diseases and surgery of the orbit Flashcards Preview

Question 1

1

ophthalmic examination

Answer

retropulsion

orbital palpation

examination of facial symmetry

globe movement

oral exam

nasal airflow

Question 2

2

retropulsion

Answer

should be equal

Question 3

3

orbital palpation

Answer

bony changes

masses in orbit

periocular soft tissue swelling

Question 4

4

examination for facial symmetry

Answer

globe position & alignment

Question 5

5

globe movement

Answer

vestibulo-ocular reflex

direction of gaze

Question 6

6

oral exam

Answer

restricted movement

pain opening mouth

oral mucosa

Question 7

7

U/s

Answer

soft tissue masses within orbit

guide FNA or Bx

Question 8

8

rads

Answer

skull or dental

req general anesthesia

good for bony lesions, radiodense FB

often non-dx

Question 9

9

MRI/CT

Answer

MRI superior for soft tissue imaging

CT superior for detection of bony lesions

evaluates extent of disease

Question 10

10

FNA/Bx

Answer

incisional bx

Tru-Cut

U/s guided

Question 11

11

exploratory orbitotomy

Answer

various approaches

obtain sample for bx

Question 12

12

diagnostic test for orbital disease

Answer

U/s

rads

MRI/CT

FNA/bx

exploratory orbitotomy

Question 13

13

microphthalmos

Answer

congenitally small globe with concurrent ocular abn

differentiate from enophthalmos

often associated with dilute coat color

nonprogressive

no therapy

Question 14

14

nanophthalmos

Answer

congenitally small globe without other abn

Question 15

15

anophthalmos

Answer

congenital absence of globe

rare

Question 16

16

cyclopia

Answer

Veratrum californicum toxicosis in sheep

day 14 in gestation

congenital anophthalmia, cyclopia and synophthalmia

Question 17

17

strabismus

Answer

abnormal eye position

exotropia

eostropia

can be congenital or acquired

Question 18

18

extropia

divergent

Answer

convergent

Answer

Siamese cats

brachycephalic dogs

hydrocephalus

usually no therapy

Answer

neurological, inflammatory and fibrosing diseases

treat underlying cause

Answer

common in SA

underlying cause often not found-FB, ascending tooth root inf, resp dz

Answer

younger animals (avg 4 yo)

acute onset

unilateral exophthalmos, raised nictitans, periorbital swelling, decreased retropulsion

pain opening mouth!

lethargy, pyrexia, leukocytosis

Answer

PE

Minimum database

FINA/bx

U/s

MRI

Answer

drain abscess

1) incise oral mucosa posterior to last maxillary molar

2) gently insert hemostats and open (DO NOT CLOSE HEMOSTATS-nerves and aa nearby)

3) swab for C&S

4) Drain and flush

Broad spectrum abx, NSAIDs for weeks

Answer

older animals (avg 10 yo)

slower progression

unilateral sx

no pain opening mouth

PE and labs-normal

Answer

PE

Min DB

Bx

u/s

MRI**

Answer

guarded

usually malignant

often euthanized shortly after presentation

Answer

loss of sympathetic innervation to the eye

Idiopathic in dogs

Gutteral pouch disease in horses

trauma

otitis media

neoplasia

rare in cats

Answer

enophtalmos

raised third eyelid

ptosis (mueller's muscle)

miosis

horse-ipsilateral sweating

cow-ipsilateral absence of sweating on the noise

Answer

denervation hypersensitivity: postganglionic lesions, in absence of NT, muscle upregulates receptors-more sensitive

indirect sympathomimetic drugs: preganglionic-pupillary dilation, post ganglionic-minimal to no pupillary dilation

direct sympathomimetic drugs: Epi, pre-pupillary dilation 30-40 min, post, pupillary dilation <20 min

Answer

pharmacologic testing localizes the lesion

further workup based on results: Otic exam, MRI, thoracic rads

idiopathic-spontaneously resolves in ~6 weeks

other tx-depends on cause

post-better px

Answer

due to loss of orbital contents or dz of adjacent structures: weight loss, muscle atrophy

tx: underlying cause, secondary entropion, conjunctivitis

Answer

shrunken globe

secondary to chronic/severe infl, glaucoma

damage to ciliary body decreases and eventually stops aqueous humor production

differentiate from microphthalmos

Answer

removal of globe, eyelid margins, conjunctiva and third eyelid

indications: blind, painful eyes, disease limited to the eye (ie galucoma, perforated globe, intraocular tumor)

