The Red Eye & Adnexal Oncology Flashcards
What is Uveitis
inflammation of the middle layer of the eye, called the uvea or uveal tract
What is involved in the uveal tract
The uveal tract includes the iris, the ciliary body, choroid, retina and blood vessels
What is a serious inflammation of the uveal tract called
Panuveitis
What is the presentation of uveitis
Pain - none/mild
Redness- pericorneal/none
Discharge - minimal/no
Vision - blurred
What is the causes of uveitis
Idiopathic
Associated with systemic disease
Infection
Masquerade
o Intraocular lymphoma
o Leukaemia
What systemic disease is uveitis associated with
Ankylosing spondylitis
Behcet’s disease
Sarcoidosis
Wegener’s
Systemic lupus erythematosis
What infections is uveitis associated with
TB
Syphilis
Toxoplasma
Heres simplex
Lyme’s disease
CMV
What is the treatment for uveitits
Treat infection
Topical anti inflammatories
Systemic steroids
Systemic immunisuppressants
What is the symptoms of acute angle closure glaucoma
Severe pain
Vomiting
Fixed, dilated pupil
What is the presentation of acute angle closure glaucoma
Pain: Severe/headache
Redness: Pericorneal
Discharge: Yes/no
Vision: Lost
What is the cause of acute angle closure glaucoma
caused by a rapid or sudden increase in intraocular pressure (IOP)
What is the signs of acute angle closure glaucoma
Mid- dilates pupil
Non responsive to light
Hard eye
What is the presentation of Bacterial conjunctivitis
Pain: None/itch
Redness: Peripheral/diffuse
Discharge: Yes/yellow
Vision: Blurred
What is the presentation of Bacterial conjunctivitis
Pain: None/itch
Redness: Peripheral/diffuse
Discharge: Yes/yellow
Vision: normal
What is the presentation of viral conjunctivitis
Pain: None/itch
Redness: Peripheral/diffuse
Discharge: Yes/watery
Vision: normal
What is the presentation of allergic conjunctivitis
Pain: None/itch
Redness: Peripheral/diffuse
Discharge: Yes/mucous
Vision: normal
What is the presentation of scleritis
Pain: Severe/boring
Redness: Sectoral/diffuse
Discharge: No
Vision: Normal
What occurs in scleritis
serious inflammatory disease that affects the white outer coating of the eye, known as the sclera.
What is the presentation of corneal ulcer (open sore on the cornea)
Pain: severe
Redness: Pericorneal
Discharge: yes/no
Vision: lost
What is symptoms and signs of preseptal cellulitis
Pain
Redness
Lid swelling
Systemically unwell
What is common causes of perceptual cellulitis
Lid cyst
Insect bite
What is the signs of orbital cellulitis
Pain, redness, lid swelling
Systemically unwell
Double vision
Conjunctivitis
Exophthalmos
Blurred vision
What is the common causes for orbital cellulitis
- Sinusitis
- Dental infections
- Haematological spread
What is orbital cellulitis
is inflammation of eye tissues behind the orbital septum
What are systemic diseases than can have ophthalmic presentations
Diabetes
Hypertension
Autoimmune
- Graves disease
- rheumatoid arthritis
- myaesthenia gravis
Inflammatory
- Ankylosing spondylitis
- Crohn’s disease
- Juvenile idiopathic arthritis
- Sarcoidosis
Infection
Heamatological
Inherited/genetic
- Albinism
- Marfan’s
- Myotonic dystrophy
- Neurofibromatosis
Thyroid eye disease
Name eight benign eyelid tumours
Squamous cell papilloma (commonest) Basal cell papilloma (seborrhoeic keratosis) Melanocytic naevus Actinic keratosis Pyogenic granuloma Keratoacanthoma Capillary haemangioma Cavernous haemangioma (rarest)
Name six malignant eyelid tumours
Basal cell carcinoma (90-95%)
Squamous cell carcinoma (2-5%)
Sebaceous gland carcinoma (1-2%)
Melanoma (<1%)
Kaposi sarcoma (<1%)
Merkel cell carcinoma (<1%)
What is the presentation of sqaumaous cell papilloma
Pedunculated or sessile (broad-based)
Characteristic ‘raspberry’ texture
Usually viral
How are squamous cell papilloma benign eyelid tumours treated
Excision or laser ablation
What is the presentation of basal cell papilloma
