Orbit, eyelid, lacrimal

Question 1

orbital roof made of

Answer 1

frontal bone

lesser wing of sphenoid

Question 2

lateral wall made of

Answer 2

zygomatic bone

greater wing of sphenoid

Question 3

medial wall made of

Answer 3

ethmoid bone
lacrimal bone
maxillary bone
sphenoid bone

Question 4

floor made of

Answer 4

maxillary bone
palatine bone
zygomatic bone

Question 5

ethmoidal foramina
what goes thru anterior ethnmoidal foramina

posterior?

Answer 5

anterior = anterior ethmoidal artery

posterior = posterior ethmoidal artery

root for infection/malignancy

Question 6

superior orbital fissure
separates?
transmits what?

Answer 6

separates greater/lesser wings of sphenoid

transmit CN 3, 4, 6, CN V part
superior ophthalmic vein

Question 7

nasolacrimal canal
houses

extends from where to where

Answer 7

houses nasolacrimal duct which allows tears to drain nasally

from lacrimal sac to inferior meatus of nose

Question 8

7 layers of eyelid

Answer 8

1) skin and subq tissue
2) muscles of protraction = orbicularis oculi/CN 7

3) orbital septum= thin multilayered fibrous tissue protect against infection/trauma
4) orbital fat

5) muscles of retraction upper and loewr eyelid
- upper = levator/superior tarsal
- lower = inferior tarsal, capsulopalpebral fascia

6) tarsus = dense plate of connective tissue
7) conjunctiva= orbit to cover interior eyelid

Question 9

what is the lacrimal canaliculi/ducts

what is the lacrimal puncta

Answer 9

small channels in each eyelid which conduct tears

puncta = minute orifices where lacrimal ducts comence

Question 10

what are meibomian glans

what are lacrimal glands

Answer 10

meibomian = sebaceous gland in eyelid; prevent rapid tear evap

lacrimal = superior, lat orbi; secrete aqueous part of tear

Question 11

what are glands of zeiss

what is the whitnall’s ligament

Answer 11

sepcialized sebacious glands for eyelids in margin

support ligament of rupper eyelid/superior orbit for levator

Question 12

what is muller muscle

what is lockwood’s ligament

Answer 12

help raise upper eyelid; smooth muscle joining levator

supports eye inferiorly and prevents downward displacement; forms hammock below

Question 13

what are parasinal sinuses

Answer 13

1) maxillary
2) frontal
3) ethmoid
4) sphenoid

Question 14

what is the annulus of zinn

Answer 14

ring of fibrous tissue around optic nerve

origin for 5 of the EO muscles

Question 15

what is blood supply

• primary?
• secondary
• drained by?

Answer 15

primary = ophthalmic artery off internal carotid

secondary = facial/maxillary artery = branch of external carotid

drained by ophthalmic vein

Question 16

what are extraocular muscles

Answer 16

( LR6 SO4 ) 3

Question 17

orbital floor fracture
what is spared?

what if blow out fracture?

presents with ….

Answer 17

orbital rim spared

blow out fracture = floor fracture with intact rim herniate into maxillary sinus

present with ecchymosis, emphsema (incr IOP), subconjunctival hemorrhage, enophthalmos (sinking of eye)

Question 18

treatment of orbital floor fracture

Answer 18

immediate if muscle entrap or oculocardiac reflex

early if diplopia, hypoglobus, large fracture, enophthalmus more than 2 mm

Question 19

pediatric orbital floor fracture
symptoms

what is white eye blow out

treatment

Answer 19

symptom = nausea/vomiting, pain with eye movement

white eye= no significant trauma; cancellous rubbery bone entrap inferior rectus

treat with surgery; implants to prevent reherniation

Question 20

AApediatric orbital teratoma

Answer 20

2+ germinal layer

present with proptosis

treat with subtotal exenteration (remove eye and adjacent structures)

Question 21

capillary hemangioma
MOST COMMON!!

appears at what age?
appears how?

treatment

AA

Answer 21

appear at 1-2 week and enlarge for 6-12 months

superficial = red bump
deep = deep blue progressive enlarging 

treatment = propranolol and steroids, anti-angiogenic factors, surgery treat strabismus/amblyopia

Question 22

dermoid cyst
made of?

appears?

location?

