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Y. neuro ophthalmology > Orbital Disease > Flashcards

Orbital Disease Flashcards

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1
Q

Non-infectious causes of Inflammatory Orbital Syndromes (7)

A
  1. TED
  2. IOIS
  3. Immunoglobulin 4 Related Disease
  4. Sarcoidosis
  5. Wegener Granulomatosis
  6. Giant Cell Arteritis
  7. Polyarteritis Nodosa
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2
Q

IOIS is likely mediated by what immune cells?

A

T and B cells

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3
Q

IOIS: lacrimal involvement in ___% of cases

A

25

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4
Q

How to distinguish TED from IOIS

A

IOIS involves pain and rapid onset

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5
Q

T/F: imaging is required to confirm dx of IOIS

A

TRUE

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6
Q

CT scan of IOIS shows…

A

Ill-defined orbit opacity + loss of definition of contents

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7
Q

IOIS demographics

A

No clear predilection

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8
Q

5 Categories of IOIS

A
  1. Anterior
  2. Diffuse
  3. Apical
  4. Lacrimal Gland
  5. Myositis
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9
Q

IOIS: What is the mechanism that causes GLC from Posterior Scleritis?

A

Scleritis causes choroidal effusion pushing anterior structures forward and blocking the angle

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10
Q

IOIS:
T/F — Posterior Scleritis is dramatically responsive to steroid therapy

A

TRUE

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11
Q

What is the most common form of IOIS in children?

A

Posterior Scleritis

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12
Q

IOIS: Posterior Scleritis manifests uni- or bi-laterally?

A

Either

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13
Q

Myositis

A

IOIS affected EOMs

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14
Q

How to differentiate between Myositis and TED

A

Tendon involvement noted on CT/MRI and A/B Scan

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15
Q

Course of IOIS

A
  1. Spontaneous remission
  2. Intermittent episodes
  3. Severe prolonged inflammation (leads to fibrosis — “frozen orbit”)
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16
Q

IOIS: What is an effective and common treatment prior to initiating steroids?

A

NSAIDs

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17
Q

T/F: in mild causes, observation is the treatment for IOIS

A

TRUE

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18
Q

Management for IOIS: (6)

A
  1. Biopsy to r/o neoplasm
  2. NSAIDs
  3. Systemic steroids (oral prednisolone)
  4. Radiotherapy
  5. Anti metabolites
  6. Systemic infliximab (tumor necrosis factor inhibitor)
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19
Q

Granulomatous Orbital Diseases

A
  1. Wegener’s
  2. Sarcoidosis
  3. Polyarteritis Nodosa
  4. Histocytic Disorders (overproduction of WBCs)
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20
Q

What signs/symptoms suggest sarcoidosis in orbital inflammation?

A
  1. Lacrimal gland enlargement
  2. Perineuritis
  3. EOM enlargement
  4. Proptosis
  5. Pain
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21
Q

Wegener’s is also referred to as

A

Granulomatosis with Polyangiitis

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22
Q

Wegener’s Granulomatosis

A

Granulomatous inflammation and necrotizing vasculitis

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23
Q

Wegener’s is mediated by

A

T-cells

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24
Q

Wegener’s presents uni/bi-laterally?

A

Bilaterally

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25
What tests are useful in confirming Wegener’s?
cANCA serology or biopsy
26
Involvement of what other system/body part is particularly associated with orbital inflammation, 2º to Wegener’s?
Sinus involvement (esp paranasal sinuses or nasopharynx)
27
Treatment for Wegener’s
Steroids and immunosuppressants (cyclophosphamide)
28
Polyarteritis Nodosa
Vasculitis of **medium and small** nerves Involves heart, kidney, liver, GI, and *occasionally* orbit
29
Acute onset of orbital inflammation is likely associated with
Infectious etiology
30
Insidious onset of orbital inflammation is usually associated with…
Neoplasm or TED (Unless spreading from sinus)
31
CT of Preseptal Cellulitis shows
Opacification anterior to orbital septum
32
Preseptal Cellulitis
Lid erythema with periorbital edema
33
Tx for Preseptal Cellulitis
IV antibiotics (augmentin)
34
Common causes of Preseptal cellulitis
1. skin trauma 2. Eye infection 3. Dacryocystitis 4. Sinusitis 5. Spread of remote infection (URI, ear, etc) spread by blood
35
T/F: sinus congestion can be used to differentiate Preseptal cellulitis and orbital cellulitis
FALSE
36
Why can Cavernous Sinus Thrombosis appear like orbital syndrome?
Impaired venous drainage —> orbital congestion
37
Common causative agents for Orbital Cellulitis
1. S. Pneumoniae 2. S. Aureus 3. S pyogenes 4. H influenza
38
Orbital Cellulitis CT scan will show
Orbital opacity posterior to orbital septum
39
Which is more urgent: Preseptal or orbital cellulitis?
Orbital ☠️
40
Cavernous Sinus Thrombosis is usually a complication of severe ____, ____, or ____ infection
Facial, sinus, or orbital
41
T/F: patients with Preseptal cellulitis will often present with malaise and fever
FALSE
42
What are two non-infectious cavernous sinus disorders that can imitate orbital inflammation?
Cavernous Sinus Fistula and Orbital Varix
43
Cavernous Sinus Fistula should be considered in all patients with (3)
1. Elevated IOP 2. Mild HAs 3. Bruit + Red eye, esp in elderly women
44
Orbital varix should be considered when
1. Eye bulging in crying infant 2. Proptosis during valsava maneuver 3. Orbital ecchymosis
45
Describe orbital lymphomas
Painless Grow slow Conform to shape of orbital tissue
46
What conj lesion is indicative of Orbital Lymphoma?
Salmon Patch
47
Origin of lymphomas
B cells
48
**Anterior lymphomas** have what type of consistency?
Rubbery
49
T/F: lymphomas generally have good prognosis
TRUE
50
Lacrimal tumors cause a lack of sensation where?
Region of orbit supplied by lacrimal nerve
51
T/F: lacrimal tumors are typically malignant
FALSE; 50/50
52
Half of lacrimal tumors are ____ in nature
Epithelial
53
T/F: lacrimal tumors have a high mortality rate
TRUE
54
Neurogenic Tumor examples
Glioma Schwannoma Meningioma
55
Most benign tumor of periorbital areas in children
Capillary Hemangioma
56
**how do you treat capillary hemangioma?**
1. Laser 2. Steroid (IV + po) 3. BB 4. Resection 5. Peds work up
57
Gender preference for capillary hemangioma
Girls
58
Capillary hemangiomas should be treated if…
1. Amblyopia 2. Compression of ON 3. Exposure keratopathy 4. Severe blemish, necrosis, or infections
59
After _____, the orbit is the most common site for metastatic invasion
Choroid
60
Most common primary tumor? Second?
Most — breast 2nd — Melanoma
61
From where can non-metastatic tumors spread to orbit?
Paranasal cavities or maxillary sinus
62
Silent Sinus Syndrome aka
Chronic Maxillary Atelectasis
63
T/F: Silent Sinus Syndrome is *not* a tumor
TRUE
64
Silent Sinus Syndrome
Painless onset of enophthalmos + vertical DV in upgaze, 2º to resorption of orbital floor bones (from chronic maxillary sinusitis)
65
CT scan of Silent Sinus Syndrome
Bowing of maxillary sinus

Y. neuro ophthalmology (10 decks)

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