Answer

enucleation with removal of all orbital contents

indications: ocular disease extending beyond sclera (ie intraocular tumor with extrascleral extension)

Answer

removal of ocular contents, leaving only cornea and sclera, followed with placement of prosthesis

indications: blind, painful eyes, disease limited to globe, caution with corneal disease

Answer

exploratory or therapeutic

various techniques

varying levels of exposure

Question 19

19

esotropia

Question 20

20

congenital strabismus

Question 21

21

acquired strabismus

Question 22

22

orbital cellulitis/abscess

Question 23

23

orbital cellulitis/absces: Presentation

Question 24

24

orbital cellulitis/abscess: Dx testing

Question 25

25

orbital cellulitis/abscess: Tx

Question 26

26

Orbital neoplasia: presentation

Question 27

27

Orbital neoplasia: Dx testing

Question 28

28

orbital neoplasia: Px

Question 29

29

Horner's syndrome: causes

Question 30

30

Horner's syndrome: clinical sxs

Question 31

31

Horner's Syndrome: Localize the lesion

Question 32

32

Horner's Syndrome: Dx & Tx

Question 33

33

secondary enophthalmos

Question 34

34

Phthisis bulbi

Question 35

35

enucleation

Question 36

36

exenteration

Question 37

37

evisceration

Question 38

38

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diseases and surgery of the orbit Flashcards Preview

ophthamology > diseases and surgery of the orbit > Flashcards

ophthalmic examination

retropulsion orbital palpation examination of facial symmetry globe movement oral exam nasal airflow

retropulsion

should be equal

orbital palpation

bony changes masses in orbit periocular soft tissue swelling

examination for facial symmetry

globe position & alignment

globe movement

vestibulo-ocular reflex direction of gaze

oral exam

restricted movement pain opening mouth oral mucosa

U/s

soft tissue masses within orbit guide FNA or Bx

rads

skull or dental req general anesthesia good for bony lesions, radiodense FB often non-dx

MRI/CT

MRI superior for soft tissue imaging CT superior for detection of bony lesions evaluates extent of disease

FNA/Bx

incisional bx Tru-Cut U/s guided

exploratory orbitotomy

various approaches obtain sample for bx

diagnostic test for orbital disease

U/s rads MRI/CT FNA/bx exploratory orbitotomy

microphthalmos

congenitally small globe with concurrent ocular abn differentiate from enophthalmos often associated with dilute coat color nonprogressive no therapy

nanophthalmos

congenitally small globe without other abn

anophthalmos

congenital absence of globe rare

cyclopia

Veratrum californicum toxicosis in sheep day 14 in gestation congenital anophthalmia, cyclopia and synophthalmia

strabismus

abnormal eye position exotropia eostropia can be congenital or acquired

extropia

divergent

esotropia

convergent

congenital strabismus

Siamese cats brachycephalic dogs hydrocephalus usually no therapy

acquired strabismus

neurological, inflammatory and fibrosing diseases treat underlying cause

orbital cellulitis/abscess

common in SA underlying cause often not found-FB, ascending tooth root inf, resp dz

orbital cellulitis/absces: Presentation

younger animals (avg 4 yo) acute onset unilateral exophthalmos, raised nictitans, periorbital swelling, decreased retropulsion pain opening mouth! lethargy, pyrexia, leukocytosis

orbital cellulitis/abscess: Dx testing

PE Minimum database FINA/bx U/s MRI

orbital cellulitis/abscess: Tx

drain abscess 1) incise oral mucosa posterior to last maxillary molar 2) gently insert hemostats and open (DO NOT CLOSE HEMOSTATS-nerves and aa nearby) 3) swab for C&S 4) Drain and flush Broad spectrum abx, NSAIDs for weeks

Orbital neoplasia: presentation

older animals (avg 10 yo) slower progression unilateral sx no pain opening mouth PE and labs-normal

Orbital neoplasia: Dx testing

PE Min DB Bx u/s MRI**

orbital neoplasia: Px

guarded usually malignant often euthanized shortly after presentation

Horner's syndrome: causes

loss of sympathetic innervation to the eye Idiopathic in dogs Gutteral pouch disease in horses trauma otitis media neoplasia rare in cats

Horner's syndrome: clinical sxs

enophtalmos raised third eyelid ptosis (mueller's muscle) miosis horse-ipsilateral sweating cow-ipsilateral absence of sweating on the noise

