the swelling (or edema) of the conjunctiva. It is due to the oozing of exudate from abnormally permeable capillaries. In general, chemosis is a nonspecific sign of eye irritation.