dermoid vs epidermoid

AA

Answer 22

made of pinched off skin fill with keratin and rupture

appears as palpable painless enlarging mass

lateral brow

dermoid = keratinizing with dermal appendage; epidermoid = lined by epidermis with keratin

Question 23

lymphangioma
age?

location?

what happens with assoc infection

treatment

AA

Answer 23

1st 10 years

conjunctiva, eyelid, orbit, oropharynx,

during infections, swelling of lymph and pressure on eye

treat= draining

Question 24

rhabdomyosarcoma
MOST COMMON MALIGNANT PEDIATRIC ORBIT TUMOR

progression as child vs early teen

derived from

treatment

AA

Answer 24

child = sudden onset, unilateral proptosis

teen = progressive proptosis

derived from undiff pluripotent mesenchymal cells

treat = radiation/chemo, exentoration for recurrent

Question 25

cavernous hemangioma MOST COMMON BENIGN ADULT progression? age? symptoms? treament AA

Answer 25

slow progressing proptosis middle age women retinal striae, hyperopia (farsight), optic nerve compression, incr IOP, lateral orbitomy

Question 26

neural tumors in orbit meningiomas (orbital) location? age? progresion? treatment AA

Answer 26

along arachnoid of optic sheath 30-40 y/o women gradual unilat vision loss, painless treatment = observe, radiation if in orbit, surgery if vision loss

Question 27

neural tumors in orbit meningiomas (sphenoid wing) location? treatment AA

Answer 27

lateral wall of orbit with dural tail treatment = observe until problem, subtotal resection, post-op radiotherapy

Question 28

neural tumors in orbit schwannoma location? age? AA

Answer 28

vestibular nerve from prolif of schwann cells encapsul by perineurium age = older/younger women

Question 29

lymphoprolif disrodrs B cell tumor of orbit usu? 4 most common lymphomas to orbit? treatment? AA

Answer 29

malignant NH lymphoma MALT, CLL, follicular center lymphoma, high grade lymphoma treat = radiotherapy, surgery, chemo

Question 30

lacrimal gland tumors usu AA

Answer 30

epith or non epith

Question 31

secondary orbital tumors extend to involve? AA

Answer 31

globe or eyelid = choroidal melanoma, retinoblastoma, basal and squamous cell carcinoma sinuses

Question 32

metastatic tumors usu in adults most common symptoms AA

Answer 32

breast and lung pain, proptosis, inflamm, bone destruction

Question 33

congenital nasolacrimal obstruction | symptoms

Answer 33

constant tearing with mucopurlence 90% resolve within 1 year

Question 34

congenital nasolacrimal obstruction dacrocystocele due to? problem? appearance can get complications

Answer 34

enlargement of nasolacrimal sac at birth --> obstruct duct prox and nasal valve of Hasner distal fluid trapped in sac = tears + amniotic fluid large blue, cystic can get intranasal cyst (problem in baby because nose breather) preseptal cellulitis orbital cellulitis intranasal cyst

Question 35

dacrocystitis what happens? what is risk for infection? what freq infects? treatment

Answer 35

complete nasal obstruction from infection of lacrimal sac chronic stasis risk for infection staph strep diphtheroid infect gram neg in diabetic and immune compromised insert prosthetic drain via bypass

Question 36

preseptal cellultiis what is it? treatment?

Answer 36

infection of skin around eye, anterior or orbital septum treat = oral antibiotics and nasal decongestants, warm compress

Question 37

orbital cellulitis infection where? usu due to? symptoms? treat?

Answer 37

infection posterior to orbital septum due to sinusitis fever, leukocytosis, proptosis, chemosis, ptosis, decr visual acuity, color treat aggressively!!!!!!! may spread to brain, cause blindness, abscess

Question 38

thyroid eye disease assoc with what? causes what effects? more common women or men

Answer 38

autoimm assoc with Grave's eyelid retract, lid lag, proptosis, restrictive myopathy, compressive optic neuropathy women

Question 39

pathogenesis of thyroid eye disease

Answer 39

orbital fibroblast with CD40 induce synth of GAGs

Question 40

treatment of thyroid eye disease

Answer 40

treat thyroid problem so normal thyroid level quit smoking orbital decompression if affect nerve

Question 41

symptoms of thyroid eye disease

Answer 41

lid retraction diplopia if infiltration of EOM so eyes can't move together blindness if enough congestion to choke optic nerve (decompressive surgery)