Signs and Symptoms Flashcards
Prolapsed orbital fat
Asymptomatic, unless causing lid malposition/exposure keratopathy
Preseptal cellulitis
Entire eyelid edema, erythema, ptosis, warmth, no pain to mild tenderness, hard bump on eyelid. NO orbital congestion, no reduced vision, no fever
Orbital cellulitis
Red eye, pain, decreased vision, headache, fever, general malaise, decreased colour vision, APD, proptosis, diplopia, pain on EOMs due to restriction
Thyroid eye disease
Prominent eyes (u/l or b/l proptosis), chemosis, FBS, tearing, photophobia, pain, diplopia, decreased vision, colour vision loss, upper lid retraction (Dalrymple sign), lagophthalmos (dry eye), SPK, eyelid erythema and edema, conj injection and edema, EOM restriction, APD, IOP may be elevated.
Thyroid eye disease grading system:
N - no signs or symptoms
O - only signs but no symptoms
S - soft tissue involvement (lid edema, chemosis, etc.)
P - proptosis
E - EOM involvement (IR usually affected first, IMSL)
C - corneal involvement (SPK, ulceration)
S - sight loss due to optic nerve compression
Von Graefe sign
Upper eyelid lag during downgaze
Kocher sign
Globe lag compared to lid movement when looking up
Carotid Cavernous Fistula
Triad: chemosis, pulsatile proptosis, ocular bruit
Other signs - episcleral venous congestion, periorbital tissue swelling, elevated IOP, diplopia (from CN 3,4,6 palsy), loss of lid/face sensation on the affected side (CN5 palsy)
Capillary hemangioma
Superficial vascular lesion (strawberry nevus) with rapid growth. Can cause proptosis and deprivation amblyopia if visual axis blocked.
Cavernous hemangioma
Painless progressive blurry vision, u/l proptosis, possible diplopia, can lead to compressive optic neuropathy, choroidal folds, and hyperopic shift. Vascularized benign growth which CT will show as a well-defined intracranial mass that does not invade surrounding structures but may displace them.
Dermoid cyst
Commonly located superior-temporally at the zygomaticofacial suture, painless, smooth palpable choriostoma comprised of a fibrous wall which encases sebaceous glands, sweat glands, and hair follicles. (Normal tissue in an abnormal location)
Diplopia, ptosis, proptosis can occur
Neurofibroma
Benign, yellow-white tumour of astrocytes, usually in superior orbit, can be isolated, multiple, u/l or b/l
Rhabdomyosarcoma
Rapid, bone-destructing tumour often superonasally, that causes progressive unilateral proptosis. Eyelid discolouration and edema. Headaches, sinusitis and nose bleeding if involving sinus.
Neuroblastoma
Acute onset of u/l or b/l superior orbital mass, proptosis, and eyelid ecchymosis “raccoon eyes”. CT shows evidence of bony erosion
Orbital pseudotumour / idiopathic orbital inflammatory syndrome
Acute “explosive” onset of unilateral pain, red eye, diplopia, swollen eyelids, blur/decreased vision. Bilateral involvement may occur in children (30% of cases) and half of affected children will have fever, nausea, vomiting.
Lid ptosis, periorbital swelling (hyperopic shift), lacrimal gland enlargement, u/l conjunctival chemosis, reduced corneal sensation, increased IOP on involved side, optic nerve swelling, EOM restrictions and proptosis.
