Word association Flashcards
Order of frequency of muscle involvement in TED
Inferior rectus > medial rectus > superior rectus > lateral rectus
Antibodies in Graves
Antithyroglbulin (anti-Tg)
Anti thyroid peroxidase (AntiTPO)
Anti TSH receptor (TBII)
Phacomatous choristoma
Inferonasal orbital choristoma of lens material; seen in young children. Benign.
= Zimmerman’s tumor
Poor prognostic feature of sebaceous carcinoma
Upper lid location more associated with death
Canaliculitis
Actinomyces
Sulfur granules
Lacrimal sac tumor
Transitional
Squamous
Orbital tumor in adult
Cavernous hemangioma
Malignant orbital tumor in adult
Lymphoma
Malignant orbital tumor in child
Rhabdomyosarcoma
Primary intraocular tumor in adult
Melanoma
Primary intraocular tumor in child
RB
Intraocular tumor
Metastasis
Antibiotics in pediatric preseptal or orbital cellulitis
Cephalexin if anterior
Amox/clav if sinus
Preseptal cellulitis in child under 5
Bacteremia, septicemia, meningitis 2/2 H flu (now less common, in the setting of vaccine)
Risks associated with MRSA cellulitis
Nec fasc, orbital cellulitis, endogenous endophthalmitis, panophthalmitis, cavernous sinus thrombosis
When is admission warranted for preseptal?
48h failed PO abx, orbital sg/sx
Location of abscess in orbital cellulitis
Subperiosteal
Infectious agent category - adult v child
Gram pos cocci
Mixed in adult
Single agent in child
When to drain an abscess in orbital cellulitis
Older than 9 yo Frontal sinusitis Nonmedial location Large abscess Suspicion of anaerobic agent Recurrence after prior drainage Chronic sinusitis (e.g. polyps) Optic nerve or retinal compromise Dental origin (suggests anaerobic)
Signs of posterior extension of orbital cellulitis
Proptosis
Ophthalmoplegia
Anesthesia is V1/V2
Nec fasc
Group A beta-hemolytic strep
Pain out of proportion
Numbness
Shock
Clinda
Branching, nonseptate hyphae stain w H&E
Zygomycoses : mucor or rhizopus
Branching hyphae is uniform width
Grocott-Gomori methenamine silver nitrate
Aspergillosis
Parasitic organisms of the orbit
Taenia soleum
Ecchinococcus
Trichinosis
Pathogenesis of TED
T cell CD154 binds fibroblast CD40
IL6, IL8, PGE2
Hyaluronan and GAG
Transformation to adiposite
IV steroid does for TED
500mg-1 g methylprednisolone 6-12wk
Or oral 1 mg/ kg
Bridge to radiotherapy/sx
IgG4 Disease
Orbitotopathy Dacryoadenitis Xanthogranuloma Orbital amyloidosis Nonspecific inflammation
What type of hypersensitivity is vasculitis
Type 3 hypersensitivity (immune complex-mediated)
Localization of NSOI
EOMs (not sparing muscle insertion) Lacrimal gland Anterior segment Apex Diffuse
Treatment of sclerosing NSOI
Aggressive systemic immunosuppression
Responds poorly to steroids or to radiation
Hemangiomas in adults and in children
Capillary = Infantile
- enlarge over 12 months; 75% involute by 3-7yo
- high flow
Cavernous = adult
- encapsulated, low-flow
Risk factors for infantile hemangioma
Female
Low birth weight
Prematurity
Maternal chorionic villus sampling
Location of infantile hemangioma
Superonasal orbit
Medical upper lid
Systemic associations for capillary hemangioma
Neck hemangioma (airway)
Visceral (thrombocytopenia)
= Kasabach-Merritt
Most common benign orbital neoplasm in adults
Cavernous hemangioma
Hemangiopericytoma
Clinically similar to cavernous hemangioma
Blue intra-op
Composed of pericytes
Uncertain metastatic potential from path
COMPLETE EXCISION, given metastatic risk
Orbital lymphatic malformation
= lymphangioma = venous + lymphatic
Congenital
Apparent 1st or 2nd decade
Enlarge w URI
Tx w sclerosing agent
Associated with intacranial AVM
Grape-like cystic lesion
Lymphatic malformation
Also w fluid layering of blood products
Orbital varix
Low-flow
Enophthalmos at rest — proptosis with valsalva or dépendent head positioning
TX AVM
Sélective occlusion of feeders
Risk or exsanguination
AV Fistula
Direct C-C
- ICA + cavernous sinus
- Trauma
- High flow = tortuous episcleral vessels, bruit, pulsative proptosis
- sequelae: anterior uveitis, blood @ Schlemm, choroidals, IOP elevations
Dural C-C
