Red eye and adnexal oncology

Question 1

what are the causes of a red eye

Answer 1

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

Question 2

what is uveitis

Answer 2

inflammation of the vascular layers of the eye

Question 3

what are the different types of uveitis

Answer 3

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

Question 4

what are the causes of uveitis

Answer 4

idiopathic

associated with systemic disease - ankylosing spondylosis, sarcoidosis

Infection - TB, HSV, syphilis

Masquerade - intraocular lymphoma, leukaemia

Question 5

what are uveitis masquerade syndromes

Answer 5

a group of various ocular diseases that may mimic intraocular inflammation

Question 6

what is the treatment for uveitis

Answer 6

topical anti-inflammatories
systemic steroid
systemic immunosuppressants

Question 7

what is episcleritis/scleritis

Answer 7

inflammation of the eipsclera/ sclera

Question 8

what are the symptoms of acute angle closure glaucoma

Answer 8

severe pain
systemic symptoms - vomiting
fixed, dilated pupil

Question 9

how does preseptal cellulitis present

Answer 9

pain, redness, lid swelling, systemically unwell

Question 10

what are the common causes of preseptal cellulitis

Answer 10

lid cyst or insect bite

Question 11

how does orbital cellulitis present

Answer 11

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

Question 12

what are common causes of orbital cellulitis

Answer 12

sinusitis
dental infections
haematological spread

Question 13

what is the ophthalmic presentations of systemic disease

Answer 13

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

Question 14

what makes up the eye adnexa

Answer 14

orbit, eyelids, lacrimal drainage system

Question 15

what are the three types of adnexal oncology

Answer 15

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

Question 16

what is a tumour

Answer 16

abnormal proliferation tissue

Question 17

what are benign tumours

Answer 17

normal cells in abnormal numbers and or/location

cells lack the ability invade local tissue to to metastasise

slow growing, mass effect

Question 18

what are malignant tumours

Answer 18

anaplastic cells - loss of form or function

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

Question 19

what are the different types of malignant tumours

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

what are the characteristics and treatment of benign SC-papilloma

Answer 22

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

excision or laser ablation

Question 23

what are the characteristics and treatment of benign BC-papilloma

Answer 23

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

excision

Question 24

what are benign melanocytic naevus

Answer 24

atypical melanocytes

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

Question 25

what are the three types of benign melanocytic naevus

Answer 25

junctional compound intradermal

Question 26

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

Answer 26

junctional - black - epidermis - very rare compound - brown - deep epidermis - mid rare intradermal - grey - papillary dermis - blue - dermis - rare

Question 27

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

Answer 27

``` 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

Question 28

what are the characteristics and treatment of benign pyogenic granuloma

Answer 28

Fast growing, highly vascularised granuloma May follow surgery, infection, trauma Erythematous pedunculated mass excision

Question 29

what are the characteristics and treatment of benign actinic keratosis

Answer 29

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

Question 30

what are the characteristics and treatment of benign keratoacanthoma

Answer 30

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

Question 31

what are the characteristics and treatment of benign capillary haemangioma

Answer 31

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

Question 32

what are the characteristics and treatment of benign cavernous haemangioma

Answer 32

Rare, congenital Well demarcated pink patch Darkens with age, does not involute Sturge-Weber Laser

Question 33

what are the features of basal cell carcinoma

Answer 33

malignant Slow, inexorable growth over months Usually non-pigmented, elevated, ulcerated Pearly, rolled, irregular border Telangiectasia Lack of tenderness

Question 34

what are the clinical subtypes of BCC

Answer 34

nodular ulcerative morpheaform/infiltrative

Question 35

what are the surgical treatments of BCC

Answer 35

Standard excision - Margin - Primary vs delayed closure Mohs surgery

Question 36

what are the non-surgical treatments of BCC

Answer 36

Topical (imiquimod, efudex) Chemotherapy (vismodegib) - Gorlin, Muir-Torre Cryotherapy Radiotherapy Photodynamic therapy

Question 37

what are the characteristics and treatment for SCC

Answer 37

Sun damaged skin and pre-existing AK Scaly surface over a thick plaque Growth over weeks rather than months Excision

Question 38

what are the characteristics and treatment of sebaceous gland carcinoma

Answer 38

Nodular, indurated lid margin Yellowish discolouration (lipid content) Pagetoid spread along conjunctiva Excision

Question 39

what are the three type of malignant melanoma

Answer 39

lentigo maligna superficial spreading nodular

Question 40

how should a tumour biopsy be taken

Answer 40

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

Question 41

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

Answer 41

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

Question 42

what are the benign orbital tumours

Answer 42

Capillary haemangioma Cavernous haemangioma Pleomorphic adenoma Optic nerve glioma

Question 43

what are the malignant orbital tumours

Answer 43

lymphoma metastatic regional spread rhabdomyosarcoma lacrimal gland sarcoma osteosarcoma liposarcoma primary melanoma