Week 5.1 - Common disorders of the orbit Flashcards
What is proptosis?
-Bulging eyelids
Describe and explain CNIV palsy
- Loss of superior oblique
- Patient unable to look down and in without diplopia-> may have subtle head tilt to compensate
Explain CNVI palsy
-Patient unable to abduct eye due to loss of abducens nerve
Describe some signs and symptoms of orbital fractures
-Trauma, lid swelling, pain, diplopoa, reduced vision and restriction of movements, enophthalmos
Which is the most common orbital fracture?
-Maxillary (floor)
Describe the presentation of a maxillary orbital fracture
- Vertical diplopia due to restriction of upgaze
- Enophthalmos
- Infraorbital anaestesia
Describe the presentation of a ethmoidal orbital fracture
- Rarely isolated
- Horizontal diplopia
- Surgical emphysema as air from nasal passage moves towards fracture
Describe the presentation of a lateral orbital fracture
- Major injury
- Horizontal diplopia
What is lid retraction?
-Pulling back of the eyelid -> can see sclera at top and bottom of iris at rest
What is lid lag?
-Slowing of closing the eyelid when closing eye/looking down
How does thyroid eye disease present?
-Proptosis, lid retraction, lidlag, restrictive myopathy, optic neuropathy
What is restrictive myopathy?
-Enlarged eye muscles causes restriction of eye muscles
What is optic neuropathy?
-Enlargemen of eye muscles causes compression of optic nerve
How do you treat an urgernt thyroid eye disease referral?
-Admit, imaging and IV steroids
What is orbital cellulitis? How does it present?
- cellulitis of the eyelid causing inflammation and discharge
- Fever, painful, proptosis, restricted eye movements,
Name 2 differential diagnoses of orbital cellulitis
-Conjunctivitis, preseptal cellulitis
What are the 3 most common catagories of orbital mass lesions?
- Inflamatory
- Cystic
- Vascular
What is an orbital mass lesion?
-Swelling in or around the orbit
What is dacryoadenitis?
-Lacrimal gland infection
What is a mucocele?
-Collection of secretions caused by blockage of sinus openings
What is a dermoid cyst?
- teretoma of cystic nature containing an array of mature tissues eg sebum/hair
- Usually painless and not harmful
What is a capillary haemangioma?
-Vascular lesion of the orbit -> Abnormal proliferation of blood vessels during development which can be superficial or deep and are usually self-involuting
What is a cavernous haemangioma?
-blood vessel malformation of adults which occurs within the eye which can lead to proptosis, restriction of movement and other visual problems
Describe and explain the presentation of CNIII palsy
- 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
