Study
Review All
Quiz!
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6 P's of orbital dz? |
Pain |
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Fast progression of orbital dz leads you to believe... |
rabdomyosarcoma/infection |
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Your pt's proptotic eye goes down and in - you suspect... |
lacrimal gland lesion |
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When your patient's eyes are proptotic and they complain of diplopia, you must first ask... |
"do you see two DISTINCT images?" Helps determine if refractive |
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A pulsating eye leads you to believe... |
vascular issue e.g. fistula |
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Positive retropulsion means... |
you push on the eye and it doesn't give |
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Mean exophthalmometry protrusion in white men? |
16.5 mm |
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Mean exophthalmometry protrusion in white women? |
15.4 mm |
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Mean exophthalmometry protrusion in black men? |
18.5 mm |
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Mean exophthalmometry protrusion in black women? |
17.8 mm |
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Mean exophthalmometry protrusion in asian men? |
16 mm |
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Mean exophthalmometry protrusion in asian women? |
16 mm |
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This EOM is the first to go in grave's... |
IR |
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Corkscrew vessels is a sign of ___ in orbital dz |
arteriovenous fistula |
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Between MRD1 and MRD2, which is more diagnostic? |
MRD1 b/c MRD2 more variable |
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What is a "thrill"? |
the vibration felt due to a hardened artery |
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What is crepitous? |
Air cracking out of orbit/skin, sign of suborbital or subdermal emphysema |
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Suborbital emphysema is... |
a sign of break in a cranial sinus (e.g. ethmoid), evident when do valsalva - air enters in sinus and causes proptosis. Due to abnormal communication b/w ethmoid and retrobulbar space |
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Subdermal emphysema is... |
a sign of abnormal communication between subdermal space and retrobulbar space - lid "blows up" when do valsalva |
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What kind of X-ray would you order for orbital dz? |
Caldwell Waters - checks for every orbital bone |
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What types of ultrasound would be useful for vascular tumors and thyroid dz? |
A & B scan |
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T/F - CAT scans are useful for vascular tumors. |
False - does not pick up BVs that well |
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T/F - CAT scans are not useful for EOMs and the orbital wall. |
False - CAT scans are useful for these structures, but not the best for vascular structures e.g. vascular tumors |
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MRIs are useful for what types of structures? |
Vascular structures e.g. vascular tumors |
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Difference b/w T1 and T2 MRIs? |
T1 = water (i.e. vitreous) is dark T2 = water is white |
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What is congenital anophthalmos? Tx? |
no orbit; Tx = socket expansion and prosthesis |
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What is goldenhar syndrome? |
aka Craniofacial cleft syndrome; dermoid at inferotemporal limbus, preauricular skin tags, vertebral skeletal defects, eyelid colobomas |
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What is Crouzon syndrome? |
"squished frog/tadpole appearance" - basically flattened face; exophthalmos due to shallow orbits, receeded cheekbones, strab, nystag, optic atrophy, craniosynotosis (coronal sutures) |
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DDx preseptal vs orbital cellulitis? |
Preseptal = no pain on motion, normal EOMs, no fever |
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What does Dr. S mean by "marching" in orbital cellulitis? |
redness tends to go further away from center, an indication of spreading/progress |
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Main DDx symptom of orbital cellulitis vs orbital tumor? |
Sudden onset of "pushing on back of my eye" = orbital cellulitis Gradual = orbital tumor |
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Common cause of orbital cellulitis? |
acute sinusitis |
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T/F - VAs can be decr in orbital cellulitis? |
True |
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Most common congested sinus in orbital cellulitis? |
ethmoid/maxillary |
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T/F - Anorexia is assoc w/ orbital cellulitis |
True |
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Tx orbital cellulitis in children? |
Admit to hospital; options: |
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Oral meds appropriate for orbital cellulitis? |
Yes, but only after pt responds to IV Tx |
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Tx preseptal cellulitis? |
Options: |
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You should order [this lab test] to DDx Pseudotumor IOIS vs [this orbital dz]. How do you know it's Pseudotumor IOIS? |
CAT scan, DDx vs Thyroid. Pseudotumor = BOTH muscles and tendons inflamed Thyroid = only muscles inflamed (not tendons) |
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Pseudotumor IOIS main complaint? |
Orbital pain |
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Tolosa-Hunt sydrome is a form of this orbital dz. |
Pseudotumor IOIS |
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What does IOIS stand for in Pseudotumor IOIS? |
