Flashcards in Lecture 3 - Orbital Myositis to Cysts Deck (14)
Idiopathic, non-specific inflammatory disorder of one or more of the EOM's, a subtype of IOID, due to chronic inflammatory cellular infiltrate in muscle fibers
Female with history of Rheumatoid arthritis, During examination of a patient complaining of eye pain, you find that EOMs increase the pain and cause diplopia, and RMR, RSR and RLR are resctricted. There is also lid edema, ptosis, and chemosis, and mild proptosis. a CT scan shows fusiform enlargement of the RMR but no sign of tendon involvement. Diagnose and treat.
1. Orbital Myositis
2. NSAID if mild, systemic steroids show dramatic imrpovement, Radiotherapy is effective in limiting recurrences that can occur with systemic steroids. Prednisolone for 3 months, 60 mg/day
Chronic if more than 2 months or recurrent attacks
Can be caused by Graves disease, but painless and systemic manifestation
Which nerves are near the cavernous sinus? -4
CN III - Oculomotor
CN IV- Trochlear
CN V1- Ophthalmic
CN V2- Maxillary
Abnormal communication between Internal Carotid Artery and Cavernous Sinus. ICA blood flows anteriorly in to the venous channels within the cavernous sinus, leading to increased episcleral and Superior Ophthalmic Vein pressure, and decreased arterial blood flow to the cranial nerves within the CS- caused by trauma or spontaneous
Direct Carotid Cavernous Fistula
Floyd "Money" Mayweather comes in to your office after a big fight with complaint of sudden onset vision loss. Upon inspection, you find corkscrew conjunctival vessels, pusatile proptosis with bruit and thrill, chemosis, affected eye that cant turn outward, increased IOPs, swollen optic disc, and intraretinal hemorrhages. Diagnose and Treat.
1. Direct Carotid Cavernous Fistula
2. Cannulation or intraorbital puncture of superior orbital vein for drainage of Superior Ophthalmic Vein
Abnormal communication between ICA and cavernous sinus, Intacarvernous portion of the internal carotid artery remains intact. Fistula occurs etween the cavernous sinus and the branches of the ICA, ECA, or both, meningeal branches anastomose with sinus channels in the cavernous sinus. Slow blood flow into sinus channels causes more subtle clinical features than a direct fistula - often misdiagnosed or overlooked.
Indirect Carotid Cavernous Fistula
Mike Tyson comes into your office with mild epibulbar injection, exaggerated ocular pulsation, increased IOP, mild proptosis with soft bruit, inability to turn eye outward, and moderate venous dilation in fundus. Diagnose and treat.
1. Indirect Carotid Cavernous Fistula
2. endovascular embolization for recanalization, cannulation or intraorbital puncture of superior orbital vein for drainage. ICCF can sometimes have spontaneous resolution
Also known as choristoma - benign mal-development of normal tissue not normally found at the specific tissue site, arise from ectoderm and may contain epithelium structures like keratin, hair, teeth.
Dermoid Cyst - superficial or deep
Superficial keratin- filled mass, usually in the Supratemporal rim
Solid mass of fatty material and hair below the bulbar conjunctival surface
A patient complains about a firm, round, smooth, painless subcutaneous mass she has had on the supratemporal portion of her left eye since birth. The edges are easily palpable so it isnt deep or extensive. Diagnose and Treat.
1. Superficial Dermoid Cyst
2. Excision, do not rupture the lesion because it will release keratin and cause a severe foreign body inflammatory response
A 22 y/o patient with proptosis shows you a CT scan he got after developing a mass protruding from bone near the eyebrow. the CT shows a well circumscribed cystic lesion extending intracranially as it is associated with a bony defect in this case. Diagnose and Treat.
1. Deep Dermoid Cyst
2. Excision, if it leaks contents into adjacent tissue it will cause painful FB reaction and fibrosis, may reoccur and cause persistent low-grade inflammation if not excised completely
Cystic lesion involving the orbit that develops when the drainage of normal paranasal sinus secretions is obstructed by allergy, infection, trauma, tumor, or congenital narrowing. If expands, will erode walls of sinuses. Becomes orbital when they invade from frontal or ethmoid sinus, sometimes maxillary sinus.