Red Eye and Adnexal Oncology

Question 1

Give differential diagnoses for conditions causing a red eye

Answer 1

Uveitis 
Conjunctivitis 
Scleritis 
Acute glaucoma 
Keratitis/corneal ulcer 
Orbital cellulitis

Question 2

Presentation of preseptal cellulitis

Answer 2

Systemically well
Pain, redness and swelling of eyelid
May be able to see an obvious bite/puncture mark

Question 3

Presentation of uveitis

Answer 3

Red eye
Blurred vision
Light sensitivity

Question 4

Part of the eye most commonly affected by uveitis

Answer 4

Anterior

can also affect intermediate and posterior

Question 5

What is panuveitis?

Answer 5

Uveitis affecting the whole eye

Question 6

Causes of uveitis

Answer 6

Systemic disease
Idiopathic
Infection
Malignancy

Question 7

Treatment of uveitis

Answer 7

Topical anti-inflammatory steroid drops and eye drops to dilate pupil and reduce scarring if anterior
Systemic immunosuppressants if posterior

Question 8

Presentation of acute angle glaucoma

Answer 8

Severe pain
Vomiting
Fixed, dilated pupil
Pupil non-responsive to light

Question 9

Treatment of corneal abrasion

Answer 9

Usually resolves on its own in 2-3 days, can give antibiotics to reduce risk of secondary infection

Question 10

Presentation of orbital cellulitis

Answer 10

Pain, redness and swelling of eyelid 
Systemically unwell 
Double vision 
Conjunctivitis/chemosis 
Exopthalmos 
Blurred vision

Question 11

Common causes of orbital cellulitis

Answer 11

Sinusitis
Dental infection
Haematological spread of infection

Question 12

Treatment of orbital cellulitis

Answer 12

IV/oral antibiotics

Question 13

Examples of benign orbital tumours

Answer 13

Capillary haemangioma
Cavernous haemangioma
Pleomorphic adenoma
Optic nerve glioma

Question 14

Examples of malignant orbital tumours

Answer 14

Lymphoma 
Metastatic regional spread 
Rhabdomyosarcoma 
Lacrimal gland carcinoma 
Osteosarcoma 
Liposarcoma 
Primary melanoma

Question 15

Examples of benign eyelid tumours

Answer 15

Squamous cell papilloma 
Basal cell papilloma 
Melanocytic naevus 
Actinic keratosis 
Pyogenic granuloma 
Keratoacanthoma 
Capillary haemangioma 
Cavernous haemangioma

Question 16

Examples of malignant eyelid tumours

Answer 16

Basal cell carcinoma 
Squamous cell carcinoma 
Sebaceous gland carcinoma 
Melanoma 
Kaposi sarcoma 
Merkel cell carcinoma

Question 17

Presentation of squamous cell papilloma

Answer 17

Pedunculated or sessile

“raspberry texture”

Question 18

Presentation of basal cell papilloma

Answer 18

Similar texture to squamous cell papilloma (“raspberry”)
Stuck-on appearance
Brown, flat, round/oval lesions

Question 19

Early signs of transformation of lesions from benign to malignant

Answer 19

Asymmetry 
Irregular border 
Colour - not consistent, very dark 
Diameter > 6mm
Evolving (growing)

Question 20

Signs suggestive of nodular malignant melanoma

Answer 20

Elevated
Firm to touch
Growing

Question 21

Presentation of pyogenic granuloma

Answer 21

Fast growing
Highly vascularised
Erythematous pedunculated mass

Question 22

Presentation of actinic keratosis

Answer 22

Flat, scaly, hyperkeratotic skin

Related to sun exposure

Question 23

Presentation of keratoacanthoma

Answer 23

Rapidly growing
Pink papule, hyperkeratotic crater
Associated with sun exposure and immunosuppression
May be spontaneous involution

Question 24

Treatment of capillary haemangioma

Answer 24

Beta-blockers
Intra-lesional steroid
Surgery

Question 25

Presentation of cavernous haemangioma

Answer 25

Well demarcated pink patch Darkens with age Does not involute

Question 26

Features suggestive of basal cell carcinoma

Answer 26

``` Slow, inexorable growth over months Non-pigmented Elevated Ulcerated Pearly, rolled, irregular border Telangiectasia Lack of tenderness - painless ```

Question 27

Clinical subtypes of basal cell carcinoma

Answer 27

Nodular Ulcerative Morpheaform/infiltrative

Question 28

Treatment of basal cell carcinoma

Answer 28

``` Surgical excision (Mohs surgery) Imiquimod, efudex topical treatment Chemotherapy Cryotherapy Radiotherapy Photodynamic therapy ```

Question 29

Presentation of squamous cell carcinoma

Answer 29

Scaly surface over a thick plaque | Growth over weeks (rather than months)

Question 30

Presentation of sebaceous gland carcinoma

Answer 30

``` Recurrent chalazion Unilateral blepharitis Nodular, indurated lid margin Yellow discolouration Pagetoid spread along the conjunctiva ```

Question 31

Types of cutaneous malignant melanoma

Answer 31

Lentigo maligna Superficial spreading Nodular