Horner's Syndrome: Localize the lesion

Horner's Syndrome: Dx & Tx

pharmacologic testing localizes the lesion further workup based on results: Otic exam, MRI, thoracic rads idiopathic-spontaneously resolves in ~6 weeks other tx-depends on cause post-better px

secondary enophthalmos

due to loss of orbital contents or dz of adjacent structures: weight loss, muscle atrophy tx: underlying cause, secondary entropion, conjunctivitis

Phthisis bulbi

shrunken globe secondary to chronic/severe infl, glaucoma damage to ciliary body decreases and eventually stops aqueous humor production differentiate from microphthalmos

enucleation

removal of globe, eyelid margins, conjunctiva and third eyelid indications: blind, painful eyes, disease limited to the eye (ie galucoma, perforated globe, intraocular tumor)

exenteration

enucleation with removal of all orbital contents indications: ocular disease extending beyond sclera (ie intraocular tumor with extrascleral extension)

evisceration

removal of ocular contents, leaving only cornea and sclera, followed with placement of prosthesis indications: blind, painful eyes, disease limited to globe, caution with corneal disease

orbitotomy

exploratory or therapeutic various techniques varying levels of exposure

Key Links

Subjects

Brainscape's Knowledge Genome^TM

retropulsion

orbital palpation

examination of facial symmetry

globe movement

oral exam

nasal airflow

bony changes

masses in orbit

periocular soft tissue swelling

vestibulo-ocular reflex

direction of gaze

restricted movement

pain opening mouth

oral mucosa

soft tissue masses within orbit

guide FNA or Bx

skull or dental

req general anesthesia

good for bony lesions, radiodense FB

often non-dx

MRI superior for soft tissue imaging

CT superior for detection of bony lesions

evaluates extent of disease

incisional bx

Tru-Cut

U/s guided

various approaches

obtain sample for bx

U/s

rads

MRI/CT

FNA/bx

exploratory orbitotomy

congenitally small globe with concurrent ocular abn

differentiate from enophthalmos

often associated with dilute coat color

nonprogressive

no therapy

congenital absence of globe

rare

Veratrum californicum toxicosis in sheep

day 14 in gestation

congenital anophthalmia, cyclopia and synophthalmia

abnormal eye position

exotropia

eostropia

can be congenital or acquired

Siamese cats

brachycephalic dogs

hydrocephalus

usually no therapy

neurological, inflammatory and fibrosing diseases

treat underlying cause

common in SA

underlying cause often not found-FB, ascending tooth root inf, resp dz

younger animals (avg 4 yo)

acute onset

unilateral exophthalmos, raised nictitans, periorbital swelling, decreased retropulsion

pain opening mouth!

lethargy, pyrexia, leukocytosis

PE

Minimum database

FINA/bx

U/s

MRI

drain abscess

1) incise oral mucosa posterior to last maxillary molar

2) gently insert hemostats and open (DO NOT CLOSE HEMOSTATS-nerves and aa nearby)

3) swab for C&S

4) Drain and flush

Broad spectrum abx, NSAIDs for weeks

older animals (avg 10 yo)

slower progression

unilateral sx

no pain opening mouth

PE and labs-normal

PE

Min DB

Bx

u/s

MRI**

guarded

usually malignant

often euthanized shortly after presentation

loss of sympathetic innervation to the eye

Idiopathic in dogs

Gutteral pouch disease in horses

trauma

otitis media

neoplasia

rare in cats

enophtalmos

raised third eyelid

ptosis (mueller's muscle)

miosis

horse-ipsilateral sweating

cow-ipsilateral absence of sweating on the noise

pharmacologic testing localizes the lesion

further workup based on results: Otic exam, MRI, thoracic rads

idiopathic-spontaneously resolves in ~6 weeks

other tx-depends on cause

post-better px

due to loss of orbital contents or dz of adjacent structures: weight loss, muscle atrophy

tx: underlying cause, secondary entropion, conjunctivitis

shrunken globe

secondary to chronic/severe infl, glaucoma

damage to ciliary body decreases and eventually stops aqueous humor production

differentiate from microphthalmos

removal of globe, eyelid margins, conjunctiva and third eyelid

indications: blind, painful eyes, disease limited to the eye (ie galucoma, perforated globe, intraocular tumor)

enucleation with removal of all orbital contents

indications: ocular disease extending beyond sclera (ie intraocular tumor with extrascleral extension)

removal of ocular contents, leaving only cornea and sclera, followed with placement of prosthesis

indications: blind, painful eyes, disease limited to globe, caution with corneal disease

exploratory or therapeutic

various techniques

varying levels of exposure