Orbital Disease (Cale) Flashcards Preview

Disease > Orbital Disease (Cale) > Flashcards

Flashcards in Orbital Disease (Cale) Deck (50):
1

thinnest wall in the orbit

medial

2

ophthalmoplegia

restriction of EOM

3

how can you test for ophthalmoplegia

forced ductions

4

clues to pathology

orbital pulsation (cavernous sinus fistula, defect in orbital roof transmitted via CSF), Bruit (carotid-cavernous fistula, carotid stenosis in CVA, A-V malformations, choroidal folds, disc edema, optic atrophy

5

Orbital septum

dense fibrous sheath acting as barrier between orbit and eyelid. Orignates from periosteum of superior and inferior orbital rims. Inserts into levator aponeurosis just above superior tarsal border and inferior lid retractors just below inferior tarsal border

6

Preseptal cellulitis

red, edematous lids, tender. No proptosis, chemosis, vision change, pupillary involvement, fever or EOM restriction. Staph aureous, strep pyogenes most common. Children H influenza

7

Causes for preseptal cellulits

laceration, insect bite. Infection spread from hordeolum, dacryocystitis, sinusitis, conjunctivitis or URI or middle ear

8

Management preseptal cellulitis

treatment (daily followup)
-afebrile, mild: oral antibiotic for 10 days. for child can use augmentin, cefaclor, bactrim. for adult can use augmentin, cefaclor, bactrim or moxifloxacin. Moderate to severe, febrile (no improvement)- hospital admission for IV antibiotics

9

orbital cellulitis

life-threatening infection of soft tissue behind orbital septum, children> adult. Spnemoniae, S. aureus, S pyogenes, H influenzae. Proptosis, pain, fever, malaise

10

complications of orbital cellulitis

meningitis, brain abscess, cavernous sinus thrombosis

11

orbital cellulitis emergency case

hospital admission, IV ceftazidime (vancomycin) and oral metronidazole (anaerobes)

12

differential Dx of acutely inflammed orbit

orbital cellulitis, fungal infection (mucormycosis), dacryocystitis, dacryoadenitis, vascular, neoplasm, thyroid eye disease, idopathic orbital inflammatory dz, myositis, collagen vascular dz or autoimmune, scleritis, conjunctivitis

13

Lacrimal gland disease

dacryoadenitits

14

dacryoadenitis

inflammatory w/ or w/o autoimmune dz, neoplastic (least common), biopsy is gold standard of diagnosis

15

inflammatory lacrimal gland disease

idiopathyc dacryoadenitits. autoimmune comorbidity frequent. acute or subacute with pain, erythema, dry eye,s welling, unilateral (80%)
autoimmunity- primary target of immune system in autoimmune disorders: sarcoid sjogren's, wegener, IgG4-related older pt, painless swelling often bilateral

16

neoplastic

unilateral palpable mass, dystopia, proptosis, low incidence of pain, redness, lympocytic infiltration (elderly), pleomorphic adenoma (young mild), carcinoma (mid-aged with high mortality)

17

lymphocytic infiltration of lacrimal gland

can run from benign hyperplasia to malignant lymphoma (subconjunctival "salmon patch" extension

18

Infectious Dacryoadenitis

pain, erythema, edema lateral upper lid's curve (kids), viral typically, bacterial rare

19

how to treat infectious dacryoadenitis

if mild and uncertain etiology follow daily with oral antibiotics, in kids with augmentin 20-40mg/kg/day, in adults augmentin 250-500mg po q8h.
If moderate to severe-hospitilize

20

viral infectious dacryoadenitis

most common epstein-barr virus, mumps, adenovirus, Hzoster, Hsimplex, rhinovirus, bilateral 40%, fever 25%

21

bacterial infectious dacryoadenitis

staph, MRSA, strep, haemophilus, neisseria, gonorrhea. Unilateral typically, afebrile

22

differential not responsive to antibiotics

viral (cold compresses, analgesic), idopathic orbital inflammatory disease (CT scan, blood tests, improves with oral steroid), tumor (non-painful, orbital CT scan, biopsy)

23

grave's ophthalmopathy in hyperthyroidism

clinical eye involvement more common in females. majority have increase in orbital fat (younger) or EOM volume (older). Smoking is primary risk factor for GO in Graves. Manifestations largely due to expanding orbital content in unyielding bony orbit

24

grave's autoimmunity etiology

attack of TSH receptor by TSH receptor auto-antibodies. Abnormal circulating T3-T4 levels (TSH cause release of these)

