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Year 1/2 > Cognition & Senses 2: Orbital Dz > Flashcards

Cognition & Senses 2: Orbital Dz Flashcards

1
Q

5 components of ASSESSMENT of the ORBITAL REGION?

what are 4 common ANCILLARY TESTS that can be done? what’s the ORDER?

A
  1. HISTORY
    –> chronic/acute
    –> signs of TRAUMA including SURGERY/DENTALS
  2. EXAMINE FROM A DISTANCE
    –> SYMMETRY is vital
    –> DEVIATION of OPTIC AXIS
  3. PALPATION of ORBITAL REGION
    –> CRACKLING, EMPHYSEMA
  4. FULL EYE EXAM
  5. ORAL EXAM
    –> look at SOFT PALATE

ANCILLARY TESTS?
1. FNA, but MUST DO IMAGING PRIOR TO KNOW WHERE TO POKE!
2. RADS
3. U/S
4. CT/MRI

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2
Q

DEFINE IMAGING MODALITY & LESION

A

FUNDIC EXAM

LESION = RETROBULBAR MASS

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3
Q

chemosis definition

A

swelling of the TISSUE that LINES THE EYELIDS & SURFACE OF THE EYE

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4
Q

MOST often, only ____ clinical signs are SEEN with ORBITAL DZ

what are the PATHOGNOMONIC signs of ORBITAL DZ? (4)

A

SOME

pathognomonic?
1. EXOPHTHALMOS

  1. LACK of RETROPULSION (thumb on upper EYELID)
  2. GLOBE DEVIATION
  3. FUNDUS LESION of GLOBE INDENTATION from RETROBULBAR MASS
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5
Q

which CLINICAL SIGN can be HARDER TO DETERMINE in BRACHYCEPHALIC BREEDS with ORBITAL DZ?

A

LACK OF RETROPULSION bc ALREADY HAS HIGH IOP

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6
Q

EPIPHORA definition

A

= EXCESSIVE WATERING of the eye

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7
Q

ID CLINICAL SIGN

PATHOGNOMONIC FOR…

A

GLOBE DEVIATION

PATHOGNOMONIC FOR ORBITAL DZ

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8
Q

EXOPHTHALMOS…

= definition?

3 common causes?

pathognomonic for…

A

= PROTRUSION of the GLOBE OUT OF THE ORBIT caused by AN INCREASE IN ORBITAL CONTENT

3 common causes?
1. ABSCESS
2. TUMOR
3. SWELLING of ORBITAL MUSCLES

pathognomonic for ORBITAL DZ

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9
Q

if we see PROTRUSION OF THE GLOBE…

what CLINICAL SIGN is this?

what are 6 PE FINDINGS that should coincide?

what ADDITIONAL ASSESSMENT should we do?

A

CLINICAL SIGN = EXOPHTHALMOS

3 PE FINDINGS?
1. SCLERA is exposed

  1. OBSERVE FROM ABOVE to see PROTRUSION OF CORNEAL APEX
  2. LACK of RETROPULSION
  3. PROTRUSION of THIRD EYELID
  4. CHEMOSIS
  5. LAGOPHTHALMOS (incomplete closure of eyelid)

ADDITIONAL ASSESSMENT = check BOTH EYES for SYMMETRY

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10
Q

LAGOPHTHALMOS definition

what can it often cause? (2 words)

A

= INCOMPLETE closure of the EYELID

can OFTEN CAUSE EXPOSURE KERATITIS

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11
Q

ID CLINICAL SIGN

A

EXOPHTHALMOS

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12
Q

EXOPHTHALMOS…

give 7 DDxs

A
  1. ZYGOMATIC MUCOCELE
  2. VASCULAR ANOMALIES (VARICES or AV FISTULA)
  3. EXTENSION of DZ from NASAL/ORAL CAVITY, TEETH, SINUSES
  4. RETROBULBAR ABSCESS
  5. ORBITAL INFLAMMATION
  6. ORBITAL TUMORS
  7. MYOSITIS (enlargement of temporal muscle)
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13
Q

EURYBLEPHARON / LAGOPHTHALMOS…

= definition

COMMON in what breed w/ what presentation?

can resemble WHAT PE finding?