Idiopathic Orbital Inflammatory Syndrome |
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Pseudotumor IOIS has this sign that is different from Orbital cellulitis, and it is caused secondary to trabeculitis. |
Incr IOP |
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What cranial nerve is affected in Pseudotumor IOIS? How? |
Decr sensation of CN V |
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T/F - Possible to see optic disc edema in Pseudotumor IOIS |
True |
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Your 34 yo pt comes in with a painful unilateral proptotic globe, restricted EOMs, eyelid erythema and edema, and intense conj injection. Your pt's temperature is normal. You suspect... |
Pseudotumor IOIS (normal temp, no fever in adults) |
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Tx Pseudotumor IOIS? |
Steroid (prednisone), anti-ulcer med (rantidine), low dose radiation if steroids fail, or as adj Tx; immunosupp Tx if above fail |
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What are Choriostomas? |
when primordial tissues fuse, dermoid/epidermoid tissue is trapped b/w suture of bone and create "skin tags". More commonly external vs internal |
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Most common benign choriostoma? |
dermoid cyst |
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These cystic tumors can have hair |
dermoids + epidermoids (orbital/periorbital) |
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Epidermoids arise from this tissue in development... |
ectoderm |
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Dermoids arise from this tissue in development... |
ecto/mesodermal |
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Your pt presents with a flesh colored bump on the brow ridge. On palpation you feel a small round "ball" that moves freely inside. There is no inflammation. You suspect... |
dermoid/epidermoid (cystic tumor) |
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Lipodermoids usually show up on... |
the conjunctiva |
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Most common benign vascular tumor in children? |
Capillary hemangiomas (strawberry nevus) |
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T/F - Capillary hemangiomas occur after birth. |
True - first several mos after birth (not at birth) |
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T/F - Capillary hemangiomas will blanch if pushed. |
True |
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Tx Capillary hemangiomas? |
Steroid IV (betamethasone and triamcinolone), but can depigment eye and incr IOP. can also just monitor b/c can resolve over time on its own |
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This tumor is often assoc w/ neurofibromatosis |
ON glioma |
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ON glioma demographic? |
Females 2-6 yrs (Females 3x > males) |
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T/F - ON gliomas are rapid growing and benign. |
False - slow growing and benign (not metastatic but can take vision) |
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Lisch nodules and cafe au-lait spots on a child are very diagnostic of... |
ON gliomas |
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What are lisch nodules? |
small brown elevations on iris, diagnostic of ON glioma |
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You want to check the VF of your 3 yo female pt, who you suspect ON glioma, but you know the responses will be poor. What is an alternative? |
Multifocal ERG |
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ON Giloma Tx? |
If VA good, NOT surgery. Surgery only if VA loss or severe proptosis Under 5 yo = chemo |
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This tumor must be ruled out in cases of sudden unilateral proptosis in young children... |
Rabdomyosarcoma |
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Most common malignant tumor of orbit in kids? |
Rabdomyosarcoma |
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Why is Rabdomyosarcoma so serious? |
Can metastasize |
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Enlarged lymph nodes at the neck/underarms, bruised eyelids (that won't go away) with a Hx of nosebleeds in a child makes you think... |
Rabdomyosarcoma |
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Why is a chest and bone x-ray indicated for Rabdomyosarcoma? |
look for metastasis |
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T/F - Main demographic of Rabdomyosarcoma is children. |
True |
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T/F - Males are more likely to get capillary hemangiomas. |
False - equal to females |
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The main difference in etiology of orbital cellulitis in adults vs kids is... |
kids = assoc w/ polyps, allergies |
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What is Red Man Syndrome? |
Side effect of vancomycin, a Tx for orbital cellulitis |
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Cavernous hemangioma demographic? |
middle aged women |
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T/F - Cavernous hemangioma tends to be slow growing. |
True - 4 yrs from signs to dx (avg) |
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Where can you find Cavernous hemangiomas? |
Muscle cone |
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T/F - Cavernous hemangiomas are vascular |
True |
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T/F - Cavernous hemangioma has (+) retropulsion |
True |
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Your pt has decreased VAs due to increased hyperopia, (+) retropulsion, axial proptosis, choroidal folds, disc edema. Orbital T2 MRI is hyperintense. CT scan reveals intracanal lesion. Dx? |
Cavernous hemangioma |
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What artery is involved in a low flow, low pressure fistula? What demographic? |
Meningiohypophyseal a. Post-menopause females |
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Your 60 yo female pt hears a whooshing sound when sleeping on her side. You note that the globe is not pulsating. Dx? |
