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Questions and Answers
What is the sign of orbital varices?
What is suggested by the presence of pain in an orbital disease?
What is the characteristic of an orbital blowout fracture?
What is the term for a backward displacement of the globe?
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What is the characteristic of a caroticocavernous fistula?
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What is the difference between orbital cellulitis and preseptal cellulitis?
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What can cause binocular diplopia?
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What is the term for a rapidly progressing tumour of the orbit?
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What is the effect of thickened inferior rectus in thyroid eye disease?
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Which of the following is a cause of diplopia in paralytic squint?
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What is a potential complication of severe proptosis?
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Which of the following can cause distortion of the macula?
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What is the primary role of CT and MRI scans in orbital disease?
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What is a rare cause of rapidly developing proptosis in children?
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What is the potential complication of orbital cellulitis?
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What is the purpose of additional systemic tests in the investigation of orbital disease?
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Study Notes
Transient Proptosis
- Induced by increasing cephalic venous pressure (e.g., Valsalva manoeuvre), a sign of orbital varices
- Speed of onset of proptosis may indicate aetiology:
- Slow onset suggests benign tumour
- Rapid onset seen in inflammatory disorders, malignant tumours, and caroticocavernous fistula
Enophthalmos
- Backward displacement of the globe
- Feature of orbital 'blowout fracture' (blunt injury to globe and orbit, fracturing thin orbital wall, and displacing orbital contents into an adjacent sinus)
- Also seen in Horner's syndrome, but this is a pseudo-enophthalmos due to narrowing of the palpebral fissure
Pain
- Present in inflammatory conditions, infective disorders, and rapidly progressing tumours
- Not usually present with benign tumours
Eyelid and Conjunctival Changes
- Conjunctival injection and swelling suggest inflammatory or infective process
- Infection associated with reduced eye movements, erythema, and swelling of the lids (orbital cellulitis)
- Anterior lid inflammation (preseptal cellulitis) has full eye movements and no globe inflammation, excluding orbital cellulitis
- Florid engorgement of conjunctival vessels suggests caroticocavernous fistula
Binocular Diplopia
- Occurs when only one eye is fixed on a target
- