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orbital and eye disorders Flashcards

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1
Q

whats are the signs of orbital disease in the soft tissue

A

chemosis- lid swelling/ odeam
ptosis
lid retraction

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2
Q

whats are the signs of orbital disease in the globe

A

proptosis
endopthalmos
dystopia- displacement of globe

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3
Q

whats are the signs of orbital disease in the muscles and nerves

A

nerve palsy
restrictive myopathy
muscle entrapment

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4
Q

whats are the signs of orbital disease in the posterior segment

A

ON swelling/atrophy
vasular congestion
choroidal folds

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5
Q

Initial questions to ask for an orbital disease

A

WHERE is the disease located- mechanical displacement of orbital structures
HOW had the disease developed-

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6
Q

what abnormal changes occur in an orbital disease

A
  1. inflammation- redness/swelling/warmth/pain/loss of function
  2. mass effect- displacement- something growing out of orbit
  3. infiltrative changes- impairment of ocular movements or neurosensory function
  4. vascular changes; venous dilation, exudation, heommahrage, proptosis
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7
Q

how do u examine an orbital px

A

OBSERVE: check their facial contours obis not their makeup contours, symmetry, eyelids, peri-ocular structures, changes in colour of the skin
VA
Examine- conjuctiva, eyelids, leavtor function, pupils for thie symmetry and reactions
VF
Ocular motility
other investigations such as MRI. X-rays, CT scans

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8
Q

what are the acute orbital inflammations:

A

Orbital cellulitis
Orbital periostitis
Orbital osteomyelitis
Tenonitis

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9
Q

whats orbital cellulitis

A

penetrating microbial infection
inflammation of post-septal aspect of eyelids
sx- lid odeama, redness, proptosis, pain, diplopia, opthalmolegia, vision loss, px ill, high fever

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10
Q

how do u assess for orbital cellulitis

A 
h&s
va
fundus examination
ocular motility
any neurological signs
their temperature
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11
Q

what do u have to differentially diagnose orbital cellulitis with-

A

pre-septal cellulitis- which lacks the opthalmegia, severe pain, vision loss and fever.
also with tumours, thyroid eye disease, allergic reaction

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12
Q

whats the management for orbital cellulitis

A

EMERGENCY refer

treat in hosp

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13
Q

what occurs in a Chronic orbital inflammation

A

Granuloma- inflammation of tissues
Pseudotumours- enlargement resembling a tumour
Myositis- inflammation of the muscles
Parasitic infestations- stings and bites from infections

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14
Q

Causes of exophthalmia

A 
Thyroid disease 
Orbital tumours - lymphoma, metastic, lacrimal gland
Inflammation
Vascular disorders
Orbital anomalies - heommarages, odeama
Intermittent exophthalmos
Pulsating exophthalmos
Lateral displacement of the globe
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15
Q

what’s exophthalmia

A

PROPTOSIS

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16
Q

Endocrine exophthalmia

A

Thyroid diseasse
most common cause of symmetrical bilateral poroptosis in adults
autoimmune reaction towards orbital fibroblasts
MH
Protosis, lid retraction, diplopia, compressive optic neuropathy, exposure keratopathy, injection, chemosis/ odeama

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17
Q

Clinically diagnostic ocular signs in thyroid orbitopathy

A

von Graefe’s sign: superior lid lag upon down gaze
Dalrymple’s sign: eyelid retraction
Stellwag’s sign : infrequent blinking
Ballet’s sign: palsy of one or more extraocular muscles

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18
Q

Positive diagnosis and management

A

bilatteral, symmetrical hyperthyroidism with lid retraction
edocroogist
u axes eye, give lubricants, teat keratopathy, VF
surgery for diplopia, lids?

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19
Q

Deformity of the orbit

A

due to surgery / trauma
bones disease/ cranial facial defomality
atrophy
hypertelorism

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20
Q

Enophthalmos

A

posterior displacement of eye

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21
Q

primary and secondary enopthalmos

A

Primary (congenital) and secondary to bone grow arrest, orbital fracture, surgery, severe infection/inflammation, phthisis bulbi

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22
Q

Pseudoenophthalmos:

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A

unilateral ptosis, Horner’s syndrome, contralateral exophthalmos, buphthalmos or eyelid retraction

23
Q

Orbital trauma

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A

Penetrating Blow-out fracture Foreign body

24
Q

Blow-out fracture

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A

force of a non-penetrating object bigger tun the orbital entrance- e.g. ball/ dashboard
u see bruises, endothalmos, muscle restrictive movements, pain, dipopia, numbness in cheek and teeth areas

