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Ocular Disease (Orbit) > Inflammatory/Infections of Orbit > Flashcards

Inflammatory/Infections of Orbit Flashcards

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1
Q

bony cavities that contain the globes, extraocular muscles, nerves, fat, & blood vessels

A

Orbits/Bony Orbit

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2
Q

pear shaped, tapering posteriorly to the apex & the optic canal

A

Bony orbit

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2
Q

_______approximately parallel and are separated by ___mm in the average adult

A

Medial orbital walls; 25mm

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3
Q

widest dimension of orbit is approximately __cm behind anterior orbital rim

A

1cm

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4
Q

allows the eye to rotate & move forward without damaging the nerve

A

The normal redundancy of optic nerve

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4
Q

segment of the optic nerve that is slightly “S-curved” and moves with the eye

A

Intraorbital segment

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5
Q

What are the 7 orbital walls

(EFLMPSZ)

A

Ethmoid
Frontal
Lacrimal
Maxilla (Maxillary)
Palatine
Sphenoid
Zygomatic

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6
Q

The evaluation of an orbital disorder should distinguish orbital from _______ and ________ lesions

A

Periorbital & intraocular lesions

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6
Q

5 categories of basic clinical patterns

A
  1. Inflammatory (acute, subacute, & chronic)
  2. Mass effect (causing globe displacement w/ axial/non-axial proptosis0
  3. Structural (congenital or acquired change in bony orbital structure)
  4. Vascular (venous or arterial lesions with characteristic dynamic changes
  5. Functional (sensory & motor dysfunction of neuro vascular structures)
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7
Q

What is the importance of the 5 basic clinical patterns

A

The classification provides a framework for development of a differential diagnosis. The evaluation begins with a detailed history.

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8
Q

What are the 6 Inflammatory/Infections of the Orbit

A
  1. Orbital cellulitis
  2. Orbital tuberculosis
  3. Zygomycosis
  4. Acute aspergillosis
  5. Nonspecific Orbital Inflammation (NSOI)
  6. Thyroid Eye Disease (TED)
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8
Q

involves structures posterior to the orbital septum

A

Orbital cellulitis

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9
Q

occurs as a secondary extension of acute or chronic bacterial sinusitis (majority of cases)

A

Orbital cellulitis

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10
Q

Clinical findings of Orbital cellulitis (FLEPCPRPDIRP)

A

a. Fever
b. Leukocytosis (75% of cases) - increased WBC
c. Erythema (redness)
d. Proptosis (exophthalmos, protrusion of the eye)
e. Chemosis (swelling)
f. Ptosis
g. Restriction upon ocular movement
h. Pain with ocular movement
i. Decreased vision
j. Impaired color vision
k. Restricted visual fields
l. Pupillary abnormalities

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11
Q

Clinical findings of Orbital cellulitis which suggest optic neuropathy that demands immediate investigation & aggressive management

A

Decreased vision,
Impaired color vision,
Restricted visual fields,
Pupillary abnormalities

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12
Q

Delay in treatment of Orbital Cellulitis may result in (BCCBD)

A

a. Blindness
b. Cavernous sinus thrombosis
c. Cranial neuropathy
d. Brain abscess
e. Death

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13
Q

Management of Orbital Cellulitis

A

ANTIBIOTIC THERAPY provide broad-spectrum coverage

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14
Q

(Orbital Cellulitis) What are the organisms involved in infections in adults

A

Gram-positive cocci
H influenzae
Moraxella catarrhalis
Anaerobes

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15
Q

occurs most commonly as a result of hematogenous spread from a pulmonary focus

A

Orbital tuberculosis

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16
Q

spread occurs from adjacent tuberculous sinusitis

A

Orbital tuberculosis

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17
Q

Clinical findings of Orbital Tuberculosis (PMBC)

A

Proptosis
Motility dysfunction
Bone destruction
Chronic draining fistulas

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17
Q

this disease is usually unilateral

A

Orbital tuberculosis

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18
Q

skin testing & fine-needle aspiration biopsy with culture early in course of disease may help establish diagnosis