Tolosa-Hunt syndrome
Acute and painful exophthalmoplegia and diplopia due to ipsilateral palsies of CN3,4,6 and loss of sensory innervation due to damage to V1 and V2
Phthisis bulbi
Shrinkage and atrophy of the globe as a result of trauma, infection, surgery, or advanced disease
Assoc w/hypotony, inflammation, blind eye
Ocular rosacea
Redness, burning, FBS, ocular irritation, characterized by papules on the cheek and forehead with telangiectasia, rhinophyma, and facial flushing. Lid disease, MGD, blepharitis, hordeola, chalazia, OSD, SPK, corneal neo inferiorly, dry eye syndrome
Contact dermatitis
Acute periorbital swelling, redness, itching, tearing, u/l or b/l erythema and crusting of the lid, significant conjunctival chemosis
Ocular cicatricial pemphigoid
Sub-acute onset of nonspecific symptoms including redness, dryness, FBS, and/or decreased vision. Conj fibrosis, scarring (seen as fine white striae), bilateral symblepharon, ankyloblepharon, and stretched inferior fornices due to shortening of the conj tissue
Stevens-Johnson syndrome
Acute - systemic prodrome of fever, malaise, headache, nausea, vomiting, followed by skin lesions (diffuse erythema or classic target/bulls eye, and papules on palms and soles), ocular lesions are severe bilateral diffuse conjunctivitis assoc. w/pseudomembranes, can progress to endophthalmitis in severe cases
Chronic - entropion, ectropion, trichiasis, meibomian gland damage, symblepharon, foreshortening or the fornices, conj keratinization, limbal stem cell damage, corneal pathology (scars, ulcers, perforation)
Blepharitis
Often asymptomatic, may have blur that clears after blinking, burning, itching, FBS, tearing, crusting and mild discharge. Seborrheic blepharitis has oily, greasy scales with flaking, and more eyelash loss or misdirected growth compared to staph blepharitis which has more inflammation
Chalazia
Hard painless immobile nodule without redness that is most commonly located on the upper lid, typically asymptomatic
Hordeolum
Tender, red, warm area of focal swelling on lid
Inclusion cyst
Congenital or acquired lesion (secondary to trauma or surgery) found on the lid and surrounding adnexal tissue that often appears white due to the accumulation of keratinous debris
Milia
Acquired lesion found on the lid and surrounding skin that may appear white and is due to occlusion of sweat pores or pilosebaceous follicles
Sebaceous cyst
Retention of fluid in glands of Zeis or retention of debris in the meibomian glands. Usually solitary smooth lesions that are yellow or opaque
Ectropion
Exposure keratopathy, epiphora, brow ptosis
Floppy Eyelid syndrome
Chronic bilateral red eyes in the morning often with mild mucus discharge. Chronic papillary conjunctivitis with loose upper lids that evert easily, PEK (50%), keratoconus
Benign essential blepharospasm
Involuntary, sustained, repetitive bilateral twitching and/or forceful closure of the eyelids that is less common during sleep. Spasms of orbicularis oculi, procerus,and corrugator
Basal cell carcinoma
Varies in appearance, most commonly presents as a shiny, firm pearly nodule with superficial telangiectasia. If not caught, can progress to central ulceration “rodent ulcer”. Most commonly on lower eyelid and medial canthus
Squamous cell carcinoma
Variable presentations, often appear similar to BCC but WITHOUT surface telangiectasia, classically described as an erythematous plaque that appears rough, scaly, and/or ulcerated and may be flat or elevated. Most commonly located on the lower eyelid or lid margin
Sebaceous gland carcinoma
Varies, the tumour is often hard and yellow. Assoc w/madarosis,thickened and red lid margins (most common on upper lid), and lymphadenopathy
Malignant melanoma
Characteristics that increase suspicion: Asymmetry, Border irregularity, Colour differences (uneven pigmentation), Large diameter, Enlargement of the lesion
Most important prognostic factors are depth of invasion and size of the lesion
Dacryoadenitis
Swelling of the outer 1/3 of the temporal upper eyelid (region near the lacrimal gland), acute - classically presents with an S-shaped ptosis, temporal upper eyelid pain, redness, swelling, preauricular lymphadenopathy, an occasional fever, and elevated WBC count. Chronic - presents as temporal upper lid swelling with less redness, swelling, and pain compared to acute. Chronic may lead to inferno nasal globe displacement and proptosis.
Canaliculitis
Smouldering, unilateral red eye often unresponsive to antibiotics, often misdiagnosed as recurrent conjunctivitis. Tenderness over the nasal portion of the upper or lower eyelid, a swollen puncta “pouting puncta”, dacryoliths, and mucopurulent discharge that occurs with palpation over the lacrimal sac region
Dacryocystitis
Swelling below the medial canthal tendon, (swelling above the medial canthal tendon is suspicious for lacrimal sac tumour), pain, often with crusting and tearing, occasional fever, prominent edema and tenderness over the lacrimal sac area. Typically more swelling and tenderness than canaliculitis.
Nasolacrimal duct obstruction
Unilateral tearing, discharge, crusting, and recurrent conjunctivitis. Epiphora, mucus reflex from the puncta after compression of the lacrimal sac, medial lower eyelid erythema, and mild to no redness or tenderness around the puncta.