25
summary of stuff that can happen to the eyelids
Disorders of the eyelashes The itchy eyelid Lid swelling Rashes Infections Blepharitis and other inflammations Common eyelid lumps and bumps Ptosis Ectropion and entropion Excessive blinking
26
Tricahiasis
misdirection of the eyelashes- growing into cornea secondary to inflammation or trauma can give pain, foreign body sensation can result in corneal erosions, ulcers, ocular irritation and pannus Tretament- epilation, electrolysis, laser, surgery difffernetialy diagnose with entropian, distichiasis, epiblepharon
27
itchy eyelid?
contact dermitits - Soreness Burning Itching we see -Well defined Scaling- Erythema -Thickening- Oedema -Hyper-/ hypopigmentation
28
WHY could u get contact demritits
``` Eye cosmetics Topical medicines Metals Nail polish Hair dye Soap Water ```
29
HOW would u diagnose contact dermatitis
u take detailed H+S ask px to bring all products to test on skin PATCH TEST
30
Treatment for contact detmitits
Avoid the substance duh coll compress cortiocsteroids topical immunomodulators
31
atopic eczema
simialr to contact dermitis | in childhoood
32
atopic dermatitis
normally top of lids | constantly rubbed by back of hands
33
complication of atopic dermatitis
``` blephorirtis keratoconus uveitis subcapsular catract rd keratoconjuctivitis ```
34
lid swelling-
due to systemuc, dermatologic and ocular conditions most likely due to renal/endocrine reasons or could be due to ageing, tiredness use faso constructers. or treat underlying cause, or avoid the factor that may be causing this
35
differential diagnosis of the swollen eyelid
Contact dermatitis Atopic dermatitis Rosacea Angioedema Blepharitis Cellulitis Herpes simplex HZO Tumours Systemic disease
36
Seborrheoic dermatitis
``` redness and greasy scaling sebacious glands dandruffy lid margins- usally- couldd lead to blepharitis u need lid hygiene ```
37
rosacea
``` mostly middle aged, fair women- multifactoria- over-active facial blood vessels v common red papules and pustules, swelling erythema, telnagictasis cheeks, nose, chin and forehead frwquent flushing ocular involvemnt- MG, chalazion, uvietis, episcleritis ``` DIFFERNTIALY DIAGNOSIS with- sebhoric dermatitis, lupus, syphilis, periorbital dermatitis, tb, carcinoid syndrome
38
Ocular rosacea
``` MGD blepharitis chalaia corneal infiltrates- ulceration? conjuctivitis episcleritis iritis ```
39
how would u manage rashes
avoid extreme temps, spicy food, excessive sunlight, alcohol orl tetracycline, lid hygiene, ointments
40
herpes zoster Mr. HUTCHINSON has herpes and has something on his nose
rash around eyelid opghalmic division of trigenimal nerve? nasocilliary nerve- hutchinsons sign- crusting on tip of nose skin atrophy- depigmentation and thinning- could lead to tissue destruction
41
symptoms and signs
pain burning unilateral vesicles, crusting use antivirals, neuralgia- therefore pain killers
42
herpes simplex
``` cold sores grouped vesicles atopic suffered more prone tiny grouped blisters with erythema that pustules and cause a conjuctival inflammation which then crust form ulcers then heal and scar.. Stain using rose bengal don't usually invoke cornea - Eczema herpeticum ```
43
Molluscum contagiosum
dome shaped- central umbilication- flesh coloured lesion conjuctivitis on lid margin pox virus grows with pper layer of skin spreads by contact- affects children normally self resolve- can do some curettage stuff- scraping it off
44
viral wart
``` human papilloma virus passed by contact rough, scaly projection small black dot on surface can get multiple difficult to treat ```
45
Blepharitis
binocular red eye acute/chronic infection canbe infectious or not can occur anterior/posterior/mixed itching/burning/scratchiness/fbs/excessive tearing/crusty debris signs: lid erythema, collarettes (a fibrin crust encircling an eyelash), madarosis (missing lashes), trichiasis, plugged meibomian glands, conjunctival injection and superficial punctate keratitis on the lower third of the cornea, papillary hypertrophy of the palpebral conjunctiva.
46
anterior blepharitis
staphylococcal- triachrisis, tiny abscesses, scars sebhorris- associated with seborrrheic dermatitis treatment with lid hygiene-
47
posterior belepahritis
due to MGD
48
how to tell if bacterial infection
milky exudate when u express the gland- oral antibiotics needed if u use sterids- check iop px who have recurrent or don't respond to meds may be suffering from acne rosaecca
49
treatment for blepharitis
``` lid scrubs warm compress massage the lids Anti-biotics 4-5weekk treatment with doxcycline ```
50
when would u refer mk/ blepharitis
Ophthalmological referral in case of severe/recalcitrant marginal keratitis GP referral in patients with recurrent/chronic blepharitis; they may need a dermatologist
51
Stye
infection/inflammation of eyelid margin- involving hair follicles of lashes or mgd painful nodule of eyelid with subacute onset painful, red, pointed nodule
52
differential diagnosis of stye, chalazion and tumour
..
53
how would u manage a stye
warm compress antibiotics incision and draiange

Anterior Eye (14 decks)

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