red eye and adnexal oncology Flashcards
1
Q
Give a differential diagnosis for conditions that cause red eye
A
• Uveitis (inflammation in the eye) - No pain- mild pain - Pericorneal redness or none • Conjunctivitis (bacterial) - No pain to itchy - Peripheral or diffuse redness • Conjunctivitis - No pain to itchy - Peripheral or diffuse redness • Conjunctivitis (allergic) - No pain to itchy - Peripheral or diffuse redness • Conjunctivitis (all): Bulbar (eyeball) and palpebral (lid) can affect one or both • Sclerites - Sever/ boring pain - Sectoral/ diffuse redness • Acute glaucoma - Severe with a headache - Pericorneal redness • Keratitis/ corneal ulcer - Sever pain and eyes closing - Pericorneal redness • Corneal abrasion - Heals quickly
2
Q
Explain uveitis
A
- Symptoms: No pain- mild pain, pericorneal redness or none, minimal discharge/ none, blurred vision
- Causes: Idiopathic, associated with systemic disease (ankylosing spondylitis, Behcet’s disease, sarcoidosis, wegner’s, systemic lupus erythematosus) , infection (TB, syphilis, toxoplasma, herpes simplex, Lyme’s disease, CMV), masquerade (intraocular lymphoma, leukaemia)
- Treatment: treat infection, topical anti-inflammatories, systemic steroid, systemic immunosuppressants
3
Q
What are the symptoms of conjunctivitis?
A
- No pain to itchy
- Peripheral or diffuse redness
- Yellow discharge (bacterial)
- Watery discharge (idiopathic)
- Mucous discharge (allergic)
- Normal vission
4
Q
What are the symptoms of sclerites?
A
- Severe/ boring pain
- Sectional/ diffuse redness
- No discharge
- Normal vision
5
Q
What are the symptoms of acute glaucoma?
A
- Severe pain with a headache
- pericorneal redness
- Could have discharge but might not
- Vision is lost
- Fixed, dilated pupils
6
Q
What are the symptoms of a corneal ulcer?
A
- Severe pain and eyes closing
- Pericorneal redness
- Might have discharge
- Lost vision
7
Q
Explain preseptal cellulitis
A
- Features: Pain, redness, lid swelling, systemically unwell
- Causes: Lid cyst or insect bite
8
Q
Explain orbital cellulitis
A
- Features: Pain, redness, lid swelling, systemically unwell, double vision/ limitation in EOEM, conjunctivitis/ chemosis, exophthalmos, blurred vision
- Common causes: sinusitis, dental infections, haematological spread
9
Q
Describe some adnexal and orbital pathologies
A
• Eyelid tumours (very common) • Lacrimal drainage tumours (very rare) • Orbital tumours (very rare and most are benign) - Capillary haemangioma (benign) - Cavernous haemangioma (benign) - Pleomorphic adenoma (benign) - Optic nerve glioma (benign) - Lymphoma (malignant) - Metastatic regional spread (malignant) - Rhabdomyosarcoma(malignant) - Lacrimal gland carcinoma (malignant) - Osteosarcoma (malignant) - Liposarcoma (malignant) - Primary melanoma (malignant)
10
Q
Explain squamous cell papilloma
A
- Benign
- Pedunculated or sessile (broad-based)
- Characteristic “raspberry” texture
- Usually viral
- Treatment: Rx excision or laser ablation
11
Q
Explain basal cell papilloma
A
- Benign
- Greasy, brown, flat, round/oval
- Similar texture to squamous cell papilloma
- “stuck on” appearance
- Unrelated to sun exposure
- Treatment: Rx excision
12
Q
Explain pyrogenic granuloma
A
- Benign
- Fast growing, highly vascularised granuloma
- May follow surgery, infection, trauma
- Erythematous pedunculated mass
- Treatment: Rx excision
13
Q
Explain actinic keratosis
A
- Common pre-malignant condition, though relatively rare on eyelids
- Flat, scaly, hyperkeratotic skin, occasionally forms cutaneous horn
- Related to exposure to sunlight
- Treatment: Rx excision or medical treatment
14
Q
Explain keratoacanthoma
A
- Rare, “squamous cell carcinoma in-situ”
- Rapidly growing in otherwise healthy skin
- Pink papule, hyperkeratotic crater
- Sun exposure, immunosuppression
- Treatment: Rx excision
15
Q
Explain basal cell carcinoma
A
- Common
- Pale skin and sun exposure
- Features: Slow, inexorable growth over months; usually non-pigmented, elevated, ulcerated; pearly, rolled, irregular boarder; telangiectasia; lack of tenderness
- Nodular: common, classic firm pearly nodule
- Ulcerative: common, may progress from nodular, cycles of crusting and bleeding
- Morpheaform/ infiltrative: less common, indurated plaques
- Treatment: excision, Mohs surgery, topical (imiquimod, efudex), chemotherapy, radiotherapy, photodynamic therapy
