orbital/lacrimal disorders

Question 1

what type of orbital disorders can you get ?

Answer 1

Trauma
Orbital cellulitis
Thyroid eye disease

Question 2

How does trauma cause orbital disorder ?

Answer 2

caused by the blunt object equal or greater than the diameter of the eye socket. That is hard and moving rapidly with resultant force in transmitted throughout the orbit causing a fracture to the orbital floor.

Question 3

How common is the trauma is disorder?

Answer 3

Very common

Question 4

How do you get a blunt trauma ?

Answer 4

when the object is not very sharp

Question 5

What are the signs of orbital floor fracture?

Answer 5

varies: minimal to max swelling and bruising around the eye. Some notice diplopia some notice diplopia after swelling has gone and they can open their eyes.
enophthalmos and hypoesthesia of the cheeks

Question 6

what are the symptoms of orbital floor fracture?

Answer 6

sometime asymptomatic

sometime pain swelling redness,

Question 7

what is the difference between enopthalmos and exopthalmos?

Answer 7

enopthalmos= sunken eye
exopthalmos= eye popping out

Question 8

what is hypoesthesia?

Answer 8

loss of sensation of the cheeks

Question 9

why are bones of orbit more vunrable to damage?

Answer 9

bones of the orbit are very thin with smaller bones in middle even thinner

Question 10

what clinical features are there for orbital floor fracture?

Answer 10

• periorbital heamotoma (just on lower lid)
• sub conjunctival haemorrhage ( conjunctiva blood vessel leaked )
• enopthalmos

Question 11

how does ocular motility work in orbital floor fracture?

Answer 11

when px look in primary position= no diplopia
if px is asked to look in upward gaze (most common) px will report diplopia due o entrapment of tissue because inferior rectus attached gets depressed in fracture
Also get nerve trauma

Question 12

which muscle is very likely to be depressed and trapped in orbital floor fracture?

Answer 12

Inferior rectus

Question 13

How do you investigate orbital floor fracture?

Answer 13

• CT scan in vertical slice
• Visual acuity
• Check for RAPD
• ocular motility/hess chart

Question 14

what is RAPD?

Answer 14

Relative afferent pupillary defect.

Question 15

How do you manage someone with orbital floor fracture?

Answer 15

• monitor
• prophylactic antibiotics and steriods to reduce swelling
• indication of surgery (large orbital fracture)

Question 16

when do you do surgery in orbital floor fracture px?

Answer 16

• large orbital fracture
• significant enopthalmos
• 50% or more orbital floor is damaged
• persistant diplopia and never getting better

Question 17

How does surgery repair orbital floor?

Answer 17

repaired with synthetic material implanted into orbital space e.g polyethylene or metallic mesh sometimes.

Question 18

What is the point of synthetic material implanted?

Answer 18

it affect is to produce an artificial orbit floor

Question 19

What is orbital cellulitis?

Answer 19

infection of the soft tissues in the orbit of the eye

Question 20

what type is orbit cellulitis?

Answer 20

post septum cellulitis

Question 21

what is post septum/ orbital cellulitis?

Answer 21

infection of soft tissues of the eye posterior to the septum (behind the septum)

Question 22

what happens if the infection is in front of the septum and not at the back?

Answer 22

pre septum cellulitis

Question 23

how do you know if it is orbital or pre septum cellulitis?

Answer 23

It is very hard to differentiate between them

Question 24

what damage is caused if orbital cellulitis untreated?

Answer 24

sight loss and potentially fatal cerebral complications. deteriorates very quickly

Question 25

why is the septum so important?

Answer 25

the septum hold the orbit flat

Question 26

what are the clinical features of orbital cellulitis?

Answer 26

1) swelling and redness of the eyes 2) periorbital swelling 3) severe orbital pain 4) extreme fever 5) swelling of conjunctiva (chemosis) 6) loss of colour vision 7) exopthalmos 8) impaired movement of the eyes

Question 27

what is the treatment for orbital cellulitis?

Answer 27

- hospital - imaging - high dosage of IV antibiotics drops inside - may need surgical intervention -surgical drainage - refer

Question 28

what is thyroid eye disease?

Answer 28

autoimmune disease , circulating the TSH receptor antibodies Autoimmune inflammation of extra ocular muscles causing swelling and swollen retrobulbar tissues. orbit becomes flat and pushes eye forward

Question 29

how many people affected in thyroid?

Answer 29

20 in 100,000 | females 5x more affected than males

Question 30

Symptoms of thyroid eye disease?

Answer 30

``` grittiness photophobia lacrimation loss of VA loss of colour vision in optic nerve involvement ```

Question 31

what are the clinical signs of thyroid eye disease?

Answer 31

``` periorbital oedema (bags under eyes) lid retraction- upper and lower lid lag (takes time to close eye lid) proptosis optic neuropathy conjunctival oedema (chemosis) corneal dryness (dessication) ```

Question 32

How can you check for thyroid eye disease?

