Orbital Diseases Flashcards

(40 cards)

1
Q

What are the signs of orbital disease?

A
  • soft tissue involvement
  • proptosis
  • enophthalmos
  • ophthalmoplegia
  • visual dysfunction
  • dynamic changes
  • fundus changes
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2
Q

What are the symptoms of orbital disease?

A
  • double vision
  • pain
  • discomfort
  • decreased vision
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3
Q

What is soft tissue involvement?

A
  • lid and periorbital oedema
  • ptosis
  • conjunctival swelling (chemosis) and injection
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4
Q

What causes soft tissue involvement?

A
  • Inflammation

- Vascular abnomalies

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5
Q

What is proptosis?

A
  • Abnormal protrusion of the globe

- direction of protrusion can be intraconal or extraconal

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6
Q

What causes proptosis?

A

thyroid eye disease
tumours
inflammation
infection

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7
Q

What is enophthalmos?

A

It is a condition in which the globe is recessed within the orbot

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8
Q

What causes enophthalmos?

A
  • small globe
  • structural bone abnormalities
  • atrophy of orbital content
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9
Q

What is opthalmoplegia?

A

paralysis or weakness of the eye muscles

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10
Q

What are the causes of opthalmoplegia?

A
  • tumour
  • restricted myopathy
  • ocular motor nerve lesions
  • trauma (long standing bone fractures)
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11
Q

What is visual dysfunction?

ie what are the problems

A
  • visual acuity (corneal exposure, ON compression, choroidal folds)
  • colour vision
  • visual field defects
  • decreased brightness sensitivity
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12
Q

What are the dynamic changes seen?

A
  • Increased venous pressure
  • Pulsation (AV communication or defect in the orbital roof)
  • Bruit (sign of carotid-cavernous fistula)
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13
Q

What are fundus changes?

A

Optic disc changes

  • optic disc swelling
  • optic disc atrophy
  • opticociliary shunt

Choroidal folds

Retinal vascular changes

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14
Q

What investigations should be carried out in orbital disease?

A

CT
MRI
Plain radiograph
Fine needle biopsy

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15
Q

What are the ocular manifestations of thyroid eye disease?

A
  • eyelid retraction/lag
  • periorbital oedema
  • exophthalmos
  • compression of the optic nerve
  • exposure keratopathy
  • soft tissue involvement
  • restrictive myopathy (50% will have permanent diplopia
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16
Q

What are the infections/inflammatory orbital diseases?

A

Orbital cellulitis

Idiopathic Orbital Inflammatory Disease

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17
Q

What is orbital cellulitis?

A

Infection behind orbital septum

usually second to ehtmoiditis

18
Q

How does orbital cellulitis present?

A

sever malaise, fever and orbital signs

19
Q

What are the orbital signs in orbital cellulitis?

A

severe eyelid odema and redness
proptosis - most frequently lateral and down
painful opthalmoplegia
optic nerve dysfunction

20
Q

What are the complications of orbital cellulitis?

A
raised intraocular pressure 
retinal vasculature occlusion 
optic neuropathy 
orbital/brain/ sunperiosteal abscess 
meningitis 
cavernous sinus thrombosis
21
Q

How is orbital cellulitis treated?

A

Hospital admission
Systemic antibiotic therapy
Monitoring of optic nerve function

22
Q

When is surgery indicated for orbital cellulitis?

A

resistance to antibiotics
orbital or subperiosteal abscess
optic neuropathy

23
Q

What is idiopathic orbital inflammatory disease (IOID)?

A

Non-neoplastic, non-infectious orbital lesion (pseudotumour)

Involves any or all soft tissue components

24
Q

How does idiopathic orbital inflammatory disease (IOID) present?

A

In 2nd to 5th decades of life with abrupt painful onset

Usually unilateral
Periorbital swelling and chemosis
Proptosis
Opthalmoplegia

25
What is the treatment of idiopathic orbital inflammatory disease (IOID)?
Anti-inflammatory druga NSAIDS Steroids Cytotoxic (steroid sparing drugs)
26
What are the vascular orbital disorders?
Orbital venous anomalies (varices) Carotid-cavernous fistula
27
What are orbital varices?
congenital enlargements of pre-existing venous channels usually bilateral may bleed or get thrombosed
28
What is a carotid-cavernous fistula?
abnormal communications between carotid and cavernous sinus can be direct/ indirect/ encephalocele
29
What are the causes of direct carotid-cavernous?
- head trauma | - spontaneous rupture in hypertensive females
30
How does a direct carotid-cavernous fistula present?
pulsatile proptosis with a bruit and thrill abolished by ipsilateral carotid compression
31
What are the causes of indirect carotid-cavernous?
congenital malformations spontaneous rupture
32
What is an encephlocele?
herniation of intracranial contents through congenital skull defect transmission of CSF pulsation causes pulsating proptosis without a bruit
33
What are the 4 types of orbital tumours?
Vascular tumours Lacrimal gland tumours Neural tumours Miscellaneous tumours
34
What is the most common orbital tumour in children?
capillary haemangioma may resolve spontaneously, treatment is with steroids
35
Which orbital tumour, presents most commonly in adults (70% females) in the 4th-5th decades of life?
cavernous haemangiomas
36
Which orbital tumour presents in the 4th-5th decade, is painless and slow growing and is treated via surgical excision?
pleomorphic lacrimal gland adenoma
37
Which tumour presents in the 4th -5th decade of life with a very poor prognosis?
lacrimal gland carcinoma
38
Which tumour affects young girls and presents at the end of the first decade with a gradual visual loss?
optic nerve glioma
39
Which tumour affects middle aged women and can be slow/fast growing?
optic nerve sheath meningioma excision if aggressive and poor vision radiotherapy if slow growing
40
Where are the common primary sites for adult metastatic tumours?
``` breast bronchus prostate skin GIT kidney ```