Conjunctival cyst
common, benign, fluid-filled (typically clear) sac on the conjunctiva that may cause irritation, also referred to as an inclusion or retention cyst
Conjunctival concretions
superficial, whitish-yellow deposits of mucous secretions and epithelial cells in the palpebral conjunctiva. Also called ocular lithiasis
Conjunctival nevus
rare, benign proliferation of melanocytes that presents 10-20yo, typically unilateral, solitary, flat (or slightly elevated), freely mobile, occasionally non-pigmented (30%). Inclusion cysts within the lesion are diagnostic for a conj nevus. Most common location is the juxtalimbal area followed by plica and caruncle
Primary Acquired Melanosis (PAM)
unilateral acquired pigmentation with indistinct margins, usually flat, benign but has premalignant potential, 30% progress to malignant melanoma. Nodular lesions with increased vascularity or growth are most suspicious. Biopsy!
Conjunctival melanoma
uncontrolled proliferation of melanocytes, pigmented or non-pigmented, most arise from PAM, most suspicious factor is thickness/elevation
Conjunctival intraepithelial neoplasia (CIN)
can vary, most commonly is a unilateral, elevated, gelatinous mass with neo, 95% found at limbus within interpalpebral fissure, “hair pin” vessels
Conjunctival squamous cell carcinoma (SCC) / OSSN
rare, slow-growing, malignant tumor found at limbus, may involve adjacent cornea, commonly contains a feeder vessel
Pyogenic granuloma
pedunculated, benign, red, vascular lesion of the palpebral conj that results from trauma, sx, chalazion, or other chronic irritation
conjunctival granuloma
inflamed area (white, yellow, or brown) located within the conj stroma that results from retained foreign bodies, sx, trauma, infections, or assoc systemic conditions (sarcoid)
asymptomatic or FBS and irritation
Simple bacterial conjunctivitis
acute onset of redness, usually begins in one eye then spreads to the other, FBS, mucopurulent discharge, PAL rare
gonococcal conjunctivitis
hyperacute onset of severe purulent discharge, redness, FBS, chemosis often w/pseudomembranes, severe papillary reaction, (+) preauricular lymphadenopathy, tender and swollen eyelids. peripheral corneal ulceration in severe cases.
adenoviral conjunctivitis
recent cold/URI, FBS, itching, burning, gritty feeling, serous discharge, diffuse hyperemia/redness, +PAL, lid edema, follicles and pseudomembranes.
PCF will also have fever and sore throat
And EKC will have bilateral central SEIs 2-3wks after infection onset and severe pain
Molluscum contagiosum
single or multiple dome-shaped, umbilicated, waxy nodules located on the lid or lid margin. Rupture of nodule can lead to chronic follicular conjunctivitis and superficial pannus
Allergic conjunctivitis
conj chemosis, papillae, itching, tearing, watery discharge (can be ropey)
Vernal keratoconjunctivitis
intense itching, photophobia, ptosis, thick mucus discharge, initial outbreak most severe. bilateral prominent papillae, cobblestone papillae (upper palp conj) or Trantas dots on the limbus. Can have corneal involvement with PEK -> large erosions, and eventually shield ulcer
Atopic keratoconjunctivitis
bilateral itching of eyelids, watery discharge, redness, photophobia, pain. Prominent outer eyelid (thickened, swollen), Dennie’s lines, “atopy shiners”, papillae are more prominent inferiorly, can lead to corneal neo, cataracts (10%), and KCN (from itching), symblepharon may also form in inferior fornices in severe cases and mimic OCP
Follicular reaction
CHAT - chlamydia, herpes, adenovirus, toxicity
papillae vs. follicles
papillae - inflamed areas of elevated conj that contain a central vessel, infiltration of eosinophils, mast cells, neutrophils and lymphocytes. non-specific sign of inflammation
follicles - avascular, white/gray nodules in tarsal and fornix conj, immature lymphocytes and macrophages in center of nodule, assoc. w/ CHAT
GPC
itching, scant mucus discharge (early) or ropy mucus discharge (later), decreased CL wear time, photophobia. Mild to severe papillae of the upper palp. conj, ptosis, mucus in eye and on CL. papillae > 0.3mm in diameter, giant is >1.0mm when they coalesce
Solution hypersensitivity/toxicity
recent switch to new solution, severe reactions most commonly to chlorhexidine or thimerosal, redness/burning after CL insertion, reduced CL wear time, follicular conjunctivitis, diffuse conj injection, diffuse SPK
Corneal warpage
initially patients often report that vision is clear in CLs but blurry in glasses, also complain of ghost images or diplopia. irregular astigmatism, can mimic KCN (high riding lens causes inferior steepening of cornea over time)