Answer 32

CT scan Thyroid function test constant double vision

Question 33

What is the management of thyroid eye disease?

Answer 33

..monitor- vision, colour vision, diplopia and degree of exopthalmos ..Conservative ..imunosupression to eleviate signs & symptoms ...decompression surgery

Question 34

what does decompression surgery involve?

Answer 34

thyroid ectomy- taking parts of thyroid out and take suppliments instead

Question 35

What is the name for lacrimal gland inefection?

Answer 35

Dacryoadenititis Dacryo-lacrimal system adenitits - gland infection

Question 36

what name do you give if the lacrimal scan is accumulated?

Answer 36

dacryocystitis

Question 37

What is Dacryoadentitis?

Answer 37

its an acute discomfort. Ptosis with hyperaemia and oedema (more in upper temporal quadrant ) injection of superotemoporal conjunctiva

Question 38

what type of outflow obstruction are there?

Answer 38

- Punctal stenosis - Canaliculitis - congenitial

Question 39

what is punctal stenosis?

Answer 39

puncta is blocked and tears cannot flow, get watery eyes and no drainage. can follow from conjunctival scarring from inflammation e.g (herpes simplex) can occur from drug therapy ( anti virals )

Question 40

how does the outflow pathway work?

Answer 40

You have two punctas tear passes down the canaliculi into the lacrimal sac. There is a tube in the nasal lacrimal duct where tears drain into through the nose

Question 41

what is canaliculitis?

Answer 41

Infection of the canaliculus e.g ( by actinomyces) this blocks the canaliculi and get discomfort in the medial side. blocks the drainage of tears to the canaliculi so you get watery eyes

Question 42

what is actinomyces?

Answer 42

bacteria

Question 43

which bacteria can cause canaliculus?

Answer 43

actinomyces

Question 44

what is congenital epiphora?

Answer 44

when children 20% of neonates show evidence of symptomatic outflow obstruction symptoms include epiphora and mucopurulent discharge 70% of affected childreen become better symptom free by 3 months or at least 90% by their first birthday. lacrimal drainage is not fully developed

Question 45

when do children start getting symptom free from epiphora?

Answer 45

70% by three months old | 90% 1 year old

Question 46

How do you treat dacryocystitis?

Answer 46

Systemic antiobiotics incision and drainage where appropriate Dacryocystogram( DCG) and surgery such as Dacryocystorhinostomy ( DCR) in follow up

Question 47

what is Dacryocystorhinstomy?

Answer 47

creatye a new channel silicon tubing placed that reroutes drainage system into the nose.

Question 48

what is the definition of the dry eye disease?

Answer 48

dry eye is a disorder of the tear film due to tear deficiency or excessive tear evaporation which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort.

Question 49

how can you get dry eyes?

Answer 49

patient cannot produce enough tears by the lacrimal gland

Question 50

How is tear deficient dry eye classified?

Answer 50

Sjogren's syndrome | non - sjogren's syndrome

Question 51

How is evaporative dry eyes classified?

Answer 51

oil deficient lid related surface change contact lens related

Question 52

what is sjogren's syndrome?

Answer 52

autoimmune disorder consisting of dry eye (KCS) and dry mouth (xerostomia) which often involves nasal and vaginal mucous membrane also.

Question 53

what is sjogren's system associated with?

Answer 53

it is associated with systemic disease such as rheumatotiod arthiritis and systemic lupus erythematosus

Question 54

what is acquired primary lacrimal disease?

Answer 54

commonest cause of tear deficient dry eyes and only lacrimal gland is involved infiltration by inflammatory cells loss of normal structure atrophy and fibrosis

Question 55

what do blood test result show in primary lacrimal disease?

Answer 55

blood test normal

Question 56

management of dry eyes?

Answer 56

``` lubricants tear preservation lid hygiene (blepharitis) oral antibiotics immunosupresants alternative therapies ```

Question 57

what lubricant is needed?

Answer 57

lubricant depends on amount of drop needed (duration ) and type of eye disease patient has

Question 58

how is tear preservation used?

Answer 58

plugs into tears to preserve tears

Question 59

what do ocular lubricants do?

Answer 59

ocular lubricants in the form of eye drops, gels and ointment are used to treat the discomfort associated with conditions in which the tear film is reduced or unstable.

Question 60

what if too much ocular lubricant is given?

Answer 60

ocular lubricants contain preservatives so its very toxic

Question 61

what if px need a lot of ocular lubricant?

Answer 61

if px needs multiple drops then they need preservative free drug (elderly px )