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Pathology-my one > Orbital Disorders > Flashcards

Orbital Disorders Flashcards

1
Q

What is an orbital blow out fracture?

A

Trauma caused by a blunt object striking the eye

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2
Q

What bones does a blow out fracture affect?

A

It damages the floor of the orbit which is called the maxilla and sometimes can also damage the medial wall which is the ethmoid bone

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3
Q

Describe the ethmoid bone

A

A paper thin bone

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4
Q

What lies underneath the orbital bones

A

Under the bones is an air filled space called the sinus eg. ethmoid sinus

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5
Q

What happens when the floor of the orbit it broken?

A

There is just space underneath so all the surrounding orbital fat and muscle goes into that space

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6
Q

What are some obvious signs of an orbital blow out fracture?

A

Enophthalmos, subconjunctival haemorrhage, periorbital haematoma (bruising/swelling)

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7
Q

What are some not so obvious signs?

A

Diplopia, orbital emphysema, hypoesthesia of the cheek on the affected side

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8
Q

What is orbital emphysema?

A

Forceful entry of air into the space

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9
Q

Which nerve can be damaged from a fracture and what does this nerve supply?

A

Infra orbital part of the trigeminal nerve.

It supplies sensation to the skin of cheek

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10
Q

Why may the patient experience diplopia after an orbital blow out fracture

A

If the floor is damaged, the eye is mechanically restricted so they will have a problem looking up so diplopia is experience in primary position but greater on upgaze

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11
Q

What test must you perform on a suspect orbital blow out fracture?

A

Ocular motility
RAPD
VA

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12
Q

What further tests are needed?

A

CT scan gives good resolution shows soft tissues and bones

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13
Q

How would you manage an orbital blow out fracture?

A

Depends on severity

Monitor or send to A&E if severe
Prophylactic antibiotics to reduce risk of infect
Corticosteroids and cold compress to reduce swelling

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14
Q

Does the orbital blow out fracture require surgery?

A

If diplopia persists, significant enophthalmos, 50% of orbital floor involved

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15
Q

How is surgery done?

A

Synthetic implants eg. polyethylene or metallic mesh is used to repair the broken orbital floor

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16
Q

What is orbital cellulitis?

A

Bacterial infection of soft tissues of the eye behind the orbital septum

17
Q

What is the orbital septum?

A

It holds back the orbital contents

18
Q

Who does orbital cellulitis commonly occur in?

A

People with sinus infections

The infection spreads via paranasal sinus to the orbital septum

19
Q

What are the signs of orbital cellulitis?

A

Proptosis, Motility pain and discomfort,

VA, colour vision reduced in severe cases, RAPD present in severe cases

Fever, swelling of orbit and between brows, conjunctivitis

20
Q

How would you manage orbital cellulitis?

A

Refer emergency as sight and life threatening.

21
Q

Why is orbital cellulitis life threatening?

A

The infection can spread from the orbit to the cranial cavity

22
Q

What will they do at the hospital for orbital cellulitis?

A

They are put on intravenous antibiotics to fight the infection

CT scan is done to investigate

May require surgery to drain the sinus of infection

23
Q

What is preseptal cellulitis?

A

Infection infornt of the orbital septum, less serious

24
Q

What are the signs of preseptal cellulitis?

A

Looks the same as orbital cellulitis meaning you will see swelling but no proptosis or RAPD, motility, VA, colour vision all normal

25
Q

How would you manage preseptal cellulitis?

A

Refer emergency, don’t try to differentiate, even in hospitals the will be put on antibiotics straight away

26
Q

What is thyroid eye disease?

A

Commonly caused by Grave’s disease

Autoimmune disease

Elevated thyroid levels

27
Q

What are the signs of TED?

A

Inflammation of EOMs and retrobulbar tissues

Exophthalmos, lid retration, lid lag

Swollen neck

Conjunctival oedema, corneal desiccation

28
Q

What are the symptoms of TED?

A

Grittiness, photophobia, lacrimation, loss of VA and colour vision if optic nerve is involved

29
Q

How can TED cause dry eyes and keratitis?

A

TED patient is not able to close their eyes fully because the eyeball is sticking out. This causes the eye surface to dry out

30
Q

How can optic nerve be affected in TED?

A

As they eye is being pushed forward the optic nerve is being stretched

31
Q

What can occur in extreme cases of TED?

A

Optic neuropathy

32
Q

How would you manage TED?

A

Monitor

Immunosuppression

Decompression surgery

33
Q

What is Immunosuppression?

A

Suppressing the body’s ability to fight disease, this is deliberately induced by drugs

34
Q

What is Decompression surgery?

A

Taking out the orbit walls to create space for the eye to go back in

Only done when vision is threatened of for cosmetic purposes

35
Q

Is TED reversible when thryoid levels come back down?

A

Sometime TED will continue to develop even if thyroid levels return back to normal

Pathology-my one (12 decks)

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