25

clinical signs of thyroid ophthalmopathy

lid retraction (dalrymple's sign), lid lag (von graefe sign), proptosis (measure with exophthalmometer), hyperemia over lateral/medial recti, exposure keratitis, periorbital swelling, chemosis, fat prolapse, EOM restriction and diplopia, optic nerve compression, superior limbic keratoconjunctivitis

26

chief complaints for thyroid ophthalmopathy

dry, gritty, blur, tearing, diplopia, pressure sensation behind the eye, other vision loss if optic nerve involved

27

Management of eye in mild disease

lubrication of SLK, exposure dryness, topical antiinflammatory agents (Steroid, NSAID, cyclosporin), sleep with head elevated to reduce periorbital edema, tape eyelids shut during sleep

28

management Grave's

endocrinologist (corticosteroids concurrently), treat exposure keratitis, orbital decompression, new approaches designed to avoid the need for orbital decompression (monoclona antibodies to target B and T cell activation and adipogenesis)

29

idopathic orbital inflammatory disease

non-infective, non-neoplastic space-occupying lesions. Unilateral (Can be bilateral in kids), F=M middle age to older. Periorbital red, swelling, pain, proptosis, ophthalmoplegia, optic nerve involvement, spontaneous remission, intermittent possible, protracted

30

treatment IOID

observation if mild, biopsy to rule out neoplasia, NSAID often effective (Ibuprofen), Oral steroids only after confirmed dx, radiotherapy if no improvement, antimetabolites if no improvement

31

Orbital myositis

idiopathic inflammation of one or more EOMs in absence of thyroid orbitopoathy, often spontaneous resolution 3-6wk, etiology unknown

32

Orbital myositis epidemiology

F>M young adult, 50% bilateral, acute (single episode lasting), chronic (persistent episode lasting), recurrent result in more chronic disease, fibrosis

33

orbital myositis signs

pain exacerbated by eye movement, diplopia (restricted EOM), injection over involved muscle, lid edema, ptosis, fibrosed muscle enlargement
-NSAID (Ibuprofen)
-oral steroids if persisting

34

Tolosa-Hunt Syndrome

Dx of exclusion, rare, idiopathic, granulomatous inflammation of cavernous sinus, superior orbital fissure, orbital apex, remissions and recurrences, proptosis, mild, oculomotor nerve palsies usually with pupil involvement, sensory loss V1, V2 of trigemina

35

tolosa hunt syndrome treatment

steroid

36

cavernous sinus Fistula

elevated venous sinus and episcleral venous pressure (signs of orbital arterial and venous stasis), hemorrhagic chemosis, pulsatile proptosis, whoosing noise in head, bruit, increase IOP, vision loss and neuro impact immediate or delayed (Optic nerve and nerves VI, III, IV, V), most not life threatening

37

Cavernous Sinus thrombosis

clotting within sinus, high mortality, rapid onset: HA, malaise, nausea/vomiting, proptosis, chemosis, reduced VA, CN III-VI involved

38

what does cavernous sinus thrombosis result from

infection (sinusitis), preseptal and orbital cellulitis, otitis

39

epiphora

defective drainage
-anatomical: malposition of puncta (ectropion)
-obstruction/stenosis
-lacrimal pump failure (horner's muscle, lower lid laxity)
hypersecretion secondary to inflammation

40

tests for epiphora

fluorescein disappearance test, johns dye, probing and irrigation, dacryocystography, nuclearl lacrimal scintigraphy

41

dacryocystitis

pain and epiphora

42

dacryocystitis treatment

warm compresses, oral antibiotics follow daily- kids give augmentin or cefaclor, adults give cephalexin or augmentin. can also give topical antibiotics in addition (trimethoprim/polymixin B (Polytrim) qid). probing is contraindicated. Consider CT scan if atypical. Incision and drainage carries risk of developing lacrimal fistula. DCR required after infection resolved

43

chronic canaliculitis

swelling and mucopurulent

44

congenital conditions

nasolacrimal duct obstruction or dacryocele

45

nasolacrimal duct obstruction

common, usually spontaneous resolution. Massage over canaliculus, lid hygiene, erythromycin ung if bacterial conj, probe after 12 months resolved

46

dacryocele

collection of amnionic fluid (noninflammatory) or mucus in lacrimal sac, due to imperforate hasner valve

47

inflammatory disease

chalazion
idiopathic orbital ID
Orbital myositis
tolosa-hunt syndrome
dacryoadenitis

48

infectious disease

dacryoadenitis
preseptal cellulitis
orbital cellulitis
dacrocystitis
chronic canaliculitis

49

autoimmune disease

graves thyroid ophthalmopathy

50

congenital conditions

nasolacrimal duct obstruction
dacryocele