Orbital Disease Flashcards
Tiroid Orbitopati; fotoğrafında kemozis (konjonktiva ödemi), proptosis vardı.
Ne bakarsın?
➢ Eyelid and Conjunctiva: eyelid edema, eyelid hyperemia, chemosis,
conjunctival hyperemia, superior limbic keratoconjunctivitis, eyelid retraction
(contraction of levator muscle, müller’s muscle’s sympathetic stimulation)
➢ Proptosis
➢ Difficulty in eye closure: exposure keratopathy, corneal ulcers, corneal perforation
➢ Restrictive Myopathy:
√ Aktif stage: difficulty in looking to effected muscle side (inflamasyon sebebiyle ayrı)
√ Inaktif Stage: Fibrozis olduğu için eye position fixed to affected side
➢ Optik Nöropati: ekstraokular kaslar tarafından sıkıştırıldığı için, dekompresyon cerrahisi
Tiroid Orbitopati; fotoğrafında kemozis (konjonktiva ödemi), proptosis vardı. Hangi testleri istersin?
➢ Tiroid fonksiyon testleri (may be increased or decreased)
➢ Anti-tiroid antikorları:
√ Antithyroglobülin antibodies
√ Antitiroid peroksidaz antibodies
√ TSH reseptör antibodies
Neler proptosis yapabilir? Ayırıcı tanı
check picture in notizen
➢ Tiroid orbitopati
➢ Karotid-kavernöz sinüs ya da dural-kavernöz sinüs fistülleri
➢ Kavernöz sinus trombozu
➢ Konjenital glokom
➢ Orbital selülit
➢ Diffüz idiyopatik orbital inflammation (pseudotumor), myosit, Wegener, sarkoidoz, SLE, PAN, IgG4 related
Tiroid orbitopatide neler etkilenir?
➢ ortbial soft tissue: adipoz doku, ekstraokular kaslar
➢ Ayrıca eyelid ve konjunktiva da etkilenir
➢ Yukarıdaki değişikliklere bağlı olarak: kornea ve optik sinir hasarı olur.
Orbital Selülit; DDX, tests, tx, complications, symp, causes
- Ayırıcı Tanı
➢ Tiroid orbitopati
➢ Pseudotumor
➢ Miyozit - Tetkik olarak ne istersin?
➢ Enfeksiyon markerları
➢ Orbital MRI
√ Etmoid sinüzit ve orbital enflamasyonu vardı - Tedavi olarak ne verilebilir?
➢ Sistemik antibiyotik
➢ Drainage of orbital abscess
➢ Drainage of sinuses - Nelere sebep olabilir, neyden korkarız?
Komplikasyonlar
➢ Optik siniri sıkıştırması
➢ Optik nörit
➢ Vaskülit
➢ İntrakraniyel apse
➢ Subdural ampiyem
➢ Kavernoz sinus trombozu
-> last three is present in post. extension
symptoms:
pain, pain in eye movement, lid edema, lid hyperemia, chemosis , proptosis, vision loss (optic nerve compression, optic neuritis, vasculitis)
causes:
sinusitis (most common)
lid or face infection, orbital f.e., hematogenous spread
What are opthalmic emergencies in orbital trauma? + what to do
ophthalmic infarction 2nd to orbital compartment syndrome (may occur from:
acute hemorrhage
soft tissue swelling
rotated bone fragments
orbital emphisema)
do: orbital n. decompression (CT-guided needle expression)
Indications for ermergnet surgery & not emergent
emergent: EOM entrapment (medial & inf. more common) -> sign: diplopia
non emergent: displaced eye ( hypoglobus, enopthalmus) -> timing for surgery btw 7-14 days
Name cases of eye trauma requiring urgent interventions
ruptured globe
retinal detachment
vitreous hemorrhage
EOM injury
Bone fragements impinging the globe
orbital cellulitis
Traumatic optic neuropathy
How to treat Thyroid Orbitopathy?
Medical treatment:
systemic steroids
orbital radiotherapy
immunosuppresive drugs
anticytokine and antilyphocyte therapy
surgical tx:
orbital decompression
strabismus surgery
Describe the intraconal and extraconal space. components + what they are divided with
Annulus of Zinn divides superior orbital fissure (SOF)
Intraconal space
Oculomotor nerve
Nasociliary branch of V
Abducens nerve (VI)
Sympathetic nerve fibers
Extraconal space:
Lacrimal nerve (V)
Frontal nerve (V)
Superior ophthalmic vein
Trochlear nerve (IV)
name causes of orbital infalmmation
Thyroid orbitopathy is most common (almost half of it)
Other common causes are:
Diffuse idiopathic orbital inflammation (Pseudotumor)
Myositis
Orbital inflammation related with systemic diseases Wegener granulomatosis
Sarcoidosis
SLE
Polyarteritis nodosa
IgG 4 related disease
Thyroid orbitopathy disease progression is influenced by
cigarette smoking
thyroid dysfunction
What does a patient of thyroid orbitopathy complain of?
retro orbital pain
f.b. sensation
epiphoria
hyperemia
blurred vision
What can cause eyelid retraction?
contraction of levator muscle
müller muscle’s sympathetic stimulation
name benign and malignant ocular tumors
benign:
Choroidal Hemangiomas
Retinal Hemangiomas
Astrocytoma of Retina
Combined Hamartoma of Retina
malignant:
Retinoblastoma
Uveal Melanoma
Lyphoma and Leukemia