A

= CONGENITAL eyelid anomaly characterized by HORIZONTAL ENLARGEMENT OF PALPEBRAL FISSURE

common in BRACHYCEPHALIC BREEDS with SHALLOW ORBITS

can resemble EXOPHTHALMOS but IT ISN’T

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14
Q

BUPHTHALMIA…

= definition

can RESEMBLE…

A

= GLOBE ENLARGEMENT secondary to GLAUCOMA

can RESEMBLE EXOPHTHALMOS but ISN’T

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15
Q

ID DZ & definition

A

BUPHTHALMIA

= GLOBE ENLARGEMENT secondary to GLAUCOMA

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16
Q

ID DZ (2 names) & definition

A

EURYBLEPHARON or LAGOPHTHALMOS

= CONGENITAL eyelid anomaly characterized by HORIZONTAL ENLARGEMENT OF PALPEBRAL FISSURE

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17
Q

ID DZ

this ____ ____ can RESEMBLE… (2)

A

ANISOCORIA

this MYDRIATIC PUPIL can RESEMBLE EXOPHTHALMOS or BUPHTHALMIA

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18
Q

ID DZ

pathognomonic for…

we expect the MASS to be located in the ___ region

A

GLOBE DEVIATION

pathognomonic for ORBITAL DZ

we expect the MASS to be located in the NASAL region!

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19
Q

ENOPHTHALMOS…

can be seen RARELY in ____ DISEASES

= definition?

4 clinical findings? which one is present in SEVERE cases?

A

ORBITAL

= RECESSION of the GLOBE into the ORBIT

4 clinical findings?
1. GLOBE RETRACTED INTO ORBIT
2. REDUCED PALPEBRAL PRESSURE
3. THIRD EYELID PROTRUSION
4. ENTROPION in SEVERE CASES

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20
Q

ENTROPION…

= definition

can often cause ____ SECONDARILY, & give definition

is often seen in WHAT clinical sign?

A

= the EYELID is ROLLED INWARD AGAINST THE EYEBALL

can often cause TRICHIASIS SECONDARILY = IRRITATION of the EYE by the EYELASHES

is often seen in ENOPHTHALMOS

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21
Q

ENOPHTHALMOS etiologies? (4)

A
  1. INTRAOCULAR PAIN like UVEITIS
  2. HORNER’S SYNDROME
  3. EMACIATION/SEVERE DEHYDRATION
  4. DECREASED ORBITAL CONTENT due to INFLAMMATION/ATROPHIC MYOSITIS
22
Q

HORNER’S SYNDROME is associated with DYSFUNCTION of _____ INNERVATION

A

SYMPATHETIC

23
Q

ID CLINICAL SIGN

A

ENOPHTHALMOS

24
Q

what 2 things SHOULD WE NOT confuse ENOPHTHALMOS with? & give definitions

A
  1. MICROPHTHALMIA = SMALL EYE CONGENITALLY
  2. PHTHISIS BULBI = when the EYE PERMANENTLY SHRINKS secondary to DISEASE
25
Q

ETIOLOGIES for ORBITAL DISEASES..

what are 4 MOST COMMON?

what are 2 UNCOMMON?

what is 1 RARE?

A

MOST COMMON?
1. TUMORS

  1. TRAUMA –> hemorrhage, FB, fracture
  2. ABSCESSES
  3. INFLAMMATION/CELLULITIS

UNCOMMON?
1. MYOSITIS
2. ZYGOMATIC CYSTS & MUCOCELES

RARE?
1. VASCULAR ANOMALIES –> AV fistula, varices

26
Q

TRAUMA to ORBIT…

give 3 MANIFESTATIONS?

A

3 MANIFESTATIONS?
1. ORBITAL FRACTURE
2. PENETRATING FOREIGN BODY
3. PROPTOSIS following some BLUNT TRAUMA

27
Q

PROPTOSIS definition

usually found in ____ breeds after experiencing ____

A

ABNORMAL PROTRUSION or DISPLACEMENT of the EYE

BRACHYCEPHALIC, TRAUMA

28
Q

if we have a PROPTOTIC EYE, it’s considered a(n) ____ ____

what is the MOST IMPORTANT thing to do for this patient?

after this is achieved, what should we do?

give an ADDITIONAL step & when we should follow up

A

OPHTHALMIC EMERGENCY

MOST IMPORTANT = STABILIZE THE PATIENT!

after stabilization, we should REPOSITION THE GLOBE while KEEPING THE CORNEA LUBRICATED

additional step = make LATERAL CANTHOTOMY (make incision) to SUTURE & REPLACE EYELIDS ABOVE THE GLOBE
–> check back again 2 weeks later!

