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NEURO > Red eye and adnexal oncology > Flashcards

Red eye and adnexal oncology Flashcards

1
Q

what are the causes of a red eye

A 
uveitis
conjunctivitis (bacterial, viral, allergic)
scleritis
acute glaucoma
corneal ulcer keratitis 
orbital cellulitis
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2
Q

what is uveitis

A

inflammation of the vascular layers of the eye

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3
Q

what are the different types of uveitis

A

anterior - iris
intermediate - ciliary body and vitreous
posterior - retina, choroid, blood vessels

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4
Q

what are the causes of uveitis

A

idiopathic

associated with systemic disease - ankylosing spondylosis, sarcoidosis

Infection - TB, HSV, syphilis

Masquerade - intraocular lymphoma, leukaemia

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5
Q

what are uveitis masquerade syndromes

A

a group of various ocular diseases that may mimic intraocular inflammation

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6
Q

what is the treatment for uveitis

A

topical anti-inflammatories
systemic steroid
systemic immunosuppressants

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7
Q

what is episcleritis/scleritis

A

inflammation of the eipsclera/ sclera

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8
Q

what are the symptoms of acute angle closure glaucoma

A

severe pain
systemic symptoms - vomiting
fixed, dilated pupil

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9
Q

how does preseptal cellulitis present

A

pain, redness, lid swelling, systemically unwell

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10
Q

what are the common causes of preseptal cellulitis

A

lid cyst or insect bite

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11
Q

how does orbital cellulitis present

A 
Pain, redness, lid swelling
Systemically unwell
Double vision/limitation in EOEM
Conjunctivitis/chemosis
Exophthalmos
Blurred vision
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12
Q

what are common causes of orbital cellulitis

A

sinusitis
dental infections
haematological spread

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13
Q

what is the ophthalmic presentations of systemic disease

A 
diabetes
hypertension
autoimmune - SLE, graves
inflammatory - ankylosing spondylitis, crohns, sarcoidosis 
infection
haematological
inherited genetic  - albinism, marfans
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14
Q

what makes up the eye adnexa

A

orbit, eyelids, lacrimal drainage system

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15
Q

what are the three types of adnexal oncology

A

eyelid tumours
lacrimal drainage tumours
orbital tumours - 2/3 benign, 1/3 malignant

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16
Q

what is a tumour

A

abnormal proliferation tissue

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17
Q

what are benign tumours

A

normal cells in abnormal numbers and or/location

cells lack the ability invade local tissue to to metastasise

slow growing, mass effect

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18
Q

what are malignant tumours

A

anaplastic cells - loss of form or function

rapidly growing, capable of invading surrounding tissue and spearing to distant locations

19
Q

what are the different types of malignant tumours

A

carcinoma - epithelial cells
sarcoma - connective tissue
lymphoma - haemopoietic cells in lymphatic tissue
leukaemia - haemopoietic cells maturing in the blood
blastoma - immature precursor or embryonic cells

20
Q

what are the different types of benign eyelid tumours (from most to least common)

A
  1. squamous cell papilloma
  2. basal cell papilloma (seborrhoea keratosis)
  3. melanocytic naevus
  4. actinic keratosis
  5. pyogenic granuloma
  6. keratocanthoma
  7. capillary haemangioma
  8. cavernous haemangioma
21
Q

what are the different types of malignant eyelid tumours (from most to least common)

A
  1. basal cell carcinoma
  2. squamous cell carcinoma
  3. sebaceous gland carcinoma
  4. melanoma
  5. kaposi sarcoma
  6. merkel cell carcinoma
22
Q

what are the characteristics and treatment of benign SC-papilloma

A

pedunclulated or sessile (board based)
characteristic raspberry texture
usually viral

excision or laser ablation

23
Q

what are the characteristics and treatment of benign BC-papilloma

A

greasy, brown, flat, round/oval
similar texture to SCpapilloma
stuck on appearance
unrelated to sun exposure

excision

24
Q

what are benign melanocytic naevus

A

atypical melanocytes

three types - location influences clinical appearance and potential for malignant transformation

