The Eye Flashcards
What is proptosis? What can it lead to?
Inc in orbital contents that displaces eye; can lead to corneal ulcers or infection from exposure to air
What are 2 orbital inflammatory diseases?
- Thyroid disease like Graves
- Idiopathic orbital inflammation
What happens to the eye in Graves disease?
Does this affect adipose tissue?
Enlargement of extraocular muscles w non-granulomatous inflammation
Note: Adipose tissue is NOT inflammed
What happens to the eye in idiopathic orbital inflammation/psuedotumor?
Does this affect adipose tissue?
Lymphocytes, plasma cells, eosinophils infiltrate
Orbital fat and tendons are replaced by fibrosis
What are the 3 things present in idiopathic orbital inflammation that differentiates it from Graves disease?
IOI will include eosinophils, adipose tissue (fibrosis), and chronic inflammatory cells
What causes orbital inflammatory disease? (3)
- Sinus infection that spreads to orbit esp in immunosuppressed or DKA pts
- Granulomatosis e polyangiitis (Wegners)
- Sarcoid: May produce bilateral granulomatous inflammation secondary to penetrating injury
What are 2 unique signs of sarcoid in orbital inflammatory disease?
- “Mutton fat” in anterior segment (keratic precipitates on cornea)
- “Candle wax drippings” on ophthalmic exam, perivascular inflammation of retina
Where does eye get dispalced when lacrimal gland is involved?
Inferiorly and medially
Two common neoplasms of the orbit?
Mostly vascular in origin
- Capillary hemangioma (infancy & early childhood)
- Cavernous hemangioma (adults)
What is blepharitis?
What is chalazion?
- Blepharitis: Chronic inflammation of eyelid margin
- Chalazion: Lipid extravasated into tissue provokes granulomatous response -> Lipogranuloma
Two common neoplasms of the eyelid?
- Basal cell carcinoma
- Sebaceous carcinoma
What is the most common malignant tumor of periocular skin?
Basal cell carcinoma
- More common in younger pts w sun-exposed skin
What are some characteristics of a BCC tumor?
- Pearly nodules
- Telangiectatic vessels
- Central ulcer
- Rolled edges
Common histo in BCC?
Nests of cells that show peripheral palisading
- Look for blue coloring below the epidermis
What is one way to differentiate between a chalazion and a sebaceous carcinoma?
Chalazion should not return after removal; if it does, think sebaceous carcinoma
How do sebaceous carcinomas spread?
What is a histo characteristic?
Rolls through BM and spreads in epidermis (intraepithelial or bowenoid spread)
Foamy cytoplasm
What stain would you use for a sebaceous carcinoma?
Oil Red O (fat stain)
Where are common sites of metastasis for a sebaceous carcinoma?
Regional lymph nodes, lung, liver, brain & skull
What will be histo characteristics of squamous cell carcinoma?
Full thickness atypia w loss of polarity and keratin pearls in substantia propria
What is a common type of lymphoma in the eye/conjunctiva?
B-cell lymphoma
Where is a common site of lymphatic spread w tumors in the eyelid or conjunctiva?
Parotid and submandibular nodes
Generally, what are pingueculas & pterygiums?
Submucosal elevations of the conjunctiva d/t actinic damage (sun)
Between pingueculas & pterygiums, which can lead to cancer
Pingueculas can lead to SCC or melanoma
Pterygium are unlikely to lead to cancers
Between pingueculas & pterygiums, which can impair vision?
Pterygiums can lead to visual impairment; encroaches on cornea in a wing-like fashion– excise when it threatens visual axis
Pingueculas do not lead to visual impairment