Week 2 - C Ophthamology 2 - (pre)Orbital cellulits, endopthalmitis, papilloedema etc

Question 1

Is orbital or preseptal cellulitis life threatening?

Answer 1

Orbital cellulitis is life threatening

Question 2

In pre septal cellulitis, what is infected?

Answer 2

Infection of the eyelids and structures anterior to the septum (septum merges with tarsal plates)

Question 3

What is a key factor in orbital cellulitis vs preseptal cellulitis? (movement of eye)

Answer 3

* In orbital cellulitis movement of the eye is associated with severe pain

* In preseptal cellulitis movement of the eye is not associated with pain

Orbital signs (pain on movement of the eye, restriction of eye movements, proptosis, visual disturbance, chemosis, RAPD) must be absent in preseptal cellulitis - their presence would indicate orbital cellulitis

Question 4

In a patient presenting with a rapid onset of temperature, per-ocular swelling and pain, What do you think?

Answer 4

Orbital cellulitis

Question 5

Patient presents with diminished vision, extreme pain and temperature with eyeball proptosis, What is this?

Answer 5

Orbital cellulitis

Question 6

Patient presents with eye lid swelling and redness, low grade fever and malaise. What is the diagnosis? A – Orbital cellulitis B – Orbital bruising C – Sinusitis D – Meniere’s syndrome E – Pre-septal cellulitis

Answer 6

E - Preseptal cellulitis

Usually no pain with eye movement but eyelid swelling is present

Question 7

What type of scan do you take in orbital cellulitis to identify any orbital abscess from sinus?

Answer 7

CT scan

Question 8

What are the most common types of causes of orbital cellultiits?

Answer 8

Streptococcus species,

staphylococcus species and

haemophilus influenza B

are the most common causative organisms

Question 9

What is the most likely cause of orbital cellulitis?

Answer 9

Direct extension from the paranasal sinuses (particularly the ethmoidal air cells)

Question 10

What is the treatment of pre-septal cellulitis?

Answer 10

Oral antibiotics are frequently sufficient - usually co-amoxiclav

Question 11

What is the antibiotic treatment of orbital cellulitis?

Answer 11

Ceftriaxone IV 2g bd + Flucloxacillin IV 2g qds + Metronidazole IV 500mg tds

Question 12

• Devastating infection inside of the eye • Post-surgical or endogenous • Painful +++, with decreasing vision • Very red eye • Sight threatening What is this?

Answer 12

This is endophthalmitis

Question 13

What surgery most commonly can cause endophthalmitis as it gives opportunity for conjunctival commensals to enter the inner eye? What is the main commensal which is the main cause of endophthalmitis?

Answer 13

Cataract surgery is the most common surgery

Main cause of endophthalmitis is staph epidermis

Question 14

What is the treatment of endophthalmitis?

Answer 14

Intravitreal amikacin and vancomycin or Intraviteral ceftazidime and vancomycin

Question 15

What type of drug is amikacin and what type of drug is vancomycin?

Answer 15

Amikacin - aminoglycoside

Vancomycin - glycopeptide

Question 16

Name one other glycopeptide apart from vancomycin

Answer 16

Teicoplanin

Question 17

Toxoplasmosis chorioretinitis (more commonly known as toxoplasmosis) is caused by what organism?

Answer 17

Caused by toxoplasmosis gondii

Undercooked meat or cat faeces

Question 18

Usually the immune system can deal with toxoplasmosis but it can affect the immunocompromised What other condition can chorioretinitis be associated with in AIDS?

Answer 18

Assoicating with Cytomegalovirus (CMV)

Question 19

What is inflammation of the lacrimal sac known as?

Answer 19

This is known as dacrocystitis

Question 20

What is the usual cause of dacrocystitis?

Answer 20

Nasolacrimal duct obstruction

Question 21

What may dacrocytitis predispose to?

Answer 21

May predispose to orbital cellulitis

Question 22

Which Le Fort fracture may interrupt the nasolacrimal duct?

Answer 22

Le Fort fracture 1 may interrupt the nasolacrimal duct by damaging the opening into the inferior meatus

Question 23

If there is a nasolacrimal duct obstruction, this may cause the infection to gather at the corner of the eye This could cause a swelling What is this dacrocystitis known as here?

Answer 23

Canaliculitis - where the infection is at the canaliculi

Question 24

What is optic nerve swelling due to raised intracranial pressure known as?

Answer 24

this is papilloedema

Question 25

• All patients with bilateral optic disc swelling should be suspected of having raised ICP should be suspected of what? When looking with ophthalmoscopy, what do you see on the fundus in papilloedema?

Answer 25

Suspected of a space occupying lesion (SOL)

Swollen optic disc, not well circumscribed with undefined margins

Loss of major vessels coming from the disc

Question 26

Subarachnoid space (SAS) around optic nerve (ON) continuous with subarachnoid space surrounding the brain When intracranial pressure increases, this is transmitted to the SAS then to the ON What are symptoms of papilloedema?

Answer 26

Patient presents with blurred vision, loss of colour vision and headaches

Question 27

Cranial nerve II is assessed with a fundoscopy as one of the examination ways How else is it assessed?

Answer 27

Visual acquity - snellen chart

Pupil reflex - direct, accomodation and swinging light reflex

Visual fields - all 4 quadrants

Colour vision - using ischira plates

Question 28

Why must blood pressure be checked in somebody presenting with papilloedema?

Answer 28

As papilloedema can be caused due to malignant hypertension