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Orbit Flashcards

1
Q

What is this?

A

Preceptal Cellulitis

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2
Q

What things are shown here?

A

Eyelid and periocular edema

Chemosis

Epibulbar injection

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3
Q

What is shown here?

A

Proptosis

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4
Q

What is shown?

A

Dystopia: Displaced eye

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5
Q

What is shown?

A

Ophthalmoplegia: Misalignment of the eyes due to muscle innervation problems

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6
Q

What might orbital pulsation be caused by?

A

Cavernous sinus fistula

Defect in orbital roof transmitted via CSF

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7
Q

What is orbital pulsation?

A

Subtle pulsing at slit lamp or exaggeratied IOP “pulse”

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8
Q

What might be causes of bruit?

A

Carotid-cavernous fistula

Carotis stenosis in CVA

A-V malformations

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9
Q

What is imaged here?

A

Choroidal Folds

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10
Q

What is imaged here?

A

Disc edema

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11
Q

What is shown here?

A

Optic Atrophy

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12
Q

What is ocular auscultation?

A

Using the bell of a stethoscope over the closed eye to listen for higher pitced sound in one eye than in the other.

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13
Q

What is a dense fibrous sheath acting as a barrier between orbit and eyelid?

A

Orbital septum

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14
Q

What does the orbital septum do?

A

Limits infection

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15
Q

Where does the orbital septum originate?

A

Periosteum of superior and inferior orbital rims

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16
Q

Where does the orbital septum insert?

A

Into the levator aponeurosis, just above the superior tarsal border

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17
Q

What is this?

A

Preceptal cellulitis

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18
Q

Is preceptal cellulitis involved with:

A) Only upper lid

B) Upper and lower lid

C) Lower lid

A

B) Upper and lower lid

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19
Q

What symptoms coincide with preceptal cellulitis?

A

Red, tender, edematous lids

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20
Q

What are important symptoms to note are not associated with preceptal cellulitis?

A

Proptosis, chemosis, vision change, pupillary involvement, fever, EOM restriction

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21
Q

What bacteria usually causes preceptal cellulitis?

A

Staph aureus

Strep pyogenes

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22
Q

Which bacteria usually causes preseptal cellulitis in children?

A

H. influenzae

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23
Q

What things causes allow the bacteria inside to cause preseptal cellulitis?

A

Laceration

Insect bite

Infection spread from hordeolum

Dacrocystitis

Sinusitis

Conjunctivitis

UR or middle ear infection

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24
Q

If any of: proptosis, chemosis, vision change, pupillary involvement, fever or EOM restriction are noted along with red, tender edematous lids, would you suspect preseptal cellulitis, or orbital cellulitis?

