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Common Disease Of Orbit Flashcards

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1
Q

What is pseudoproptosis?

A

slight prominence of eyes like myopia, paralysis of extra ocular muscles, obese people, mullers stimulation by cocaine

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2
Q

What is proptosis?

A

Abnormal protrusion of eyeballs

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3
Q

What is exophthalmos?

A

prominence of the eye secondary to thyroid disease

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4
Q

What are the causes of unilateral proptosis?

A
  • orbital cellulitis
  • idiopathic orbital inflammatory disease
  • thrombosis of orbital vein
  • arterio- venous aneurysms
  • tumors of orbit
  • orbital hemorrhage
  • emphysema
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5
Q

What are the causes of bilateral proptosis?

A
  • endocrine exophthalmos
  • cavernous sinus thrombosis
  • symmetrical orbital tumors
  • oxycephaly (diminished orbital volume)
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6
Q

In which conditions are proptosis seen in children?

A
  1. Dermoid & epidermoid cyst
  2. Capillary hemangioma
  3. Optic nerve glioma
  4. Rhabdomyosarcoma
  5. Leukemia
  6. Metastatic neuroblastoma
  7. Plexiform neurofibromatosis
  8. Lymphomas
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7
Q

In which conditions are proptosis seen in adults?

A
  1. Metastases
  2. Cavernous hemangioma
  3. Mucocele
  4. Lymphoid tumors
  5. Meningiomas
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8
Q

What is axial proptosis?

A

eye is pushed directly forwards
lesions situated in optic nerve & central space

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9
Q

What is non-axial proptosis?

A

Lesions situated elsewhere in orbit pushes eye in opposite direction

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10
Q

In which condition is proptosis static?

A

Congenital cases

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11
Q

In which condition is proptosis increasing?

A

Rhabdomyosarcoma
Neuroblastoma
Hemopoietic

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12
Q

In which condition is proptosis gradual?

A

Meningiomas

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13
Q

In which condition is proptosis pulsatile?

A

Carotid cavernous fistula

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14
Q

In which condition is proptosis intermittent?

A

Orbital varicosity

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15
Q

What are the clinical signs of proptosis?

A
  1. Impaired mobility
  2. Diplopia
  3. Papilloedema
  4. Optic atrophy
  5. Hertel exophthalmometry = >18 mm
  6. Different btwn 2 eyes > 2 mm (+ve)
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16
Q

What are the investigation done for proptosis?

A
  • ENT examination
  • all lab investigation
  • imaging of bony structure - orbital x-ray
  • imaging of soft tissues - CT, MRI
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17
Q

What is orbital cellulitis?

A

Purulent inflammation of the cellular tissue of the orbit

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18
Q

What are the causes of orbital cellulitis?

A
  • spread of infection from neighbouring structures like nasal sinuses, eyelids, eyeball (like in cases panopthalmitis)
  • deep penetrating injuries (foreign body)
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19
Q

What is pre-septal cellulitis?

A

Situated in structures anterior to orbital septum

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20
Q

What is orbital cellulitis?

A

Situated behind orbital septum

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21
Q

What are the C/F of pre-septal cellulitis?

A
  • erythema chemosis
  • conjunctival discharge w/o restriction of ocular movement & visual impairment
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22
Q

What are the C/F of orbital cellulitis?

Study These Flashcards
A
  • severe pain, fever
  • diminution of vision (due to retrobulbar neuritis or compression of optic nerve/vessel)
  • massive swelling of eyelids
  • chemosis
  • proptosis
  • restriction of ocular movements
  • diplopia
23
Q

What are the complications of orbital cellulitis?

Study These Flashcards
A
  • panopthamitis
  • extension into brain through meninges, cavernous sinus thrombosis
  • fungal superinfection
24
Q

What is the management of orbital cellulitis?

Study These Flashcards
A
  • culture & sensitivity of pus/blood
  • treatment = broad spectrum IV antibiotic & anti-inflammatory
  • abscess incision & drainage
25
C/F of Graves’ disease
- exophthalmos - all sign of thyrotoxicosis (tachycardia, muscular tremors, raised BMR)
26
What is Dalrympte sign in Graves’ disease?
palpebral aperture is wide open due to lid retraction
27
What is Von Graefe sign in Graves’ disease?
upper lid fail to follow downward movement of eye
28
What are ophthalmic signs of Graves’ disease?
- lid retraction, lag, edema - infrequent blinking & incomplete closure of eyelid (stellwag sign) - exophthalmos - conjunctival congestion - convergence insufficiency (mobius sign) - raised IOP
29
Werner Classification of Signs (Score = 0)
No signs or symptoms
30
Werner Classification of Signs (Score = 1)
Only signs
31
Werner Classification of Signs (Score = 2)
Soft tissue involvement with symptoms & signs
32
Werner Classification of Signs (Score = 3)
Proptosis > 20mm
33
Werner Classification of Signs (Score = 4)
Extraocular muscle involvement
34
Werner Classification of Signs (Score = 5)
Corneal involvement
35
Werner Classification of Signs (Score = 6)
Sight loss (visual acuity < 0.67)
36
What is exophthalmic opthalmoplegia?
Proptosis + external opthalmoplegia Asymmetrical limiting upward movement and abduction due to swollen, pale edematous, infiltrated ocular muscle
37
What is the risk of exophthalmic opthalmoplegia?
Exposure keratitis Globe dislocation Mechanical compression of optic nerve & ophthalmic vessels
38
Is exophthalmic opthalmoplegia reducible or irreducible?
It’s irreducible
39
What is the medical treatment for exophthalmic opthalmoplegia?
Short term oral steroid therapy (dose 40-60 mg) + radiotherapy (1000 rad) - controls soft tissue inflammation
40
What is the surgical management for exophthalmic opthalmoplegia?
Exposed cornea protected by - (lateral) tarsorrhaphy OR - Orbital decompression (severe cases)
41
Type 1 characterized by
Symmetrical mild proptosis Lid retraction
42
Type 1 is associated with
Thyrotoxicosis
43
Type 2 is characterized by
Extreme exophthalmos Compressive neuropathy Extraocular muscle involvement
44
Type 2 is associated with
Hypothyroidism After thyroidectomy
45
What are the investigations for Graves’ disease?
1. Thyroid function test 2. Thyroid antibody assay 3. USG, CT, MRI
46
Clinical activity score (features of pain)
1. Retrobulbar pain 2. Pain on ocular movement
47
Clinical activity score (features of redness)
1. Redness of lids 2. Redness (congestion) of conjunctiva
48
Clinical activity score (features of swelling)
1. Swelling of lids 2. Swelling of conjunctiva 3. Swelling of caruncle 4. Proptosis (> 2mm increase over 1-3 months)
49
Clinical activity score (features of function)
1. Decrease in eye movement by +/- 5 over 1-3 months 2. Decreased vision by >1 snellen line over 1-3 months
50
What is the non-surgical management for grave disease?
1. Smoking cessation 2. Head elevation 3. Lubricating artificial tear drops 4. Eye lids tapping 5. Guanethidine 5% 6. Prisms 7. Systemic steroid 8. Radiotherapy
51
What is the surgical management for grave disease?
1. Orbital decompression 2. Extraocular muscle surgery 3. Eyelid surgery
52
What is the cause of exophthalmos?
Edema, lymphocytic infiltration and fibrosis of orbital contents and extra-ocular muscle
53
What is the cause of lid retraction?
Contraction of muller muscle

Ophthal (18 decks)

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