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40 Cards in this Set

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Common causes of preseptal cellulitis
Hordeolum (#1), dacrocystitis, skin trauma(insect bite)
Orbital cellulits
-common cause of exophthalmos in kids
-hx of fever, *sinus(ethmoid)/dental infection, trauma
-Staph (adults), influenza(flu) (kids)
-Immunocompromised can develop mucormycosis(fungus) leads to black eschar (mouth, nose)
Ddx orbital from preceptal
Preceptal:no fever, proptosis, EOM restriction, increased pain with eye-movement
Normal exophthalmometry readings:
Whites:12-22
Blacks:12-24
Asians:12-18
Assymetry <4mm
thyroid eye disease (TED)
"NO SPECS"
-Kocher's sign (the stare)
-Von Graefe's sign(lid lag during downgaze)
-Corneal exposure (SPK,SLK)
-Inferior rectus first
-Inflammation at orbital apex>nerve damage
Carotid Cavernous Fistula
-Abnormal communication between artery and vein.
-Increases venus BP resulting in decreased outflow from orbit>**Pulsatile proptosis, redness, chemosis, CN6 palsy, bruit
Cavernous Hemangioma
**Most common benign orbital tumor in adults
-Unilateral proptosis (tumor post. to globe)
General symptoms of Orbital Tumors
APD, progressive decrease in VA, progressive proptosis (unilaterl)
Capillary Hemangioma
**Most common benign orbital tumor in children (capillaries are small, kids are small)
-Usually diagnosed early because of strawberry cutaneus lesions
-70% are gone by age 7
Rhabdomyosarcoma
"RhaBD-rapid bone descruction"
-**Most common malignant pediatric orbital tumor
-Tumor of mesenchyme (bone)
Neuroblastoma
**2nd most common overall malignant tumor in peds (after Rhabdo)
**Most common secondary pediatric tumor
-Usually kid already has abdomen cancer
Meningioma
**Most common benign brain tumor
-Middle aged women
-Slow vision loss, proptosis nerve swelling, APD, diplopia
Most common intercranial tumor to spread to orbit
Sphenoid meningioma
Primary orbital meningiomas classic triad:
VA loss, optic atrophy, optociliary shunt vessels (connect choriod with retina)
Dermoid Cysts
Contain hair follicles and sebaceous glands
-GOLDENHAR's syndrom (ocular dermoid, skin tag, vertebral dysplasia)
Lymphoma
Slow onset tumor of orbit
50-70yo
optic nerve glioma (juvenile pilocytic astrocytoma)
-age 2-6
*Most common intrinsic tumor of optic nerve
-50%association with neurofibromatosis type 1 (lisch nodules, fibromas, cafe aulait spots)
Orbital pseudotumor
Similar to thyroid eye disease (20-50, unilateral, proptosis) but also has sudden pain and inflammation of periorbit (chemosis, lacrimal, hyperoptic shift)
-Idiopathic inflammator process
-If bilateral, Raise suspicion for Wegeners granulomatosis, Polyarteritis nodosa, lymphoma
Tolosa-Hunt Syndrome
Inflammation of Cavernous sinus (CN 3,4,5i,5ii,6) resulting in possible paresis of these nerves
Ocular rosacea
-Common, middle aged women of european ancestry
-Telangetasia, rhinophyma(huge nose)
-**Triggers (food, sun)
Ocular cicatridcial Pemphigoid
-Autoimmune damge to mucus membranes
-Symblepharon (eyelid-eyeball)
-Ankyloblepharon(eyelid-eyelid
-can be drug induced (beta blocker)
Dermatochalasis
Weakend orbital septum allows prolapse of fat
Chalazion
-sterile inflammation
-ask about acne rosacea, seborrheic dermatitis
Hordeolum
Acute staph infection of meibomian glands(internal), zeis/moll (external)
Ectropion
-out turning of lid
-mechanical (tumor
-cicatricial
-paralytic
-congenital
-involutional(age related)
Entropion
-can cause keratitis to pannus
-can be caused by Tracoma
-classically cause by lashes growing posteriorly of Distichiasis (second row of lashes from meib glands)
Floppy eyelid Syndrome
**Obese men with sleep apnea
-Spontaneos upper lid eversion and pillow exposure
Benign Essential Blepharospasm
*Bilateral
-spasms of Obicularis, procerus, corrugator
-often accompanied by DES
-if also suffers lower face abnormalities>Meige's syndrome
Basal Cell Carcinoma
-More common in males 2:1
-**Most common eyelid cancer (90%)
-Small firm shiny pearl with "rodent ulcer(late sign)"
-lower lid, UV exposure
-Surface telangetasia
Squamous cell carcinoma
-2nd most common eyelid cancer
-erythematous Plaque
-Often derived from actinic keratosis
Actinic Keratosis
-Premalignant elevated pink scaly lesion on sus-exposed skin
-*MOST common pre-malignant skin lesion)
Sebaceous Gland Carcinoma
*Bad boy of lid
**Recurrent chalazion
*unilateral bleph
-madarosis, lymphadenopathy
-Arises from meibmian glands
Malignant Melanoma
Extreamly rare but are most lethal primary skin cancer
Keratocanthoma
Initially similar to BCC or SCC, then they grow quickly, then involute/resolve.
Common causes of nasolacrimal duct obstruction
Involutional Stenosis (older people) Membranous blockage of valve of Hasner (youner)
dacrycystitis
-occors shen duct is plugged,
-Always below medial canthal tendon
-if above could indicate tumor
-If chronic, suspect cancer
*don't irrigate/refer untill tx started
canaliculitis
-unresponsive to AB tx
-Pouting puncta
-Discharge with palpation
*Most common cause Israeli bacteria
Dacroadenitis
*S-shaped ptosis
-Most common is chronic(*sarcoid, TB, graves)
-Rule out tumor with biopsy
-Acute: bacteria, virus, fever
Jones 1 test
Fluorescein is instilled, after 5 min eye is examined for NaFl, if it's gone and patient has NaFl in throat/nose that equals (+)test. Positive for flow.
-If (-) perform Jones 2
Jones 2 test
Irrigate, if saline comes out either punctum it's blocked