- meningeal branches off medicine
- age/ OCD;
- degenerative/HTN
- lower flow — XR angiogram gold standard, but MRI accepted as safer
Chiasmal involvement in optic nerve glioma
50%
Intracranial associations of optic nerve glioma
ICH
Reduced hypothalamic and pituitary function
Glioblastoma sg sx
Pain, vision loss, swelling/hemorrhage of nerve head
Poor prognosis
Fibrous histocytoma
Less than 10% metastatic, but are locally aggressive
Fibroblast and histiocyte
Solitary fibrous tumor
Spindle cells
CD34 positive
Metastatic potential w incomplete excision
Fibrous dysphasia
Hyperostotic bone without dural enhancement
Albright syndrome w cutaneous pigmentation, endocrine disorders
Resection c debulking as needed
Common presentations of orbital lymphoma
Non Hodgkin B cell (90% of malignant). 4 types:
MALT - 40-60%; may have chlamydia association in conj (H pylori in GI). May go into remission or transform, usually higher-grade
CLL
Folicular Center
High grade (large cell, lymphoblastic, Burkett)
Medial fullness with respect to medial canthal tendon
Superior: encephalocele
Inferior: lacrimal sac distension
Epiphora in infant—important pertinent positive/negative
Mucopuruent discharge (localize to upper or lower)
Site of blockage in congenital NLDO
Valve of Hasner, nasal end of NLD ~20-22mm from nostril
Percentage NLDO resolving by age 1
90%
Percentage NLDO resolved with probing
90%
Basal tear secretion test
Anesthestic in
Strip in 5 min
Normal = 10-15
Schumer 1 v 2
Schirmer I: no anesthesia, paper in eyelid, measure tears
Schrumer 2; fatigue block sign, nasal stimulation x2 min incr reflex tear
Tests in suspected NLDO
Dye disappearance (5min; asymmetry in drainage), nasal secretion, irrigation, Jones I and Jones II
What are the Jones 1 and Jones 2 tests?
Jones 1 - primary dye test: fluroescein to fornix and check at inferior meatus at 2 and 5 min
(Not commonly done)
Jones 2 - after Jones 1, irrigation of lacrimal system and test for fluroescein in irrigant solution
If lacrimal system irrigation results in distension of lacrimal sac, but reflux, where is obstruction
Valve of Rosenmuller
Epilation effect duration
3 weeks
Corneal ulcer with negative culture not responding to treatment
Anesthetic abuse
Presents as an abrasion and tends to progress to KP, infiltration, incl ring infiltrate
Drug induced cicatricial pemphagoid
Subconj fibrosis in the setting of long term gtt use (e.g. miotics) causing scarring of fornix, symblepharon, pannus, punctual stenosis
Confirm w conj bx
Primary lumbar stem cell deficiency
PAX6 mutation (aniridia) Ectodactyl-ectodermal dysplasia-clefting syndrome Sclerocornea Keratitis-ichthyosis-deafness syndrome Congenital eryrhromeratodermia
Secondary causes of lumbar stem cell deficiency
Radiation Chemical burn Thermal burn Toxic medication —long term (pilo, antimetabolite, keratitis-inducing meds) PTG Inflammatory disease (pemphagoid, SJS) Infectious conjunctivitis (trachoma) Dysplasia/neoplasia
LADD
Lacrimal-auriculo-dental-digital syndrome
= Levy-Hollister
Assd w limbal stem cell deficiency
Surgical management of limbal stem cell deficiency
SCL
Autograft if 1 eye
Allograft or Kpro if bilateral
Blepharophimosis syndrome
AD in FOXL (ch3)
AKA: blepharophimosis-ptosis-epicanthus inversus (BPES)
Blepharophimosis (narrow palpebral fissure)
Proptois — dysplasia of levator aponeurosis
- Can cause ambly
- Usually treat this last
Telecanthus — I.e. normal interpupillary distance, but wide intercanthal distance
Epicanthus inversus — skin fold covers medial canthus
Premature ovarian failure (type 1 only)
Breslow Depth
Melanoma in situ - epithelial
Stage I - 0.8mm “early melanoma” (excision)
Stage II - 0.8-4.0mm and/or ulceration (excision + LN)
Stage II “thick” - > 4mm — higher risk of metastatic spread, 50% survival at 5 years, rec LN biopsy
Stage III - metastasis; ulceration plays prognostic role, Breslow depth does not
High-flow CC fistula
Internal carotid rupture or leak within the cavernous sinus
Severe proptosis, diffuse ophthalmoplegia, CRVO, arterialization of conjunctival vessels