25
Q

what are the three types of benign melanocytic naevus

A

junctional
compound
intradermal

26
Q

what is the colour, level and risk of malignant transformation for each type of benign melanocytic naevus

A

junctional

  • black
  • epidermis
  • very rare

compound

  • brown
  • deep epidermis
  • mid rare

intradermal

  • grey - papillary dermis
  • blue - dermis
  • rare
27
Q

what are the early signs of malignant transformation of benign melanocytic naevus

A 
A Asymmetry
B Border (irregular)
C Colour (variegated)
D Diameter (>6mm)
E Evolving (growing)

Concerning signs (suggesting nodular MM)
E Elevated
F Firm to touch
G Growing

28
Q

what are the characteristics and treatment of benign pyogenic granuloma

A

Fast growing, highly vascularised granuloma

May follow surgery, infection, trauma

Erythematous pedunculated mass

excision

29
Q

what are the characteristics and treatment of benign actinic keratosis

A

Common pre-malignant condition, though relatively rare on eyelids

Flat, scaly, hyperkeratotic skin, occasionally forms cutaneous horn

Related to sun exposure

excision or medical treatment

30
Q

what are the characteristics and treatment of benign keratoacanthoma

A

Rare, ‘squamous cell carcinoma in-situ’

Rapidly growing in otherwise healthy skin

Pink papule, hyperkeratotic crater

Sun exposure, immunosuppression

Often spontaneous involution after 2-3/12

excision

31
Q

what are the characteristics and treatment of benign capillary haemangioma

A

Although rare, one of the commonest tumours of infancy

Predilection upper lid +/- orbital extension

Amblyopia, astigmatism

Involution from age 2, 40% by 4, 70% by 7

β-blockers, intralesion steroid, surgery

32
Q

what are the characteristics and treatment of benign cavernous haemangioma

A

Rare, congenital

Well demarcated pink patch

Darkens with age, does not involute

Sturge-Weber

Laser

33
Q

what are the features of basal cell carcinoma

A

malignant
Slow, inexorable growth over months

Usually non-pigmented, elevated, ulcerated

Pearly, rolled, irregular border

Telangiectasia

Lack of tenderness

34
Q

what are the clinical subtypes of BCC

A

nodular
ulcerative
morpheaform/infiltrative

35
Q

what are the surgical treatments of BCC

A

Standard excision

  • Margin
  • Primary vs delayed closure

Mohs surgery

36
Q

what are the non-surgical treatments of BCC

A

Topical (imiquimod, efudex)

Chemotherapy (vismodegib) - Gorlin, Muir-Torre

Cryotherapy

Radiotherapy

Photodynamic therapy

37
Q

what are the characteristics and treatment for SCC

A

Sun damaged skin and pre-existing AK

Scaly surface over a thick plaque

Growth over weeks rather than months

Excision

38
Q

what are the characteristics and treatment of sebaceous gland carcinoma

A

Nodular, indurated lid margin

Yellowish discolouration (lipid content)

Pagetoid spread along conjunctiva

Excision

39
Q

what are the three type of malignant melanoma

A

lentigo maligna
superficial spreading
nodular

40
Q

how should a tumour biopsy be taken

A

Adequate size

Try to include area of normal tissue

Try not to crush or use excess cautery

Give histologist as much info. as possible

Suspected MM:
Excision biopsy with small margin

41
Q 
what are the excision margins for the following malignant eyelid tumours:
BCC
SCC
sebaceous gland carcinoma 
malignant melanoma
A

BCC - 2/3mm
SCC - 4mm
sebaceous gland carcinoma - 5-10mm
malignant melanoma - 10-30mm

42
Q

what are the benign orbital tumours

A

Capillary haemangioma

Cavernous haemangioma

Pleomorphic adenoma

Optic nerve glioma

43
Q

what are the malignant orbital tumours

A

lymphoma

metastatic regional spread

rhabdomyosarcoma

lacrimal gland sarcoma

osteosarcoma

liposarcoma

primary melanoma

NEURO (51 decks)

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