What are 7 signs that patients with orbital disease may present with?
- Soft tissue involvement
- Proptosis
- Enophthalmos
- Ophthalmoplegia
- Visual dysfunction
- Dynamic changes
- Fundus changes
What are 4 symptoms that patients with orbital disease may present with?
- Diplopia
- Pain
- Discomfort
- Decreased vision
What are 4 common and 2 less common investigations that would be done for orbital disease?
- CT scan
- MRI scan
- Plain radiographs
- Fine needle biopsy
Other:
- Thyroid function tests (TFT)
- Searching for primary/secondary neoplasia
What type of disease is thyroid eye disease?
Autoimmune
What are the 7 ocular manifestations of thyroid eye disease?
- Eyelid retraction/lag
- Periorbital oedema
- Exophthalmos (proptosis)
- Compression of the optic nerve
- Exposure keratopathy (dry eyes)
- Soft tissue involvement
- Restrictive myopathy
What fraction of patients with thyroid eye disease have exophthalmos?
1/3
What % of patients with exophthalmos have optic neuropathy?
5%
What 5 examinations should you do to check for optic neuropathy?
- VA
- Colour vision
- Papillary reactions
- Visual fields
- Regular fundoscopy
What is the main manifestation of restrictive myopathy in thyroid eye disease?
What causes the symptom in the early and late stages?
Diplopia (permanent in 50%)
Diplopia caused by oedema in active stages and fibrosis in late
What is orbital cellulitis?
How serious is it?
An infection behind the orbital septum
It is an acutely sight threatening and potentially life threatening emergency
What can orbital cellulitis be secondary to?
Ethmoiditis
What are the signs/symptoms of orbital cellulitis according to:
- Systemic (2)
- Anterior eye (2)
- Orbital (6)
Systemic:
- Severe malaise
- Fever
Anterior eye:
- Acute onset of unilateral swelling of conjunctiva and lids
- Oedema, erythema, pain, chemosis
Orbital signs:
- Proptosis (common)
- Extraocular muscle ophthalmoplegia (common)
- Blurred vision
- Reduced VA
- RAPD
- Involvement of the optic nerve
What are complications of untreated orbital cellulitis (5)?
- Orbital/subperiosteal abscess
- Brain abscess
- Meningitis
- Cavernous sinus thrombosis
- Sepsis
What is the management of orbital cellulitis (3)?
1. Acute hospital admission with systemic Abx therapy 2 Monitor optic nerve function 3. Surgery indicated if: -Resistance to Abx -Orbital/subperiosteal abscess -Optic neuropathy
What is a pseudotumour?
How is it diagnosed?
An idiopathic orbital inflammatory disease. A non-neoplastic and non-infectious orbital lesion.
It is a diagnosis of exclusion
How does pseudotumour present? What age range does it usually present at?
(3)
- Abrupt painful onset
- Involves any or all soft tissue components
- Presents in 2nd-5th decades of life
What is the treatment of pseudotumour (3)?
Anti-inflammatory drugs:
- NSAIDs
- Steroids
- Cytotoxic (steroid sparing drugs)
What are the 2 main orbital venous disorders?
- Orbital venous anomalies (varices)
2. Carotid-cavernous fistula
What are orbital varices (2)?
- Congenital enlargements of pre-existing venous channels
2. Usually bilateral
What are 2 possible consequences of orbital varices?
- Bleed
2. Thrombose
What are carotid-caverous fistulas?
Abnormal communications between the carotid and cavernous sinus
What are the 3 forms of carotid-cavernous fistulas?
- Direct - Rapid flow shunt, most commonly caused by trauma
- Indirect - slow flow shunt, congenital/spontaneous rupture
- Encephalocele - herniations of intracranial contents through congenital skill defects. Transmission of CSF pulsation causes pulsating proptosis without a bruit
What are 2 types of vascular tumour in the eye?
- Capillary haemangioma
2. Cavernous haemangioma
What age group does capillary haemangioma occur in?
Orbital tumour in children
