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Ant Seg I > Orbital Dx > Flashcards

Orbital Dx Flashcards

1
Q

Pulsatile proptosis

A

Defect in orbital roof; CSF

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2
Q

Which part of the orbital floor is affected in a blowout fracture?

A

Posteromedial portion of maxillary bone

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3
Q

Maxillary carcinoma invades the orbit via the ___ and displaces the globe upwards.

A

Maxillary sinus (orbital floor forms roof of maxillary sinus)

Enophthalmos and eye movement problems

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4
Q

Orbital cellulitis is frequently secondary to

A

Ethmoidal sinusitis

If pt has a stye, treat quickly before it spreads into orbit.

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5
Q

Tolosa-Hunt

A

Inflammation of SOF and apex

Ophthalmoplegia, venous outflow obstruction - Ddx: angle closure attack

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6
Q

Clinical signs of orbital disease

A 
Soft tissue involvement
Proptosis
Enophthalmos
Ophthalmoplegia
Pulsation
Bruit
Fundus changes: optic disc swelling, optic atrophy, opticociliary collaterals, choroidal folds
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7
Q

Causes of soft tissue involvement

A

Thyroid eye disease, orbital inflammatory disease, obstruction to venous drainage

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8
Q

Signs of soft tissue involvement

A

Lid and periorbital edema, skin discoloration, ptosis, chemosis

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9
Q

Causes of proptosis

A

Retrobulbar lesions, shallow orbit

Direction of proptosis may indicate pathology

  • lesions in muscle cone (cavernous hemangioma and ON tumors) -> axial proptosis
  • extraconal lesions -> eccentric proptosis
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10
Q

Proptosis characteristics

A

Greater than 20mm - Ddx: high myopic eye (normal, not proptotic)
Difference of 2mm btw the two eyes - more important

Also note palpebral apertures and any lagophthalmos

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11
Q

Pseudoproptosis

A

Facial asymmetry
Severe ipsilateral enlargement of glob (high myopia or buphthalmos)
- buphthalmos - concern w/ congenital glx
Ipsilateral lid retraction
Contralateral enophthalmos - blowout fracture or congenital (phthisis bulbi); other eye appears to be proptotic

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12
Q

Causes of enophthalmos

A

Atrophy of orbital contents
Sclerosis orbital lesions: metastatic scirrhous carcinoma and chronic sclerosis goes inflam orbital dx
Pseudoenophthalmos- microophthalmos or phthisis bulbi

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13
Q

Ophthalmoplegia causes

A

Orbital mass
Restrictive myopathy (thyroid eye disease)
Ocular motor nerve involvement asso w/ lesions in cavernous sinus, orbital fissures or posterior orbit (carotid-cavernous fistula), Tolosa-Hunt, malignant lacrimal gland tumors
Tethering of EOM of fascia in blowout fracture - ex: IR trapped secondary to blowout fracture - eyeball can’t move up

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14
Q

Which tests are used to determine if a lesion is restrictive or paretic? And how does it work?

A

Forced duction test
Positive FDT - eye cannot move (restricted)
Negative FDT - eye can move (nerve problem)

Differential IOP test
6mmHg or more in direction of restricted lesion

Saccades show reduced velocities in paretic lesions

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15
Q

Dynamic clues to etiology of lesion

A

Increasing venous pressure w/ head position, Valsalva maneuver, jugular compression can induce/exacerbate proptosis in pts w/

  • orbital venous anomalies
  • infants w/ orbital capillary hemangiomas

Pulsation - arteriovenous communication (bruit dep on size) or defect in orbital roof (no asso bruit - CSF)
* best seen during applanation tonometry
Bruit = carotid-cavernous fistula; sound lessened or abolished by gently compressing ipsilaeral carotid artery in neck; decr VA/RAPD/+CV

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16
Q

Initial feature of compressive optic neuropathy

A

Optic disc swelling
* may precede optic atrophy (severe compressive optic neuropathy)

Caused by thyroid eye dx and optic nerve tumors

17
Q

Opticociliary collaterals

A

Enlarged peripapillary capillaries which divert blood from central retinal venous circ to peripapillary choroidal circ when there is an obstruction

