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Nervous System: Unit III > Opthalmology I > Flashcards

Flashcards in Opthalmology I Deck (17)
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Indications for treatment of orbital trauma

  • Immediate: Muscle entrapment, oculocardiac reflex (bradycardia)
  • Early repair: symptomatic diplopia, hypoglobus, large fracture, enopthalmus > 2mm (recession of eyeball), progressive infraorbital hypesthesia.


Mechanisms of treatment of orbital trauma

  • Go in the inside part of eyelid, dissect down to infraorbital layer
  • incise periosteum
  • expose bone, widely expose floor of orbit
  • cut an implant from porous polyethylene, put it over the fracture
  • ensure that eyes can move freely


Common pediatric orbital tumors

  • capillary hemangioma
  • dermoid cyst
  • lymphangioma
  • rhabdomyosarcoma


Clinical characteristics & treatment: capillary hemangioma

  • Dramatic presentation: Mechanical ptosis, superficial are red bumps, deep are deep blue progressive enlarging mass
  • Treatment:
    • Propranolol and steroid (anti-angiogenic factors)
    • surgical excision
  • 75% resolve by 5


Clinical characteristics & treatment: dermoid cyst

  • Lateral brow, smooth, slow growing, palpable
  • Treatment unknown


Clinical characteristics & treatment: lymphangioma

  • First decade of life, benign vascular formation, increased pressure, big intraocular cyst
  • Treatment: Surgery to drain blood and lymph


Clinical characteristics & treatment: rhabdomysocarcoma

  • Most common pediatric orbital malignancy of childhood.  
  • Sudden onset and rapidly progressive unilateral proptosis (protrusion of eye) in kids, or more subtle if teens.
    • Delayed diagnosis can lead to death. Always have on DDx.
  • Treatment: radiation and systemic chemotherapy.  Exentoration if recurrent cases.
  • If confined to orbit, 95% survive. 


Common adult orbital tumors

  • cavernous hemangioma
  • neural tumors
    • schwannoma
    • meningioma


Clinical characteristics & treatment: cevernous hemangioma

  • Most commmon benign neoplasm in adults
  • Tumor behind eye compressing optic nerve, slowly progressive proptosis
  • Treatment: Lateral orbitotomy, benign most often do not reoccur


Clinical characteristics & treatment: Shwannoma

  • Vestibular nerve tumor
  • slow growing
  • older/young women predominantly
  • Tx: lateral orbitotomy


Clinical characteristics & treatment: Meningioma

  • Sphenoid wing
  • Optic nerve sheath - enlarged, gradual decrease in vision, proptosis.
  • Also optociliary nerve vessels seen on opth exam
  • Sphenoid wing meningiomas: observe, radiation, fractionated static radiotherapy, surgery
    • lateral orbitotomy possible


Clinical features & tx: nasolacrimal duct obstruction

  • constant tearing w/frequent mucopurlence
  • Tx: dacryocystorhinostomy
    • incision @ side of nose ==>
    • create passage between lacrimal ducts and nasal canal


Acute and Chronic conditions resulting from nasolacrimal duct obstruction

  • Acute: dacrocystitis
  • Chronic: epiphora chronic dacrocystitis


Clincial features & tx: preseptal cellulitis 

  • infection of skin surrunding eye
  • tx:
    • antibiotics
    • nasal decongestants
    • warm compress


Clinical features and tx: complicated orbital cellulitis

  • Caused by sinusitis, disease posterior to orbital septum
  • ==> decrease in visiual acuity
  • Sx: Fever, leukocytosis, proptosis, chemosis, ptosis, restriction of movement and pain with ocular motility
  • Tx:
    • Treat immediately
    • Oral antibiotics
    • low threshold for surgical draining



Clinical characteristics of thyroid opthomology

  • characterized by extraocular muscle hypertrophy
    • auto-antibodies ==> fibroblast stimulation ==> inflammation + adipogenesis ==> EOM hypertrophy
  • Sx: 
    • proptosis
    • lid lag


Evaluation and tx of thyroid opthalmology

  • Establish euthyroid state, supportive care, surgery if severe.
  • Quit smoking.
  • Orbital decompression: through the nose, shave portion of ethmoid bone, and allow adipose to escape and releave compression