29
Q

ABSCESS/CELLULITIS…

clinical signs & presentation looks ___ between the two

progression?

unilateral vs. bilateral?

give 2 IMPORTANT clinical signs!

3 etiologies?

A

IDENTICAL

ACUTE

UNILATERAL

IMPORTANT clinical signs…
1. FEVER
2. PAIN upon RETROPULSION or OPENING MOUTH

etiologies?
1. FB
2. WOUND
3. SECONDARY to SINUSITIS, TOOTH ROOT ABSCESS or INFECTION of ZYGOMATIC/LACRIMAL GLAND

30
Q

CELLULITIS definition

A

= NON-SUPPURATIVE inflammation of the PERCUTANEOUS tissue

31
Q

why can we see PAIN UPON OPENING MOUTH in ABSCESSES/CELLULITIS of the ORBIT?

A

when opening mouth, mechanism can PUSH ON THE SOFT TISSUE OF THE ORBIT that MAY BE INFLAMED/PAINFUL

32
Q

3 DIAGNOSTICS for ABSCESSES/CELLULITIS of ORBIT? list why for each

A
  1. CBC –> confirm INFECTION/INFLAMMATION
  2. IMAGING (US, CT, MRI)
  3. FNA –> INFLAMMATORY or INFECTIOUS?
33
Q

TREATMENT for ORBITAL CELLULITIS/ABSCESSES..

it’s USUALLY (duration, type of medication & name)

what OTHER 2 MEDICATIONS do we often give?

what medication SHOULD WE NOT GIVE?

name 1 +/- treatment?

A

it’s USUALLY = SYSTEMIC ANTIBIOTICS for 2-3 WEEKS that is GOOD AGAINST ANAEROBES, such as AMOXICILLIN + CLAVULANIC ACID

other 2 meds?
1. SYSTEMIC NSAIDs
2. SYSTEMIC OPIOIDS (for pain)

DO NOT GIVE STEROIDS!

+/- = TOPICAL LUBRICATION OF CORNEA if it’s exposed

34
Q

how do we DRAIN an ORBITAL ABSCESS/CELLULITIS? (2)

is this always done?

what is a MAJOR CONCERN we should keep in mind?

A
  1. need to MAKE SHALLOW INCISION BEHIND THE LAST UPPER MOLAR to FIND MASS/ABSCESS
  2. after making incision, use CLOSED HEMOSTATS & do BLUNT DISSECTION to GET THROUGH MUSCLES to GAIN ACCESS TO ORBITAL CAVITY

NOT ALWAYS DONE

concern? = we have to WORRY ABOUT HITTING THE MAXILLARY ARTERY that is RIGHT ABOVE THE SOFT PALATE, so WORK CAREFULLY!

35
Q

describe process

A

DRAINAGE of ORBITAL ABSCESSS

36
Q

MOST orbital tumors are what 2 things?

A

PRIMARY & MALIGNANT

37
Q

6 CLINICAL SIGNS/SIGNALMENT for ORBITAL TUMORS…

what is the MOST COMMON presentation?

A
  1. OLDER animals
  2. UNILATERAL
  3. INITIALLY no pain unless PUSHING EYE OUT & causing EXPOSURE KERATITIS/ULCERS
  4. EXOPHTHALMOS –> MOST COMMON PRESENTATION
  5. LIMITED to NO RETROPULSION
  6. GLOBE INDENTATION
38
Q

how can an ORBITAL TUMOR cause ENOPHTHALMOS

A

if the tumor is LOCATED ROSTRAL TO THE GLOBE (pushing from OUT to IN)

39
Q

TRUE/FALSE

the GLOBE is ALWAYS DEVIATED with ORBITAL TUMORS

A

FALSE, only sometimes

40
Q

TRUE/FALSE

VISION is RETAINED WITH ORBITAL TUMORS

A

TRUE

41
Q

DIAGNOSTICS for ORBITAL TUMORS (2)

TREATMENT if BENIGN vs. MALIGNANT?

A
  1. FNA
  2. IMAGING (x-rays, US, CT, MRI)

Tx?

BENIGN = ORBITOTOMY & REMOVAL OF TUMOR if BENIGN & VISUAL and RESECTABLE

MALIGNANT = EXENTERATION +/- CHEMO

42
Q

EXENTENERATION definition

A

removal of the ENTIRE EYE & surrounding TISSUES & NERVES

43
Q

ZYGOMATIC MUCOCELE/CYST

= definition

5 clinical signs?