May be asso w/ orbital or optic nerve tumors which compress intraorbital ON and impairs blood flow thru CRV

  • optic nerve sheath meningioma
  • optic nerve glioma
  • CRVO
  • idiopathic intracranial HTN and glx
18
Q

Choroidal folds

A

Orbital lesions (tumors, thyroid eye dx, inflam conditions)

Usually asymptomatic, no vision loss

More common w/ greater amounts of proptosis and ant located tumors; sometimes can precede proptosis

19
Q

Swollen ONH always causes vision loss. True or false

A

False - maybe, maybe not

20
Q

Pale ONH (= optic atrophy) causes RAPD, color vision defect, decreased vision. True or false?

A

True

21
Q

Choroidal folds w/ vision loss (although usually asymptomatic)

A

Central

Something behind the eye is pushing it forward

22
Q

What causes preseptal cellulitis?

A

Skin trauma
Local infection (stye, dacryocystitis, sinisitis)
Remote infection of upper respiratory tract or middle ear by haematogenous spread

23
Q

Signs of preseptal cellulitis

A

Unilateral tender and red lid w/ periorbital edema

NO PROPTOSIS/CHEMOSIS, NO EFFECT ON OPTIC NERVE FXN

24
Q

Preseptal cellulitis tx

A

Oral antibiotics: Augmentin 500mg tid x 10 days, cephalosporin 500mg x10 days days

Rarely IV antibx s

25
Q

Bacterial orbital cellulitis is more common in children. True or false?

A

True

26
Q

Pathogenesis of orbital cellulitis

A 
Sinus-related
Pre-septal cellulitis
Local spread (dental/ear infections)
Hematogenous
Post-trauma
Post-surgical (retinal, lacrimal, orbital)
27
Q

Diagnosis of orbital cellulitis

A

Fever

Decreased VA, RAPD, color defect

Unilateral tender warm and red periorbital and lid edema

Proptosis - often obscured by lid swelling (usually lateral and downwards)

Painful ophthalmoplegia

ON dysfunction

28
Q

Complications of orbital cellulitis

A

Exposure keratopathy, incr IOP, CRVO/CRAO, intracranial complications (meningitis, brain abscess, cavernous sinus thrombosis)

29
Q

IOID can result inflammation of soft tissues such as myositis, dacryoadenitis (THINK SARCOIDOSIS), optic perineuritis, or scleritis. True or false?

A

True

*pain w/ any of these, think orbital disease. Then r/o orbital cellulitis w/ biopsy first.

30
Q

IOID in adults is unilateral and bilateral in children. True of false?

A

True

31
Q

Treatment for IOID is antibx eyedrops. True or false?

A

False - eyedrops will not help; steroid IV or oral

32
Q

IOID is asso w/ proptosis, ophthalmoplegia, ON dysfunction. True or false?

A

True

33
Q

Treatment for IOID

A

Steroids - make sure pt doesn’t have any other underlying dx first
Antimetabolites
Biological
NO ANTIBX - NOT AN INFECTION

34
Q

Dacryoadenitis

A

Lacrimal gland involvement in 25% of pts w/ IOID
Usually occurs in isolation and resolves spontaneously w/o tx
Rarely caused by bacteria

35
Q

Tolosa-Hunt

A

Nonspecific granulomatoius inflammation of cavernous sinus, SOF, and/or orbital apex

Idiopathic

Dx of exclusion

36
Q

Carotid cavernous sinus fistula

A

Arterial blood flows anteriorly into ophthalmic beings - venous and arterial stasis, incr EVP, decr arterial blood flow to cranial nerves w/in cavernous sinus

Classified based on etiology (spontaneous and traumatic), hemodynamics (high and low flow), and anatomy (direct and indirect)

37
Q

Signs of CCF

A

Severe bulbar redness, ptosis, pulsatile proptosis (Ddx: defect in orbital roof), bruit, ophthalmoplegia, ON dysfunction, radial bvs coming from around sclera

38
Q

Anophthalmic socket:

A

Enucleation - removal of globe but leaves EOMs intact
Evisceration - removal of globe but leaves sclera and EOMs intact
Exenteration - removal of glob and soft tissues (everything out)

Ant Seg I (3 decks)

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