The Red Eye & Adnexal Oncology

Question 1

what is it likely to be if there is blurred vision, no/mild pain, no/pericorneal redness and no/minimal discharge?

Answer 1

uveitis

Question 2

what is it likely to be if there is normal vision, no/itchy pain, diffuse/peripheral redness and yellow discharge?

Answer 2

bacterial conjunctivitis

Question 3

what is it likely to be if there is normal vision, no/itchy pain, diffuse/peripheral redness and watery discharge?

Answer 3

viral conjunctivitis

Question 4

what is it likely to be if there is normal vision, no/itchy pain, diffuse/peripheral redness and mucous discharge?

Answer 4

allergic conjunctivitis

Question 5

what is it likely to be if there is normal vision, severe/boring pain, sectoral/diffuse redness and no discharge?

Answer 5

scleritis

Question 6

what is it likely to be if there is lost vision, severe/headache pain, pericorneal redness and maybe discharge?

Answer 6

acute glaucoma

Question 7

what is it likely to be if there is lost vision, severe/eye closing pain, pericorneal redness and maybe discharge?

Answer 7

keratitis/corneal ulcer

Question 8

what is it likely to be if there is normal vision, severe/periocular pain, no redness and maybe discharge?

Answer 8

orbital cellulitis

Question 9

what is uveitis

Answer 9

Inflammation in the eye

can be: Anterior, Posterior, Intermediate, Panuveitis

Question 10

what are the causes of uveitis?

Answer 10

idiopathic
Associated with systemic disease
infection
Masquarade

Question 11

what is the treatment of uveitis?

Answer 11

Infection:
Topical anti-inflammatories
Systemic steroid
Systemic immunosuppressants

Question 12

what is scleritis?

Answer 12

inflammation of the sclera

Question 13

what are the symptoms of acute angle-closure glaucoma?

Answer 13

Severe pain
Vomiting
Fixed, dilated pupil (non-responsive to light)

Question 14

what are causes of a corneal ulcer?

Answer 14

infection, physical and chemical trauma, corneal drying and exposure, and contact lens overwear

Question 15

what are features of preseptal cellulitis?

Answer 15

Pain, redness, lid swelling

Systemically well

Question 16

what are common causes for preseptal cellulitis?

Answer 16

Lid cyst or insect bite

Question 17

what are features of orbital cellulitis?

Answer 17

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

Question 18

what are common causes for orbital cellulitis?

Answer 18

Sinusitis / dental infections

Haematological spread

Question 19

how common are eyelid tumours?

Answer 19

Very common

Up to 20% of Caucasians in their lifetime

Question 20

how common are Lacrimal drainage tumours?

Answer 20

Vanishingly rare

lacrimal gland tumours are considered to be orbital

Question 21

how common are orbital tumours?

Answer 21

Very rare

2/3 benign, 1/3 malignant

Question 22

describe Squamous Cell Papilloma

Answer 22

most common benign eyelid tumour
Pedunculated or sessile (broad-based)
Characteristic ‘raspberry’ texture
Usually viral

Question 23

describe Basal Cell Papilloma (Seborrhoeic keratosis)

Answer 23

benign eyelid tumour
Greasy, brown, flat, round/oval
Similar texture to squamous cell papilloma
‘Stuck on’ appearance

Question 24

what are Melanocytic Naevus?

Answer 24

benign eyelid tumour
Composed of atypical melanocytes
Location of these melanocytes influences clinical appearance and potential for malignant transformation

Question 25

what are early signs of malignant transformation?

Answer 25

Asymmetry
Border (irregular)
Colour (variegated)
Diameter (>6mm)
Evolving (growing)

Question 26

what are concerning signs that suggest nodular malignant melanoma?

Answer 26

Elevated
Firm to touch
Growing

Question 27

describe Pyogenic granuloma

Answer 27

benign eyelid tumour
Fast growing, highly vascularised granuloma
May follow surgery, infection, trauma
Erythematous pedunculated mass

Question 28

describe Actinic Keratosis

Answer 28

Common pre-malignant condition, though relatively rare on eyelids
Flat, scaly, hyperkeratotic skin, occasionally forms cutaneous horn
Related to sun exposure

Question 29

describe Keratoacanthoma

Answer 29

Rare, ‘squamous cell carcinoma in-situ’
Rapidly growing in otherwise healthy skin
Pink papule, hyperkeratotic crater
Sun exposure, immunosuppression
Rx  Excision

Question 30

describe Capillary haemangioma

Answer 30

Although rare, one of the commonest tumours of infancy
Predilection upper lid +/- orbital extension
Amblyopia, astigmatism
many resolve on their own by 2 or 7

Question 31

describe Cavernous haemangioma

Answer 31

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

Question 32

what is the common treatment of benign eyelid tumours?

Answer 32

Rx Excision or laser ablation

Question 33

describe basal cell carcinoma

Answer 33

Commonest cancer worldwide
can occur on the eyelid
malignant

Question 34

what features suggest basal cell carcinoma?

Answer 34

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

Question 35

what is the management of basal cell carcinoma?

Answer 35

Standard excision (Margin required)
Mohs surgery
Non-surgical:
Topical 
Chemotherapy 
Cryotherapy
Radiotherapy
Photodynamic therapy

Question 36

describe squamous cell carcinoma

Answer 36

Malignant eyelid tumour
Sun damaged skin and pre-existing AK
Scaly surface over a thick plaque
Growth over weeks rather than months
Metastatic risk of 3-10%

Question 37

describe Sebaceous Gland Carcinoma

Answer 37

Malignant eyelid tumour
Nodular, indurated lid margin
Yellowish discolouration (lipid content)
Pagetoid spread along conjunctiva, map biopsy

Question 38

how common is malignant melanoma on the eyelids?

Answer 38

Rare on the eyelids