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Duke Elder > Orbit and Adnexa > Flashcards

Orbit and Adnexa Flashcards

1
Q

Which bones form the orbital roof?

A

Frontal bone

lesser wing of sphenoid

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2
Q

What sign indicated a defect in the orbital roof?

A

pulsatile proptosis

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3
Q

Which bones form the lateral wall of the orbit?

A

greater wing of sphenoid

zygomatic bone

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4
Q

Which bones form the floor of the orbit?

A

zygomatic bone
palatine bone
maxilla

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5
Q

Which bone in the orbital floor is mostly likely to fracture?

A

maxilla

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6
Q

What sign indicates maxillary fracture?

A

unable to elevate eye due to inferior rectus entrapment

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7
Q

Which bones make up the medial wall of the orbit?

A

maxilla
lacrimal bone
ethmoid bone

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8
Q

which structures enter/leave the orbit via the optic canal?

A

optic nerve

ophthalmic artery

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9
Q

Which structures enter/leave the orbit via the SOF?

A

superior and inferior divisions of ophthalmic vein
CN III, IV and VI
larimal, frontal and nasociliary branches of CN V1

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10
Q

Which structures enter/leave the orbit via the IOF?

A

inferior ophthalmic vein
infraorbital artery, vein and nerve
zygomatic nerve (branch of CN V2)

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11
Q

Which muscles attach to the common tendinous ring (annulus of Zinn)?

A

4 recti

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12
Q

Hx of eyelid trauma. Eyelid swelling and erythema, associated low grade fever.

A

pre-septal cellulitis

treat oral Abx

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13
Q

What is the most common cause of unilateral and bilateral axial proptosis in adults?

A

thyroid eye disease

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14
Q

What leads to ophtalmoplegia and eyelid retraction in thyroid eye disease?

A

sympathetic overstimulation of Muller’s muscle

fibroblastic deposition of glycosaminoglycans in the EOM resulting in oedema and fibrosis.

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15
Q

Describe the following signs seen in thyroid eye disease:
Dalrymple sign
Kocher sign
Von Graefe’s sign

A

Lid retraction
Staring appearance
Lid lag on downward gaze

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16
Q

What muscle is most commonly affected in thyroid eye disease related restrictive myopathy?

A

inferior rectus

REMEMBER I’M SLO

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17
Q

What MRI changes might be seen in thyroid eye disease?

A

coke bottle appearance- thickening of EOM muscle bellies ( commonly IR and MR) with tendon sparing

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18
Q

Elderly hypertensive female. Pulsatile proptosis, diplopia, whooshing sound, decreased VA. dilated conjunctival vessels, raised IOP and ophthalmoplegia.

A

direct carotid-cavernous fistula

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19
Q

What is the most common benign orbital tumour in adults?

A

cavernous haemangioma

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20
Q

Pregnant lady. Unilateral axial proptosis, globe indentation, induced hyperopia, decreased visual acuity. MRI shows well circumscribed lesion within the muscle cone

A

cavernous haemangioma

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21
Q

what are the three layers of the tear film and where are they secreted from?

A

lipid layer- meibomian gland
aqueous layer- lacrimal gland
mucous layer- conjunctival goblet cells

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22
Q

Which valve in the lacrimal system prevents reflux of tears?

A

Rosenmuller valve

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23
Q

Which valve in the lacrimal system prevents air entering the nasolacrimal system during increased intranasal pressure?

A

Valve of Hasner

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24
Q

What are three causes of acquired lacrimal obstruction?

A

punctal stenosis
Nasolacrimal obstruction
conjunctivochalasis (ageing)

25
Q

Unilateral epiphora, red eye and discharge on pressure over the canaliculus?

A

canaliculitis

26
Q

What is the most common causative organism in canaliculitis?

A

Actinomyces israelii (gram positive)

27
Q

erythematous tender swelling over the lacrimal sac. associated epiphora

A

acute dacryocystitis

28
Q

epiphora and recurrent unilateral conjunctivitis.

A

chronic dacryocystitis

29
Q

What is the most common lacrimal gland tumour?

A

pleomorphic adenoma

30
Q

Which lacrimal tumour has a swiss cheese growth pattern?

A

adenoid cystic carcinoma

31
Q

what sort of gland is the meibomian gland?

A

holocrine

32
Q

which nerves give sensory supply to the upper eyelid?

A

lacrimal and frontal (CNV1)

33
Q

which nerve gives sensory supply to the medial canthal area?

A

infratrochlear nerve (CNV1)

34
Q

Which nerve gives sensory supply to the inferior eyelid?

A

infraorbital nerve

35
Q

What are the attachments of LPS?

A

lesser wing of sphenoid to tarsal plate

36
Q

What is the function of LPS?

A

Eyelid retraction

37
Q

What are the attachments of Mullers muscle?

A

aponeurosis of LPS to tarsal plate

38
Q

What is the nervous supply to Mullers muscle?

A

sympathetic

39
Q

What is the function of Mullers muscle?

A

Assists with eyelid retraction

40
Q

Histologically, what is a chalazion?

A

sterile lipogranuloma

41
Q

Patient with rosacea. Presents with painless, slow growing, round nodule within the superior tarsal plate that has appeared over a few weeks.

A

chalazion

42
Q

Which eyelid is more commonly affected by BCC?

A

lower

43
Q

Which surgical technique can be used to remove BCC or SCC?

A

Mohs micrographic surgical excision

44
Q

What is trichiasis?

A

misdirected growth of lash follicles

45
Q

What are the most common causes of trichiasis?

A

herpes zoster ophthalmicus and blepharitis

46
Q

What is distichiasis?

A

formation of a posterior row of lashes

47
Q

What organism most commonly causes a hordoleum (stye)?

A

staph

48
Q

What is the pathogenesis of aquired distichiasis?

A

meibomian gland metaplasia to pilosebaceous units

49
Q

Dysfunction of which gland causes posterior blepharitis?

A

Meibomian gland

50
Q

What skin conditions can cause anterior blepharitis?

A 
atopic dermatitis (staphylococcal)
Seborrhoeic dermatitis
51
Q

What skin condition is a risk factor for posterior blepharitis?

A

acne rosacea and demodex mites

52
Q

Patient with atopic dermatitis. Bilateral lid hyperaemia and swelling. Hard scales and crusting of the base of the lashes.

A

staphylococcal anterior blepharitis

53
Q

Patient with seborrhoeic dermatitis. Lid hyperaemia and oily lid margins. Waxy scales.

A

Seborrhoeic anterior blepharitis

54
Q

Patient with acne rosacea. Foamy and unstable tear film. Posterior lid margin hyperaemia and telangectasia.

A

Posterior blepharitis

55
Q

What is the treatment for blepharitis?

A

lid hygiene and warm compresses
tetracyclines
tea tree oil for demodex mites

56
Q

What causes congenital ptosis?

A

failure of development of LPS

57
Q

what causes age related ptosis

A

dysfunction of levator aponeurosis

58
Q

Whats the most common cause of lid retraction?

A

Graves

Duke Elder (8 decks)

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