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Flashcards in Conditions Deck (30):

Muscles affected in TED

(In order - IM SLO)

Inferior rectus, medial rectus, superior, lateral, oblique?

Often leading first to hypotropia and esotropia.

Treatment: orbital decompression followed by strab surgery.


Orbital Pseudotumour

- unilateral, painful proptosis, chemosis, elevated IOP
- young to middle aged
- reduced VA due to ON compression
- restricted EOMs
- CT scan will show inflammation of EOM and tendons


Malignant melanomas commonly arise from?

Dysplastic nevi or tumour metastasis from the lungs (men) or breasts (women).


Early signs of Keratoconus

- Fleischer's ring (iron deposit)
- Scissors reflex
- irregular mires
- inferior steepening of the cornea


Late signs of Keratoconus

- Hydrops
- Munson's sign
- Vogt's striae


What is a corneal ulcer?

Epithelial defect with an underlying infiltrate.


Infectious vs Sterile Corneal Ulcer

- size matters! Larger usually infectious.

Infectious ulcers will have epithelial defects bigger than the infiltrate or about the same size.

Sterile will have a smaller epithelial defect than the infiltrate.


Which bacteria can invade an intact corneal epithelium?

Canadian National Hockey League!!!!

- Corynebacterium diphteria
- Nisseria gonorrhea and meningitidis
- Haemophilus
- Listeria


Asides from trauma, what systemic condition is higher risk for hyphema?

Sick-cell anemia

Test for: CBC, prothrombin/partial thromboplastin time (PT/PTT).


Treatment/management for hyphemas?

- B-scan ultrasound indicated if hyphema blocks view of fundus/risk of retinal detachment
- bedrest with head elevated at 30 degrees to decrease risk of corneal blood staining and IOP rise


Problems with corneal blood staining

5% of patients and typically develops in late stages of hyphema.

Associated with:
- large hyphemas
- elevated IOPs
- compromised corneal endothelial cells


What SHOULD NOT be performed in a patient with hyphema?

Gonioscopy and scleral depression.

- pressure may increase risk of rebleeding.

Gonio should be done when hyphema has resolved.


Commotio retinae

Disruption of the RPE and photoreceptor outer segments due to trauma.
- gray-white discolouration of the retina
- Berlin's edema when located within the macula
- hyper-reflectivity on OCT photoreceptor outer segment

Typically resolves in 24-48 hours without sequelae. Permanent VA/VF loss may occur.


Sympathetic ophthalmia

Immune mediated response in fellow eye after the other eye undergoes penetrating foreign body/surgery.

Characterized by subretinal infiltrates (Dalen Fuchs nodules), vitritis, serous retinal detachments, and papillitis.


Suspected orbital blow-out fracture should be evaluated for?

- EOM restriction
- crepitus
- vergences
- infraorbital hypoesthesia (decreased sensation of the cheek on the affected side due to damage of the infraorbital nerve)
- step-off
- exophthalmometry
- globe ptosis
- asymmetric monocular PDs


Most common location for an orbital blow-out fracture

Maxillary bone in the orbital floor


Nerve most susceptible to trauma?

CN 4.

Longest course from the brainstem. Can be congenital or acquired palsy:
- neoplasm/aneurysm (10%)
- ischemic (20%)
- undetermined (30%)
- trauma (40%)


Common causes of fungal keratitis

- aspergillus
- fusarium

Candida albicans often occurs in eyes with chronic corneal disease or immunocompromised


Familial adenomatous polyposis (FAP)

Autosomal dominant inherited condition that results in hundreds of polyps throughout the colon in post-puberty patients.

If left untreated, 100% of patients will develop colon cancer (usually by the age of 50).

Refer to internal medicine.


Gardner's syndrome

Variant of FAP - has multiple CHRPs in the fundus. Triad of multiple intestinal polyps, skeletal hamartomas and soft tissue tumours. 50% of these patients will have dental anomalies.

Refer to internal medicine.


Goldenhar syndrome

Incomplete development of facial structures. Dermoids appear over face - commonly inferotemporal limbus and may involve entire cornea.

- ocular dermoids
- preauricular skin tags
- vertebral dysplasia


Crouzan's syndrome

Craniofacial disorder.
- shallow orbits with PROPTOSIS
- aniridia
- blue sclera
- strabismus
- optic atrophy
- hypertelorism
- congenital cataracts


Congenital encephalocele

Results in proptosis at birth. Increases in proptosis and becomes pulsatile during crying.


Fabry's disease

X-lined autosomal recessive lysosomal storage disease - mostly in males.
- cornea verticilata
- posterior spoke-like crystalline lens opacities

Patients often report episodes of excruciating pain in the fingers and toes.
- premature death (ages 40-50) from renal or cardiovascular complications


Alcoholism's effect on optic nerve

Temporal pallor of both optic nerves.
- complaints of bilateral, painless, progressive vision loss

(FYI, trauma and medications can lead to pallor too)


What kind of vision loss is caused in temporal disc pallor?

Central or centrocecal visual field loss.

Macular fibres/papillomacular bundle enter the temporal optic nerve.


Marfan's syndrome

Autosomal dominant inherited connective tissue disorder caused by mutation in the fibrillin gene on chromosome 15.

- lens subluxation (sup temp), myopia, retinal detachments
- tall stature with disproportionately long arms, legs, and digits (arachnodactyly), joint laxity with disclocation is common
- cardiovascular abnormalities (eg. aortic aneurysm, mitral valve prolapse)

* no breakage in zonules, just stretch!


Ehlers-Danlos Syndrome

Rare inherited autosomal dominant collagen disorder caused by a deficiency in hydroxylysine.

- lens subluxation, blue sclera, angioid streaks, keratoconus, and megalocornea
- cardiovascular abnormalities (eg. aortic aneurysm, mitral valve prolapse)
- joint laxity with dislocation



Autosomal recessive disorder caused by deficiency in enzyme cystathionine synthase.

- lens subluxation (commonly inferior) and glaucoma (due to pupil block or dislocation of the lens into the anterior chamber)
- tall stature with features similar to Marfan's however intelligence is below normal


Weill-Marchesani Syndrome

Rare inherited (autosomal dominant or recessive) connective tissue disorder.

- short stature with small, short, stubby appendages
- lens subluxation (bilateral and inferior), microspherophakia and retinal detachment