A

Orbital cellulitis

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25
How if afebrile, mild preseptal cellulitis best treated in adults?
Oral antibiotic for 10 days Ex: Augmentin 500mg p0 q8h Cefaclor 250-500mg po q8h Bactrim or moxifloxacin if allergic to penicillin
26
How is afebrile preseptal cellulitis treated in children under 5?
Augmentin 20-40 mg/kg/day po Cefaclor 20-40 mg/kg/day po Bactrim (trimethoprim/sulfamethoxazole) if allergic to penicillin
27
With moderate to sever, febrile preseptal cellulitis in a child under 5, what should be done?
Hospital admission for IV antibiotics
28
What is orbital cellulitis?
A life-threatening infectio of soft tissue behind the orbital septum
29
Orbital cellulitis is ___ (better, worse) in children than in adults.
Worse
30
Which bacteria are usually the cause of orbital cellulitis?
S. pneumoniae S. aureus S. pyogenes H. influenzae
31
What symptoms are commonly seen in orbital cellulitis?
Proptosis Pain with EOM restriction Fever Malaise Visual imparment (if optic nerve involved) APD
32
What are the potential complications of orbital cellulitis?
Meningitis Brain abscess Cavernous sinus thrombosis
33
If orbital cellulitis is deemed emergent, what should be done?
Hospital admission, IV ceftazidime (or vancomycin) + oral metronidazole (anerobes)
34
What is this?
Chalazion
35
What is dacryoadenitis?
Most commonly an inflammaotory lacrimal gland disease. May also be an autoimmune disease
36
Idiopathis dacryoadenitis makes up \_\_% of the leasions.
50%
37
Comorbidity is frequent with which type of dacryoadenitis?
Autoimmune
38
Dacryoadenitis is unilateral \_\_% of the time.
80%
39
Bilateral, painless swelling describes which dacryoadenitis?
Autoimmune dacryoadenitis
40
Which is the least common type of dacryoadenitis?
Neoplastic dacryoadenitis
41
What symptomes are associated with neoplastic dacryoadenitis?
Unilateral palpable mass Dystopia Proptosis Low incidence of: pain, redness Lymphocytic infiltration in elderly Pleomorphic adenoma in young Carcinoma - middle age, rare w/ high mortality
42
What is this?
Dacryoadenitis
43
What may occur with lymphocytic infiltration of the lacrimal gland?
Can change from benign hyperplasia to malignant lymphoma
44
What is a common sign of lymphocytic infiltration of the lacrimal gland?
Subconjunctival salmon patch extension
45
What is this?
Infectious dacryoadenitis
46
What are some symptoms of infectious dacryoadenitis?
Pain Erythema Edema of lateral upper lid - "S" curve
47
What age group usually is seen with infectious dacryoadenitis?
Children and young adults, typically
48
Viral infectious dacryoadenitis is usually caused by which diseases?
Epstein-Barr (mono) Mumps Adenovirus Herpes zoster Herpes simplex Rhinovirus
49
What age group usually gets viral infectious dacryoadenitis? Bacterial?
Viral - under 40 Bacterial - over 40 (rare)
50
Which bacteria are usually the cause of bacterial infectious dacryoadenitis?
Staph MRSA Strep H. Influenzae Gonorrhea
51
What is a primary risk factor for Grave's ophthalmopathy?
Smoking
52
What is the etiology of Grave's autoimmunity?
Attack of TSH receptor by TSH receptor auto-antibodies Abnormal circulating T3/T4 levels (TSH causes release of these)
53
What signs are noted here?
Proptosis Lid retraction Conjunctival hyperemia Periorbital edema All from Graves' Ophthalmopathy
54
What is Dalrymple's Sign?
Lid retraction
55
What is Von Graefe's sign?
Lid lag
56
What is idiopathic orbital inflammatory disease?
Non-infective, non-neoplastic, space-occupying lesions. Generally unilateral
57
Idiopathic orbital inflammatory disease, though usually unilateral, may be bilateral in \_\_\_.
Children
58
What are some common signs and sypmtoms of idiopathic orbital inflammatory disease?
Periorbital redness, swelling, pain Proptosis, ophthalmoplegia May have optic nerve involvement
59
What is the treatment for mild idiopathic orbital inflammatory disease?
Observation...
60
What are the treatments for idiopathic orbital inflammatory disease?
Biopsy to rule out neoplasia NSAID - Ibuprofen 100-400 mg tid Oral steroids 60-80 mg/day after confirmed Dx Radiotherapy if no improvement Antimetabolites (methotrexate) if no improvement
61
What is this?
Orbital Myositis
62
What is this?
Idiopathis orbital inflammatory disease (IOID)
63
What is this?
Orbital myositis
64
What signs/symptoms are expected in orbital myositis?
Pain exacerbated by eye movement Diplopia - restricted EOM Injection over involved muscle Lide edema, ptosis Fibrosed muscle enlargement
65
What are treatments for orbital myositis?
NSAID - Ibuprofen 100-400mg tid 3 weeks Oral steroids if persisting (40-60mg qd, tapered 1-4 wk)
66
What is Tolosa-Hunt Syndrome?
Rare, idiopathic, granulomatous inflammation of the cavernous sinus, superior fissure, orbital apex
67
What may Tolosa-Hunt syndrome cause?
Mild proptosis Oculomotor nerve palsies, usually with pupil involvement \*Sensory loss of V1, V2 of trigeminal nerve
68
What is the treatment for Tolosa-Hunt syndrome?
Steroids
69
What is this?
Carotid Cavernous Fistula
70
What signs/symptoms are associated with cavernous sinus fistula?
Elevated venous sinus and episcleral venous pressure Hemorrhagic chemosis Pulsatile proptosis, whooshing noise in the head, bruit Increased IOP with exaggerated "ocular pulse" Vision loss and neuro impact - immediate or delayed; mostly CN VI, some III, IV, V
71
What is this?
Conjunctivochalasis
72
What is dacryocystography (DCG) used for?
To identify the site of obstruction of the drainage system
73
What is this?
Dacryocystitis
74
What signs/symptoms are associated with dacryocystitis?
Pain Epiphora
75
What is the treatment for dacryocystitis?
Warm compresses Oral antibiotics - Children: augmentin 20-40 mg/kg/day, or cefaclor 20-40 mg/kg/day Oral antibiotics - adults: cephalexin 500 mg po q6h, or augmentin 500 mg po q8h Topical antibiotics (in addition) - trimethoprim/polymyxin B qid
76
For which disease is probing contraindicated?
Dacryocystitis
77
What is this?
Chronic canaliculitis
78
What are the signs/symptoms of chronic canaliculitis?
Swelling Mucopurulent discharge
79
What are the two congenital conditions?
Nasolacrimal duct obstruction Dacryocele
80
What is a dacryocele?
Collection of amniotic fluid or mucus in lacrimal sac, due to imperforate valve of Hasner

Ocular Disease (4 decks)

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