The Red Eye & Adnexal Oncology Flashcards
what is it likely to be if there is blurred vision, no/mild pain, no/pericorneal redness and no/minimal discharge?
uveitis
what is it likely to be if there is normal vision, no/itchy pain, diffuse/peripheral redness and yellow discharge?
bacterial conjunctivitis
what is it likely to be if there is normal vision, no/itchy pain, diffuse/peripheral redness and watery discharge?
viral conjunctivitis
what is it likely to be if there is normal vision, no/itchy pain, diffuse/peripheral redness and mucous discharge?
allergic conjunctivitis
what is it likely to be if there is normal vision, severe/boring pain, sectoral/diffuse redness and no discharge?
scleritis
what is it likely to be if there is lost vision, severe/headache pain, pericorneal redness and maybe discharge?
acute glaucoma
what is it likely to be if there is lost vision, severe/eye closing pain, pericorneal redness and maybe discharge?
keratitis/corneal ulcer
what is it likely to be if there is normal vision, severe/periocular pain, no redness and maybe discharge?
orbital cellulitis
what is uveitis
Inflammation in the eye
can be: Anterior, Posterior, Intermediate, Panuveitis
what are the causes of uveitis?
idiopathic
Associated with systemic disease
infection
Masquarade
what is the treatment of uveitis?
Infection:
Topical anti-inflammatories
Systemic steroid
Systemic immunosuppressants
what is scleritis?
inflammation of the sclera
what are the symptoms of acute angle-closure glaucoma?
Severe pain
Vomiting
Fixed, dilated pupil (non-responsive to light)
what are causes of a corneal ulcer?
infection, physical and chemical trauma, corneal drying and exposure, and contact lens overwear
what are features of preseptal cellulitis?
Pain, redness, lid swelling
Systemically well
what are common causes for preseptal cellulitis?
Lid cyst or insect bite
what are features of orbital cellulitis?
Pain, redness, lid swelling Systemically unwell Double vision/limitation in EOEM Conjunctivitis/chemosis Exophthalmos Blurred vision
what are common causes for orbital cellulitis?
Sinusitis / dental infections
Haematological spread
how common are eyelid tumours?
Very common
Up to 20% of Caucasians in their lifetime
how common are Lacrimal drainage tumours?
Vanishingly rare
lacrimal gland tumours are considered to be orbital
how common are orbital tumours?
Very rare
2/3 benign, 1/3 malignant
describe Squamous Cell Papilloma
most common benign eyelid tumour
Pedunculated or sessile (broad-based)
Characteristic ‘raspberry’ texture
Usually viral
describe Basal Cell Papilloma (Seborrhoeic keratosis)
benign eyelid tumour
Greasy, brown, flat, round/oval
Similar texture to squamous cell papilloma
‘Stuck on’ appearance
what are Melanocytic Naevus?
benign eyelid tumour
Composed of atypical melanocytes
Location of these melanocytes influences clinical appearance and potential for malignant transformation
what are early signs of malignant transformation?
Asymmetry Border (irregular) Colour (variegated) Diameter (>6mm) Evolving (growing)
what are concerning signs that suggest nodular malignant melanoma?
Elevated
Firm to touch
Growing
describe Pyogenic granuloma
benign eyelid tumour
Fast growing, highly vascularised granuloma
May follow surgery, infection, trauma
Erythematous pedunculated mass
describe Actinic Keratosis
Common pre-malignant condition, though relatively rare on eyelids
Flat, scaly, hyperkeratotic skin, occasionally forms cutaneous horn
Related to sun exposure
describe Keratoacanthoma
Rare, ‘squamous cell carcinoma in-situ’ Rapidly growing in otherwise healthy skin Pink papule, hyperkeratotic crater Sun exposure, immunosuppression Rx Excision
describe Capillary haemangioma
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
describe Cavernous haemangioma
Rare, congenital
Well demarcated pink patch
Darkens with age, does not involute
Sturge-Weber
what is the common treatment of benign eyelid tumours?
Rx Excision or laser ablation
describe basal cell carcinoma
Commonest cancer worldwide
can occur on the eyelid
malignant
what features suggest basal cell carcinoma?
Slow, inexorable growth over months Usually non-pigmented, elevated, ulcerated Pearly, rolled, irregular border Telangiectasia Lack of tenderness
what is the management of basal cell carcinoma?
Standard excision (Margin required) Mohs surgery Non-surgical: Topical Chemotherapy Cryotherapy Radiotherapy Photodynamic therapy
describe squamous cell carcinoma
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%
describe Sebaceous Gland Carcinoma
Malignant eyelid tumour
Nodular, indurated lid margin
Yellowish discolouration (lipid content)
Pagetoid spread along conjunctiva, map biopsy
how common is malignant melanoma on the eyelids?
Rare on the eyelids
