Evaluation of Orbital Disorders

Question 1

Salmon colored mass in cul-de-sac?

Answer 1

lymphoma

Question 2

Eyelid retraction and lid lag?

Answer 2

thyroid eye disease

Question 3

Vascular congestion over the insertions of the rectus muscles (esp. lateral rectus)?

Answer 3

thyroid eye disease

Question 4

Corkscrew conjunctival vessels?

Answer 4

AV fistula

Question 5

Vascular anomaly of eyelid skin?

Answer 5

Lymphatic malformation, varix, or hemangioma

Question 6

S-shaped eyelid?

Answer 6

plexiform neurofibroma or lacrimal gland mass

Question 7

Eczematous lesions of eyelids?

Answer 7

mycosis fungoides (T-cell lymphoma)

Question 8

Ecchymosis of eyelid skin?

Answer 8

metastatic neuroblastoma, leukemia, or amyloidosis

Question 9

Prominent temple?

Answer 9

sphenoid wing meningioma, metastatic neuroblastoma

Question 10

Edematous swelling of lower eyelid?

Answer 10

meningioma, inflammatory tumor, metastases

Question 11

Optociliary shunt vessels?

Answer 11

meningioma, CRVO, glaucoma, chronic papilledema

Question 12

Frozen globe?

Answer 12

metastases or zygomycosis

Question 13

Black crusted lesions in nasopharynx?

Answer 13

mucormycosis

Question 14

Facial asymmetry?

Answer 14

fibrous dysplasia or neurofibromatosis

Question 15

What is exorbitism?

Answer 15

angle between lateral orbital walls greater than 90 degrees

Question 16

What is hypertelorism, or telorbitism?

Answer 16

wider than normal separation between medial orbital walls (“wide-clopse”)

Question 17

What is telecanthus?

Answer 17

abnormally increased distance between medial canthi

Question 18

Location and types of lesions causing axial displacement of globe?

Answer 18

intraconal mass behind globe, such as cavernous hemangioma, glioma, meningioma, metastases, and AVMs

Question 19

Most common cause of bilateral proptosis in adults? What are other causes?

Answer 19

• thyroid eye disease

- lymphoma, vasculitis, NSOI, mets, CC-fistulas, cavernous sinus thromboses, leukemic infiltrates

Question 20

Most common cause of unilateral proptosis in adults?

Answer 20

TED

Question 21

Differential for bilateral proptosis in children?

Answer 21

TED, NSOI, metastatic neuroblastoma, leukemic infiltrates

Question 22

What is the cutoff for a clinically significant difference in exophthalmometry between fellow eyes?

Answer 22

2 mm

Question 23

What EOM is most commonly affected in TED?

Answer 23

inferior rectus

Question 24

What is the von Graefe sign, and what is it highly suggestive of?

Answer 24

delay in the upper eyelid’s descent (“lid lag”) in downgaze; TED

Question 25

Most common physical signs of TED?

Answer 25

lid lag of upper eyelid and eyelid retraction of upper and lower lids

Question 26

Differential for palpable lesion in superonasal quadrant?

Answer 26

mucocele, mucopyocele, encephalocele, neurofibroma, rhabdomyosarcoma, or lymphoma

Question 27

Differential for palpable lesion in superotemporal quadrant?

Answer 27

prolapsed lacrimal gland, dermoid cyst, lacrimal gland tumor, lymphoma, NSOI

Question 28

Orbital locations where MRI is better than CT?

Answer 28

orbitocranial junction and soft tissues of orbital apex