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Ocular Disease > The Orbit > Flashcards

The Orbit Flashcards

1
Q

What are these signs of orbital disease?

A

Eyelid & periocular edema

Chemosis

Epibulbar injection

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2
Q

What is this sign of orbital disease?

A

Proptosis

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3
Q

What is orbital pulsation and what is it a clue too?

A

Cavernous sinus fistula, defect in orbital roof transmitted via CSF

It is a clue to orbital pathology

Example: Pulsating mires (normal usually)

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4
Q

What is this sign of orbital disease?

A

Dystopia (R inferior)

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5
Q

What is this sign of orbital disease?

A

Ophthalmoplegia (R hypotropia)

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6
Q

What are some clues to orbital pathology?

A

Orbital pulsation

Bruit

Choroidal folds

Disc Edema

Optic Atrophy

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7
Q

What is Ocular Auscultation?

A

Listen to eye for high pitched sounds or compare eyes to each other.

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8
Q
A

Preseptal Cellulitis

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9
Q

What is the presentation of preseptal cellulitis?

A

Red, edematous lids, tender

No proptosis, chemosis, vision change, pupillary involvement, fever or EOM restriction

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10
Q

What are the most common bacteria/viruses that cause preseptal cellulitis?

A

Bacteria: staph aureus, strep pyrogenes

Children: H influenza

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11
Q

What are some common causes of preseptal cellulitis?

A

Laceration, insect bite

Infection spread from hordeolum, dacryocystitis, sinusitis, conjunctivitis or URI

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12
Q

What is the treatment for preseptal cellulitis?

A

Daily Follow Up

Afebrile: Oral antibiotic for 10 days

Augmentin, Cefalcor, Bactrim

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13
Q

How should you treat a patient <5yo with moderate to severe preseptal cellulitis that is febrile and showing no improvement?

A

Send them to the hospital for IV antibiotics.

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14
Q

What is orbital cellulitis?

A

A life threatening infection of soft tissue behind the orbital septum

Children > Adults

Proptosis, Pain (EOM restriction), fever, malaise

Must be hospitalized immediately

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15
Q

What are some differentials to lid swelling?

A

Conjunctivitis

Dacryoadenitis

Dacryocystitis

Chalazion or hordeolum

Preseptal cellulitis

Orbital cellulitis

Tumor

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16
Q
A

Chalazion

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17
Q
A

Dacryoadenitis

18
Q

What is the most common form of dacryoadenitis?

A

Inflammatory dacryoadenitis

19
Q

What percent of dacryoadenitis lesions are idiopathic and how does it present?

A

50% of lesions

Acute or subacute with pain, erythema, dry eye, swelling

Unilateral 80% of the time

20
Q

What is the least common form of dacryoadenitis?

A

Neoplastic

21
Q

What are the common disease associated with inflammatory autoimmune dacryoadenitis?

A

Sarcoid

Sjogren’s

Wegener

22
Q

How is autoimmune dacryoadenitis different from idiopathic?

A

Painless swelling which is often bilateral

23
Q

What is the gold standard of diagnosis for non-infectious disease?

A

Biopsy

24
Q
A

Subconjunctival “salmon patch” extension from lymphocytic infiltration of the lacrimal gland

25
Q

What is a risk that can run when lymphocytic infiltration of the lacrimal gland?

A

Can go from a benign hyperplasia to malignant lymphoma

26
Q

What at the common infectious agents for infectious dacryoadenitis?

A

Typically Viral: Epstein Barr, mumps, adenovirus, Hzoster, Hsimplex, rhinovirus

Rarely Bacterial: Staph, MRSA, strep, Haemophilus, Gonorrhea

27
Q

How does infectious dacryadenitis present?

A

Pain, erythema, edema lateral upper lid “s” curve

Children and your adults typically

28
Q

How is viral infectious dacyroadenitis different from bacterial?

A

Viral = Bilateral 40%, Fever 25%

Bacterial = Unilateral, Afebrile

29
Q

How should you treat infectious dacryoadenitis?

A

Follow daily

Oral antibiotics

Hospitalize if moderate to severe

30
Q

What are some differentials if antibiotics are not working for infectious dacryoadenitis?

A

Viral (cold compresses & analgesic)

Idiopathic Orbital Inflammatory Disease (IOID)

Tumor

31
Q

What is Idiopathic Orbital Inflammatory Disease?

A

Orbital Pseudotumor, nonspecific orbital inflammatory dz

Afebrile

Orbital CT scan, blood tests

Improves dramatically w/ oral steroids

32
Q

What percent of hyperthyroidism patients have Grave’s Ophthalmopathy?

A

25-50%

Females 5:1

Majority have increased orbital fat &/or EOM volume

33
Q

What is a primary risk factor for GO in Grave’s?

A

Smoking

34
Q
A

Thyroid Ophthalmopathy

35
Q

What is Dalrymple’s sign?

A

Lid retraction

36
Q

What is Von Graefe’s sign?

A

Lid lag

37
Q

What are the chief complaints of a thyroid ophthalmopathy patient?

A

Dry, gritty

Blur

Tearing

Diplopia

Pressure sensation behind eye

Other vision loss if optic nerve involved

38
Q

How do you manage thyroid ophthalmopathy?

A

Lubrication

Topical anti-inflammatory agents

Sleep w/ head elevated to reduce periorbital edema

Tape eyelifs shut during sleep

39
Q

How do you manage Grave’s disease?

A

Endocrinologist

Treat exposure keratitis

Orbital decompression

40
Q

What is an alternative to orbital decompression?

A

Monoclonal antibodies to target B and T cel activation

Ocular Disease (7 decks)

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