Week 5.1 - Common disorders of the orbit

Question 1

What is proptosis?

Answer 1

-Bulging eyelids

Question 2

Describe and explain CNIV palsy

Answer 2

• Loss of superior oblique

- Patient unable to look down and in without diplopia-> may have subtle head tilt to compensate

Question 3

Explain CNVI palsy

Answer 3

-Patient unable to abduct eye due to loss of abducens nerve

Question 4

Describe some signs and symptoms of orbital fractures

Answer 4

-Trauma, lid swelling, pain, diplopoa, reduced vision and restriction of movements, enophthalmos

Question 5

Which is the most common orbital fracture?

Answer 5

-Maxillary (floor)

Question 6

Describe the presentation of a maxillary orbital fracture

Answer 6

• Vertical diplopia due to restriction of upgaze
• Enophthalmos
• Infraorbital anaestesia

Question 7

Describe the presentation of a ethmoidal orbital fracture

Answer 7

• Rarely isolated
• Horizontal diplopia
• Surgical emphysema as air from nasal passage moves towards fracture

Question 8

Describe the presentation of a lateral orbital fracture

Answer 8

• Major injury

- Horizontal diplopia

Question 9

What is lid retraction?

Answer 9

-Pulling back of the eyelid -> can see sclera at top and bottom of iris at rest

Question 10

What is lid lag?

Answer 10

-Slowing of closing the eyelid when closing eye/looking down

Question 11

How does thyroid eye disease present?

Answer 11

-Proptosis, lid retraction, lidlag, restrictive myopathy, optic neuropathy

Question 12

What is restrictive myopathy?

Answer 12

-Enlarged eye muscles causes restriction of eye muscles

Question 13

What is optic neuropathy?

Answer 13

-Enlargemen of eye muscles causes compression of optic nerve

Question 14

How do you treat an urgernt thyroid eye disease referral?

Answer 14

-Admit, imaging and IV steroids

Question 15

What is orbital cellulitis? How does it present?

Answer 15

• cellulitis of the eyelid causing inflammation and discharge
• Fever, painful, proptosis, restricted eye movements,

Question 16

Name 2 differential diagnoses of orbital cellulitis

Answer 16

-Conjunctivitis, preseptal cellulitis

Question 17

What are the 3 most common catagories of orbital mass lesions?

Answer 17

• Inflamatory
• Cystic
• Vascular

Question 18

What is an orbital mass lesion?

Answer 18

-Swelling in or around the orbit

Question 19

What is dacryoadenitis?

Answer 19

-Lacrimal gland infection

Question 20

What is a mucocele?

Answer 20

-Collection of secretions caused by blockage of sinus openings

Question 21

What is a dermoid cyst?

Answer 21

• teretoma of cystic nature containing an array of mature tissues eg sebum/hair
• Usually painless and not harmful

Question 22

What is a capillary haemangioma?

Answer 22

-Vascular lesion of the orbit -> Abnormal proliferation of blood vessels during development which can be superficial or deep and are usually self-involuting

Question 23

What is a cavernous haemangioma?

Answer 23

-blood vessel malformation of adults which occurs within the eye which can lead to proptosis, restriction of movement and other visual problems

Question 24

Describe and explain the presentation of CNIII palsy

Answer 24

• Ptosis -> Loss of levator palpabrae superioris
• Dilated pupil (if parasymp involvement) -> loss of pupillae constrictor
• Down and out pupil -> loss of 4 of 6 extraocular muscles -> lateral rectus pulls out superior oblique pulls down
• Unable to adduct eye or look up
• Partially able to look down due to superior oblique