Orbital Diseases Flashcards
(40 cards)
What are the signs of orbital disease?
- soft tissue involvement
- proptosis
- enophthalmos
- ophthalmoplegia
- visual dysfunction
- dynamic changes
- fundus changes
What are the symptoms of orbital disease?
- double vision
- pain
- discomfort
- decreased vision
What is soft tissue involvement?
- lid and periorbital oedema
- ptosis
- conjunctival swelling (chemosis) and injection
What causes soft tissue involvement?
- Inflammation
- Vascular abnomalies
What is proptosis?
- Abnormal protrusion of the globe
- direction of protrusion can be intraconal or extraconal
What causes proptosis?
thyroid eye disease
tumours
inflammation
infection
What is enophthalmos?
It is a condition in which the globe is recessed within the orbot
What causes enophthalmos?
- small globe
- structural bone abnormalities
- atrophy of orbital content
What is opthalmoplegia?
paralysis or weakness of the eye muscles
What are the causes of opthalmoplegia?
- tumour
- restricted myopathy
- ocular motor nerve lesions
- trauma (long standing bone fractures)
What is visual dysfunction?
ie what are the problems
- visual acuity (corneal exposure, ON compression, choroidal folds)
- colour vision
- visual field defects
- decreased brightness sensitivity
What are the dynamic changes seen?
- Increased venous pressure
- Pulsation (AV communication or defect in the orbital roof)
- Bruit (sign of carotid-cavernous fistula)
What are fundus changes?
Optic disc changes
- optic disc swelling
- optic disc atrophy
- opticociliary shunt
Choroidal folds
Retinal vascular changes
What investigations should be carried out in orbital disease?
CT
MRI
Plain radiograph
Fine needle biopsy
What are the ocular manifestations of thyroid eye disease?
- eyelid retraction/lag
- periorbital oedema
- exophthalmos
- compression of the optic nerve
- exposure keratopathy
- soft tissue involvement
- restrictive myopathy (50% will have permanent diplopia
What are the infections/inflammatory orbital diseases?
Orbital cellulitis
Idiopathic Orbital Inflammatory Disease
What is orbital cellulitis?
Infection behind orbital septum
usually second to ehtmoiditis
How does orbital cellulitis present?
sever malaise, fever and orbital signs
What are the orbital signs in orbital cellulitis?
severe eyelid odema and redness
proptosis - most frequently lateral and down
painful opthalmoplegia
optic nerve dysfunction
What are the complications of orbital cellulitis?
raised intraocular pressure retinal vasculature occlusion optic neuropathy orbital/brain/ sunperiosteal abscess meningitis cavernous sinus thrombosis
How is orbital cellulitis treated?
Hospital admission
Systemic antibiotic therapy
Monitoring of optic nerve function
When is surgery indicated for orbital cellulitis?
resistance to antibiotics
orbital or subperiosteal abscess
optic neuropathy
What is idiopathic orbital inflammatory disease (IOID)?
Non-neoplastic, non-infectious orbital lesion (pseudotumour)
Involves any or all soft tissue components
How does idiopathic orbital inflammatory disease (IOID) present?
In 2nd to 5th decades of life with abrupt painful onset
Usually unilateral
Periorbital swelling and chemosis
Proptosis
Opthalmoplegia