Greasy, brown, flat, round/oval
Similar texture to squamous cell papilloma
‘Stuck on’ appearance
(Unrelated to sun exposure)
How is basal cell papilloma treated
Excision
What is the presentation of mealoncytic naveus benign eye lid tumours
Composed of atypical melanocytes
Location of these melanocytes influences
clinical appearance and potential for malignant transformation
What is early signs of malignant transformation in melanocytic naves
A Asymmetry
B Border (irregular)
C Colour (variegated)
D Diameter (>6mm)
E Evolving (growing)
Concerning (suggesting nodular MM)
E Elevated
F Firm to touch
G Growing
What is the presentation of pyogenic granuloma benign eyelid tumour
Fast growing, highly vascularised granuloma
May follow surgery, infection, trauma
Erythematous pedunculated mass
Treat - excision
What is the presentation of actinic keratosis
Common pre-malignant condition, though relatively rare on eyelids
Flat, scaly, hyperkeratotic skin, occasional forms cutaneous horn
Related to sun exposure
Treatment - excision or medical treatment
What is the presentation of keratocanthoma benign eyelid tumour
Rare, ‘squamous cell carcinoma in-situ’
Rapidly growing in otherwise healthy skin
Pink papule, hyperkeratotic crater
Sun exposure, immunosuppression
Often spontaneous involution after 2-3/12
Treatment excision
What is the presentation of capillary haemangioma benign eye lid tutor
Although rare, one of the commonest
tumours of infancy
Predilection upper lid +/- orbital extension
Amblyopia (dim vision), astigmatism
treatment
- B blockers
- intralesion steroid
- surgery
What is the presentation of cavernous haemangioma
Rare, congenital
Well demarcated pink patch
Darkens with age, does not involute
Treatment - Rx Laser
What is the presentation of basal cell carcinoma malignant eyelid tumour
Commonest cancer worldwide
Pale skin and sun exposure
Locally invasive, risk of metastasis
treat - Excision (2-3mm)
What are the features suggesting basal cell carcinoma
Slow, inexorable growth over months
Usually non-pigmented, elevated, ulcerated
Pearly, rolled, irregular border
Telangiectasia
Lack of tenderness
What is the 3 clinical subtypes of basal cell carcinoma
Nodular
- Common
- Classic firm pearly nodule
Ulcerative
- Common
- May progress from nodular
- Cycles of crusting and bleeding
Morpheaform/infiltrative
- Less common,
- Indurated plaques
What is the management of basal cel carcinoma
Standard excision (3mm margin)
Mohs surgery
Non-surgical
- Topical
- Chemotherapy
- Cryotherapy
- Radiotherapy
- Photodynamic therapy
What is the presentation of squamous cell carcinoma
Sun damaged skin and pre-existing AK
Scaly surface over a thick plaque
Growth over weeks rather than months
Metastatic risk of 3-10%
treatment - excision (4mm margin)
What is the presentation of sebaceous gland carcinoma
Nodular, indurated lid margin
Yellowish discolouration (lipid content)
Pagetoid spread along conjunctiva,
Treat - Excision (5-10mm)
What is the presentation of malignant melanoma
Rare on the eyelids
3 types of cutaneous MM
Treat -excision (10-30mm)
What is the three types of malignant melanoma and there presentations
Letingo maligna
- Flat variably pigmented macule
- Superficial spreading
- Slightly raised pigmented plaque
Nodular
- Vertically invasive
For what malignant eyelid tumours should you consider sentinel node biopsy
Sebaceous gland carcinoma
Malignnat melanoma
What should aslo be considered with squamous cell carcinoma
MRI
Abdomina Ultrasound
Name four benign orbital tumours
Capillary haemangioma
Cavernous haemangioma
Pleimorphic adenoma
Optic nerve glioma
Name seven malignant orbital tumours
Lymphoma
Metatatis
Phabdomysarcoma
Lacrimal gland sarcoma
Osterosarcoma
Liposarcoma
Primary melanoma
Where also can a rare tumour occur in the eye
Lacrimal drainage tumours
Are the majority of orbital tumours benign or malignant
2/3 benign
1/3 malignant