A

Orbital tuberculosis

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18
Q

Treatment/Management of Orbital tuberculosis

A

ANTITUBERCULOUS THERAPY is usually curative

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19
What are the other names for Zygomycosis
Phycomycosis, Mucormycosis
19
What are the the most common & most virulent fungal disease involving the orbit
Mucor & Rhizopus
20
The fungi invade blood vessel walls, producing _________
"Thrombosing vasculitis"
21
Who are the at risk of Zygomycosis
Older adults - relatively immunosuppressed therefore at risk of virulent infections
21
The resultant tissue necrosis promotes further _______
fungal invasion
22
Diagnosis: _______ of the necrotic-appearing tissues in the nasopharynx or involved sinus or orbit
Biopsy
23
Treatment of Zygomysocis: ____________ should be given via IV administration of ___________ or _________
Antifungal therapy; amphotercin B, liposomal amphotericin B
23
fungal disease characterized by fulminant sinus infection with secondary orbital invasion
Acute aspergillosis
23
Clinical Manifestations of Acute aspergillosis (SDP)
Severe periorbital pain Decreased vision Proptosis
24
Diagnosis for Acute aspergillosis
Biopsy
25
Management of Acute aspergillosis
- Therapy of aggressive surgical excision of all infected tissues. -Administration of ampotericin B, flucytosine, rifampin, voriconazole, caspofungin, or combination of these
25
Management of Acute aspergillosis: Administration of what 5 antifungal (AFRVC)
amphotericin B, flucytosine, rifampin, voriconazole, caspofungin, or a combination of these
26
benign inflammatory process of orbit characterized by a polymorphous lymphoid infiltrate with varying degrees of fibrosis
Nonspecific Orbital Inflammation (NSOI)
27
no known local or systemic cause
NSOI
28
diagnosis of exclusion that should only be used after all specific causes of inflammation have been eliminated
NSOI
28
NSOI is also known as
-Orbital pseudotumor -Idiopathic orbital inflammation -Idiopathic orbital inflammatory syndrome
28
Pathogenesis of NSOI: _______ -generally believed to be an ___________ because it is often associated with SYSTEMIC IMMUNOLOGIC DISORDERS
Controversial/unknown; immune-mediated process
29
Systemic immunologic disorders related to NSOI (CSRDMA)
-Crohn disease -Systemic lupus erythematosus -Rheumatoid arthritis -Diabetes mellitus -Myasthenia gravis -Ankylosing spondylitis
29
Symptoms & findings of NSOI (dictated by degree & anatomical location of inflammation)
-EOM (Myositis) - pain associated with ocular movement -Lacrimal gland (Dacryoadenitis) - CT reveals diffuse enlargement of lacrimal gland -Anterior orbit (Scleritis) - vision may be impaired if optic nerve or posterior sclera is involved -Orbital Apex - diffuse inflammation throughout the orbit
29
autoimmune inflammatory disorder whose underlying cause continues to be cleared
Thyroid Eye Disease (TED)
29
TED is also known as
Graves ophthalmopathy Thyroid ophthalmopathy Thyroid associated orbitopathy Thyrotoxic exophthalmos
29
NSOI Treatment/Management
-Systemic corticosteroids - rapid & favorable response -Immunosuppressive agents
30
31
Clinical signs of TED (EVPRCECC)
-Eyelid retraction -Von Graefe sign (lid lag) -Proptosis -Restrictive extraocular myopathy -Compressive optic neuropathy -Exposure keratopathy -Conjunctival erythema (redness) -Conjunctival chemosis
32
TED was originally described as part of triad that constitutes (GHPH)
Graves disease Hyperthyroidism Pretibial myxedema Hashimoto thyroiditis (immune-induced hypothyroidism)
33
most common clinical feature of TED ( and TED is the most common cause of ______)
Eyelid retraction
34
most common cause of unilateral or bilateral proptosis
Thyroid Eye Disease (TED)
35
TED may be markedly ______
asymmetric
36
TED is associated with ______ in 90% of patients, 6% of patients may be ________
Hyperthyroidism; euthyroid
37
True/False: Severity of TED usually does not parallel serum levels of T$or T3
True
38
TED is 6 times as common in _______ as in ________
women; men
39
______ is associated increased risk & severity of TED. Urgent care may be required for optic neuropathy or severe proptosis with corneal decompensation
Smoking
40
(TED) If surgery is needed what is the usual order of procedures
Orbital decompression Strabismus surgery Eyelid retraction repair
40
TED Diagnosis: Concurrent or recently treated immune-related thyroid dysfunction: (GHP)
- Graves hyperthyroidism - Hashimoto thyroiditis - Presence of circulating thyroid antibodies
40
TED Diagnosis: Radiographic evidence- unilateral/bilateral fusiform enlargement of one or more of the following:
-Inferior rectus muscle -Medial rectus muscle -Superior rectus & or levator muscle complex -Lateral rectus muscle
40
TED Diagnosis: Typical ocular signs one or more of the following:
- Unilateral/bilateral eyelid retraction with typical temporal flare (w/ or w/o lagophthalmos) -Unilateral/bilateral proptosis -Restrictive strabismus in typical pattern -Compressive optic neuropathy -Fluctuating eyelid edema & or erythema -Chemosis & or caruncular edema
40
Treatment & prognosis of TED
TED is a self-limiting disease - last 1 year in non-smokers - between 2-3 years in smokers
41
therapy usually is directed toward either decreasing orbital congestion & inflammation
Severe Orbital inflammation
41
Treatment & prognosis: Severe Orbital inflammation To prevent:
Corneal exposure Globe subluxation Optic neuropathy
42
Treatment & prognosis: Severe Orbital inflammation
1. Periocular corticosteroids 2. Systemic corticosteroids 3. Periocular radiotherapy 4. Surgical orbital decompression - expanding orbital bony volume
43
____% of px with TED undergo surgical treatment
20%
44
13% of patients underwent______
eyelid surgery
44
9% of patients underwent __________
Strabismus surgery
45
7% of patients underwent _______
Orbital decompression
46
only _____% required all 3 types of surgery
2%
47
Elective orbital decompression, strabismus surgery, & eyelid retraction repair are delayed until a _________ has been maintained & ophthalmic signs have been confirmed stable for ______ months
"Euthyroid state"; 6-9 months
47
Consideration of that delay until euthyroid state:
Unless urgent intervention is required to reverse vision loss due to compressive optic neuropathy or corneal unresponsive to maximal medical measures.

Ocular Disease (Orbit) (2 decks)

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