TYPICALLY NOT ASSOCIATED WITH ___ and THEREFORE ___

A

= when SALIVA from ZYGOMATIC GLAND LEAKS OUT & forms a CYST in ORBITAL CAVITY

clinical signs?
1. ORBITAL SWELLING
2. EXOPHTHALMOS
3. THIRD EYELID PROTRUSION
4. PROTRUSION of ORAL MUCOSA BEHIND LAST MOLAR
5. NO PAIN

TYPICALLY NOT ASSOCIATED WITH INFLAMMATION and THEREFORE PAIN

44
Q

what is DIAGNOSTIC for ZYGOMATIC MUCOCELE/CYST?

A

when doing ORBITOTOMY or FNA, see HONEYLIKE LIQUID that is SALIVA

45
Q

TREATMENT for ZYGOMATIC MUCOCELE/CYST? (simple answer)

A

REMOVAL of the GLAND & its CONTENTS via SURGICAL EXCISION

46
Q

POLYMYOSITIS…

what are the 2 SUB-CATEGORIES in EYES?

A
  1. EXTRAOCULAR POLYMYOSITIS
  2. MASTICATORY MUSCLE MYOSITIS
47
Q

EXTRAOCULAR POLYMYOSITIS

= definition

etiology?

progression?

unilateral vs. bilateral?

3 clinical sign?

1 BREED predilection?

A

= INFLAMMATION of the MUSCLES THAT MOVE THE EYE/EXTRAOCULAR MUSCLES

etiology = IMMUNE-MEDIATED

progression = ACUTE

unilateral vs. bilateral = BILATERAL

clinical signs?
1. FEVER
2. ANOREXIA from PAIN when MOVING MOUTH INTO EXTRAOCULAR MUSCLES
3. ENOPHTHALMOS from ATROPHY of extra ocular muscles

breed = GOLDEN RETRIEVER

48
Q

ID CLINICAL SIGN & likely DZs (2)

how can we DISTINGUISH one from the other? (first has 1, second has 2)

A

ENOPHTHALMOS BILATERALLY

DZ = likely EXTRAOCULAR MYOSITIS causing ATROPHY or MASTICATORY MUSCLE MYOSITIS

if EXTRAOCULAR POLYMYOSITIS = CT/MRI can see SWOLLEN EXTRAOCULAR MUSCLES

if MASTICATORY MUSCLE MYOSITIS…
1. do MUSCLE BIOPSY of TEMPORALIS or MASSETER muscle to see CELLULAR INFILTRATES
2. look for SERUM 2M ANTIBODIES on BLOODWORK

49
Q

MASTICATORY MUSCLE MYOSITIS..

= definition

likely etiology?

duration?

unilateral vs. bilateral?

3 clinical signs?

3 breeds?

A

= INFLAMMATION of the MASTICATORY MUSCLES

etiology = IMMUNE-MEDIATED

duration = ACUTE

unilateral vs. bilateral = BILATERAL

3 clinical signs?
1. FEVER
2. ANOREXIA (pain from moving mouth)
3. LATER STAGE = MUSCLE ATROPHY & ENOPHTHALMOS

3 breeds?
1. GOLDEN RETRIEVER
2. GSD
3. WEIMARANER

50
Q

TREATMENT for EXTRAOCULAR POLYMYOSITIS or MASTICATORY MUSCLE MYOSITIS? (name 3 potential drugs & duration of tx)

A

IMMUNOSUPPRESSIVE DOSES OF CORTICOSTEROIDS, AZATHIOPRINE OR CYCLOSPORINE for 3-4 WEEKS

51
Q

DIFFERENCE between ENUCLEATION & EXENTENERATION?

when would you do ONE vs. ANOTHER?

A

ENUCLEATION = removal of OCULAR GLOBE but LEAVE THE SOFT ORBITAL TISSUE
–> DAMAGE of EYE but NOT ORBIT
–> if PAINFUL EYE from GLAUCOMA

EXENTENERATION = REMOVAL OF OCULAR GLOBE with RESECTION OF COMPLETE ORBITAL SOFT TISSUE
–> when there’s ORBITAL DZ such as ABSCESS, TUMOR or ZYGOMATIC MUCOCELE

52
Q

why should we REMOVE THE THIRD EYELID in ENUCLEATION?

A

because if we remove everything else, IT WILL KEEP PRODUCING TEARS & FILL UP ORBITAL CAVITY WITH TEARS

Year 1/2 (139 decks)

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