Fistula at meningiohypophyseal a. |
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High flow fistula demographic and cause? |
Young male, trauma; ICA fistula in cavernous sinus |
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T/F - You do not see incr IOP in arteriovenous fistulas. |
False - there is incr IOP, in high flow |
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Orbital bruit with pulsatile proptosis are key indicators of... |
high flow arteriovenous fistula |
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What type(s) of palsies occur in high flow arteriovenous fistulas? Low flow? |
High flow = 3rd/6th palsy Low flow = 6th palsy |
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T/F - You see engorged episcleral veins only in high flow arteriovenous fistulas. |
False - seen both in high and low flow |
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Cavernous hemangioma appearance on MRI T1 and T2? |
T1 = hypointense Remember tumor is vascular |
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Typical VF defect on cavernous hemangioma? |
Variable - ON is choked at muscle cone |
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On orbital CT scan or MRI, you see this highly diagnostic sign on arteriovenous fistulas. |
Enlargement of sup ophthalmic vein |
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Tx high flow arteriovenous fistula? Low flow? |
High = surgery |
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Lacrimal gland tumors include these types... |
Pleomorphic adenoma, pleomorphic adenocarcinoma, cylindroma |
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S-shaped lid is a sign of this tumor. |
Lacrimal gland tumor |
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Lacrimal gland tumor demographic? |
males slightly more vs females 2nd-5th decade, 4th decade highest |
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T/F - Lacrimal gland tumor progression is rapid. |
False - slow (Sx for 12 mos) |
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What type of Lacrimal gland tumor has a 50% survival at 5 yrs? |
cylindrome type |
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Most common cancers in women? Men? |
Women = breast & lung |
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Chemo/radiotherapy for cancer often results in this ocular Sx. |
Dry eye |
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Breast cancer has its highest risk of metastasis during... |
First 2 years |
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What is the most important factor in Dx orbital tumor secondary to metastatic breast cancer? |
Hx of cancer |
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Radiation retinopathy involves... |
closing of microvasculature therefore see multiple CWS |
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T/F - Orbital ultrasound is indicated for metastatic tumors to the orbit. |
False - not a solid mass (diffuse) therefore not diagnostic |
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T/F - Anisocoria is commonly found in blowout fractures of the orbit. |
True - parasymp damage |
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What EOM is usually affected in orbital blowout fractures? |
IR (orbital floor break so IR gets trapped) |
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T/F - Proptosis occurs with blowout fractures. |
False - enophthalmos (orbital floor drops so globe pulls back) Thus also can see ptosis |
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#1 place of orbital trauma? #2? |
#1 = home, #2 = street/highway |
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Orbital trauma almost always occurs in (males/females)? |
males |
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Top occupation of orbital trauma |
construction |
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Top activity leading to orbital trauma? |
hammering |
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Orbital trauma usually results in what kind of VAs? |
Hand motion |
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Orbital trauma usually (sharp/blunt) objects? |
blunt |
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% not wearing eye protection in orbital trauma? |
80 |
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Afrin is indicated for orbital trauma because... |
(nasal decongestant) so pt won't blow nose (valsalva can push sinus contents into orbit) |
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If the AC is not well-formed in orbital trauma, what test should you do? |
Seidel test to make sure no leakage |
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T/F - Orbital floor blowout fracture is an ocular emergency that must get surgery STAT |
False - not necessarily an emergency, want swelling to subside first Surgical repair of orbit at day 7-14 if persistent diplopia or large fracture of bone present |
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T/F - Orbital roof blowout fracture is an ocular emergency that must get surgery STAT |
True - possible CSF leakage |
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If your pt talks about any Hx of flying FBs and complains of pain (whether active or subsided), MUST do this test... |
Orbital X-ray |
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Wood and vegatative matter are tolerated (poorly/fairly well/well) as a foreign body. |
poorly |
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Copper alloys, brass, bronze are tolerated (poorly/fairly well/well) as a foreign body. |
fairly well |
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Lead is tolerated (poorly/fairly well/well) as a foreign body. |
well |
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Steel is tolerated (poorly/fairly well/well) as a foreign body. |
well |
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Stone is tolerated (poorly/fairly well/well) as a foreign body. |
well |
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T/F - Topical antibiotics are indicated for intraorbital foreign bodies. |
False - systemic e.g. cefazolin |
