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Ocular Disease > Orbit > Flashcards

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
Q

How if afebrile, mild preseptal cellulitis best treated in adults?

A

Oral antibiotic for 10 days

Ex:

Augmentin 500mg p0 q8h

Cefaclor 250-500mg po q8h

Bactrim or moxifloxacin if allergic to penicillin

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26
Q

How is afebrile preseptal cellulitis treated in children under 5?

A

Augmentin 20-40 mg/kg/day po

Cefaclor 20-40 mg/kg/day po

Bactrim (trimethoprim/sulfamethoxazole) if allergic to penicillin

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27
Q

With moderate to sever, febrile preseptal cellulitis in a child under 5, what should be done?

A

Hospital admission for IV antibiotics

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28
Q

What is orbital cellulitis?

A

A life-threatening infectio of soft tissue behind the orbital septum

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29
Q

Orbital cellulitis is ___ (better, worse) in children than in adults.

A

Worse

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30
Q

Which bacteria are usually the cause of orbital cellulitis?

A

S. pneumoniae

S. aureus

S. pyogenes

H. influenzae

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31
Q

What symptoms are commonly seen in orbital cellulitis?

A

Proptosis

Pain with EOM restriction

Fever

Malaise

Visual imparment (if optic nerve involved)

APD

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32
Q

What are the potential complications of orbital cellulitis?

A

Meningitis

Brain abscess

Cavernous sinus thrombosis

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33
Q

If orbital cellulitis is deemed emergent, what should be done?

A

Hospital admission, IV ceftazidime (or vancomycin) + oral metronidazole (anerobes)

34
Q

What is this?

A

Chalazion

35
Q

What is dacryoadenitis?

A

Most commonly an inflammaotory lacrimal gland disease. May also be an autoimmune disease

36
Q

Idiopathis dacryoadenitis makes up __% of the leasions.

A

50%

37
Q

Comorbidity is frequent with which type of dacryoadenitis?

A

Autoimmune

38
Q

Dacryoadenitis is unilateral __% of the time.

A

80%

39
Q

Bilateral, painless swelling describes which dacryoadenitis?

A

Autoimmune dacryoadenitis

40
Q

Which is the least common type of dacryoadenitis?

A

Neoplastic dacryoadenitis

41
Q

What symptomes are associated with neoplastic dacryoadenitis?

A

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
Q

What is this?

A

Dacryoadenitis

43
Q

What may occur with lymphocytic infiltration of the lacrimal gland?

A

Can change from benign hyperplasia to malignant lymphoma

44
Q

What is a common sign of lymphocytic infiltration of the lacrimal gland?

A

Subconjunctival salmon patch extension

45
Q

What is this?

A

Infectious dacryoadenitis

46
Q

What are some symptoms of infectious dacryoadenitis?

A

Pain

Erythema

Edema of lateral upper lid - “S” curve

47
Q

What age group usually is seen with infectious dacryoadenitis?

A

Children and young adults, typically

48
Q

Viral infectious dacryoadenitis is usually caused by which diseases?

A

Epstein-Barr (mono)

Mumps

Adenovirus

Herpes zoster

Herpes simplex

Rhinovirus

49
Q

What age group usually gets viral infectious dacryoadenitis? Bacterial?

A

Viral - under 40

Bacterial - over 40 (rare)

50
Q

Which bacteria are usually the cause of bacterial infectious dacryoadenitis?

A

Staph

MRSA

Strep

H. Influenzae

Gonorrhea

51
Q

What is a primary risk factor for Grave’s ophthalmopathy?

A

Smoking

52
Q

What is the etiology of Grave’s autoimmunity?

A

Attack of TSH receptor by TSH receptor auto-antibodies

Abnormal circulating T3/T4 levels (TSH causes release of these)

53
Q

What signs are noted here?

A

Proptosis

Lid retraction

Conjunctival hyperemia

Periorbital edema

All from Graves’ Ophthalmopathy

54
Q

What is Dalrymple’s Sign?

A

Lid retraction

55
Q

What is Von Graefe’s sign?

A

Lid lag

56
Q

What is idiopathic orbital inflammatory disease?

A

Non-infective, non-neoplastic, space-occupying lesions. Generally unilateral

57
Q

Idiopathic orbital inflammatory disease, though usually unilateral, may be bilateral in ___.

A

Children

58
Q

What are some common signs and sypmtoms of idiopathic orbital inflammatory disease?

A

Periorbital redness, swelling, pain

Proptosis, ophthalmoplegia

May have optic nerve involvement

59
Q

What is the treatment for mild idiopathic orbital inflammatory disease?

A

Observation…

60
Q

What are the treatments for idiopathic orbital inflammatory disease?

A

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
Q

What is this?

A

Orbital Myositis

62
Q

What is this?

A

Idiopathis orbital inflammatory disease (IOID)

63
Q

What is this?

A

Orbital myositis

64
Q

What signs/symptoms are expected in orbital myositis?

A

Pain exacerbated by eye movement

Diplopia - restricted EOM

Injection over involved muscle

Lide edema, ptosis

Fibrosed muscle enlargement

65
Q

What are treatments for orbital myositis?

A

NSAID - Ibuprofen 100-400mg tid 3 weeks

Oral steroids if persisting (40-60mg qd, tapered 1-4 wk)

66
Q

What is Tolosa-Hunt Syndrome?

A

Rare, idiopathic, granulomatous inflammation of the cavernous sinus, superior fissure, orbital apex

67
Q

What may Tolosa-Hunt syndrome cause?

A

Mild proptosis

Oculomotor nerve palsies, usually with pupil involvement

*Sensory loss of V1, V2 of trigeminal nerve

68
Q

What is the treatment for Tolosa-Hunt syndrome?

A

Steroids

69
Q

What is this?

A

Carotid Cavernous Fistula

70
Q

What signs/symptoms are associated with cavernous sinus fistula?

A

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
Q

What is this?

A

Conjunctivochalasis

72
Q

What is dacryocystography (DCG) used for?

A

To identify the site of obstruction of the drainage system

73
Q

What is this?

A

Dacryocystitis

74
Q

What signs/symptoms are associated with dacryocystitis?

A

Pain

Epiphora

75
Q

What is the treatment for dacryocystitis?

A

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
Q

For which disease is probing contraindicated?

A

Dacryocystitis

77
Q

What is this?

A

Chronic canaliculitis

78
Q

What are the signs/symptoms of chronic canaliculitis?

A

Swelling

Mucopurulent discharge

79
Q

What are the two congenital conditions?

A

Nasolacrimal duct obstruction

Dacryocele

80
Q

What is a dacryocele?

A

Collection of amniotic fluid or mucus in lacrimal sac, due to imperforate valve of Hasner

Ocular Disease (4 decks)

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