Disorders

Question 1

orbital fracture

Answer 1

Floor: 
weakest bone - maxillary bone - posterior medial floor 
enophthalmos
diplopia
infraorbital hyperthesia
can get entrapment with restriction 

medial - depressed nasal bridge; can get epistaxis 2/2 injury of anterior ethmoidal artery; CSF rhinorrhea

apex: involve optic canal/SOF
can get CSF leak, carotid/cavernous fistula

roof - affect frontal sinus, cribriform place/brain

tripod of zygoma - zygomaticomaxillary suture, zygomaticofrontal suture, zygomatic arch discontinuity of orbital rim, flat malar eminence

Question 2

LeForte fractures

Answer 2

I - low transverse fracture of maxillary bone above teeth; NO orbital involvement
II - pyramidal fracture of nasal, lacrimal and maxillary bones; involves medial orbital floors
III - craniofacial dysjunction; involves orbital floor, lateral and medial walls; and can involve optic canal

Question 3

orbital myositis

Answer 3

EOMs, MR and LR most common (33% each); IR (10%)
s/s: diplopia, pain, proptosis, ptosis, conj injection, chemosis
can end up with fibrosis/strabismus

Question 4

Tolosa Hunt

Answer 4

localized to SOF, optic canal and cavernous sinus;
painful ophthalmoplegia, decreased VA
thought to be 2/2 inflammation, but unknown etiology
r/o craniopharygioma, mengioma, migraine
tx with steroids; patients do well

Question 5

Eye Findings in Graves

Answer 5

NO SPECS
No signs or symptoms 
Only signs
Soft tissue involvement 
proptosis
EOM involvement
Corneal involvement 
Sight loss

Question 6

TED

Answer 6

inflammation spares tendon

IMSLO (IR> MR> SR>LR> obliques)

Question 7

von Graefe sign

Answer 7

lid lag on downgaze