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Ophthalmology > Other orbital diseases > Flashcards

Other orbital diseases Flashcards

1
Q

What are 7 signs that patients with orbital disease may present with?

A
  1. Soft tissue involvement
  2. Proptosis
  3. Enophthalmos
  4. Ophthalmoplegia
  5. Visual dysfunction
  6. Dynamic changes
  7. Fundus changes
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2
Q

What are 4 symptoms that patients with orbital disease may present with?

A
  1. Diplopia
  2. Pain
  3. Discomfort
  4. Decreased vision
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3
Q

What are 4 common and 2 less common investigations that would be done for orbital disease?

A
  1. CT scan
  2. MRI scan
  3. Plain radiographs
  4. Fine needle biopsy

Other:

  1. Thyroid function tests (TFT)
  2. Searching for primary/secondary neoplasia
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4
Q

What type of disease is thyroid eye disease?

A

Autoimmune

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5
Q

What are the 7 ocular manifestations of thyroid eye disease?

A
  1. Eyelid retraction/lag
  2. Periorbital oedema
  3. Exophthalmos (proptosis)
  4. Compression of the optic nerve
  5. Exposure keratopathy (dry eyes)
  6. Soft tissue involvement
  7. Restrictive myopathy
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6
Q

What fraction of patients with thyroid eye disease have exophthalmos?

A

1/3

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7
Q

What % of patients with exophthalmos have optic neuropathy?

A

5%

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8
Q

What 5 examinations should you do to check for optic neuropathy?

A
  1. VA
  2. Colour vision
  3. Papillary reactions
  4. Visual fields
  5. Regular fundoscopy
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9
Q

What is the main manifestation of restrictive myopathy in thyroid eye disease?

What causes the symptom in the early and late stages?

A

Diplopia (permanent in 50%)

Diplopia caused by oedema in active stages and fibrosis in late

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10
Q

What is orbital cellulitis?

How serious is it?

A

An infection behind the orbital septum

It is an acutely sight threatening and potentially life threatening emergency

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11
Q

What can orbital cellulitis be secondary to?

A

Ethmoiditis

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12
Q

What are the signs/symptoms of orbital cellulitis according to:

  1. Systemic (2)
  2. Anterior eye (2)
  3. Orbital (6)
A

Systemic:

  1. Severe malaise
  2. Fever

Anterior eye:

  1. Acute onset of unilateral swelling of conjunctiva and lids
  2. Oedema, erythema, pain, chemosis

Orbital signs:

  1. Proptosis (common)
  2. Extraocular muscle ophthalmoplegia (common)
  3. Blurred vision
  4. Reduced VA
  5. RAPD
  6. Involvement of the optic nerve
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13
Q

What are complications of untreated orbital cellulitis (5)?

A
  1. Orbital/subperiosteal abscess
  2. Brain abscess
  3. Meningitis
  4. Cavernous sinus thrombosis
  5. Sepsis
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14
Q

What is the management of orbital cellulitis (3)?

A 
1. Acute hospital admission with systemic Abx therapy
2 Monitor optic nerve function
3. Surgery indicated if:
-Resistance to Abx
-Orbital/subperiosteal abscess
-Optic neuropathy
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15
Q

What is a pseudotumour?

How is it diagnosed?

A

An idiopathic orbital inflammatory disease. A non-neoplastic and non-infectious orbital lesion.

It is a diagnosis of exclusion

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16
Q

How does pseudotumour present? What age range does it usually present at?
(3)

A
  1. Abrupt painful onset
  2. Involves any or all soft tissue components
  3. Presents in 2nd-5th decades of life
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17
Q

What is the treatment of pseudotumour (3)?

A

Anti-inflammatory drugs:

  1. NSAIDs
  2. Steroids
  3. Cytotoxic (steroid sparing drugs)
18
Q

What are the 2 main orbital venous disorders?

A
  1. Orbital venous anomalies (varices)

2. Carotid-cavernous fistula

19
Q

What are orbital varices (2)?

A
  1. Congenital enlargements of pre-existing venous channels

2. Usually bilateral

20
Q

What are 2 possible consequences of orbital varices?

A
  1. Bleed

2. Thrombose

21
Q

What are carotid-caverous fistulas?

A

Abnormal communications between the carotid and cavernous sinus

22
Q

What are the 3 forms of carotid-cavernous fistulas?

A
  1. Direct - Rapid flow shunt, most commonly caused by trauma
  2. Indirect - slow flow shunt, congenital/spontaneous rupture
  3. Encephalocele - herniations of intracranial contents through congenital skill defects. Transmission of CSF pulsation causes pulsating proptosis without a bruit
23
Q

What are 2 types of vascular tumour in the eye?

A
  1. Capillary haemangioma

2. Cavernous haemangioma

24
Q

What age group does capillary haemangioma occur in?

A

Orbital tumour in children

25
Q

What is the course and treatment of capillary haemangioma (2)?

A
  1. May have spontaneous resolution

2. Treated with steroids

26
Q

What age group does cavernous haemangioma occur in?

A

Orbital tumour in adults - usually present in 4th-5th decade

27
Q

Are cavernous haemangiomas more common in M or F?

A

F

28
Q

What are 2 lacrimal gland tumours?

A
  1. Pleomorphic lacrimal gland adenoma

2. Lacrimal gland carcinoma

29
Q

What age do Pleomorphic lacrimal gland adenomas present?

A

4th-5th decade

30
Q

How do pleomorphic lacrimal gland adenomas present?

A

Painless and very slow growing mass

31
Q

What is the treatment of pleomorphic lacrimal gland adenomas?

A

Surgical excision

32
Q

What age does lacrimal gland carcinoma present at?

A

4th-5th decade

33
Q

What is the prognosis of lacrimal gland carcinoma?

A

Poor

34
Q

What is the treatment of lacrimal gland carcinoma?

A

Radical surgery and radiotherapy

35
Q

What are 2 types of neural tumours?

A
  1. Optic nerve glioma

2. Optic nerve sheath meningiona

36
Q

What age group does optic nerve glioma affect?

A

Young girls at end of 1st decade

37
Q

How does optic nerve glioma present?

A

Gradual visual loss

38
Q

What age group does optic nerve sheath meningioma affect?

A

Middle aged women

39
Q

What is the nature of an optic nerve sheath meningioma (2)?

A

Can be:

  1. Slow growing
  2. Agressive
40
Q

How are optic nerve sheath meningiomas treated according to the nature of it (2)?

A
  1. Slow growing tumours are observed

2. Aggressive tumours are excised with radiotherapy

Ophthalmology (12 decks)

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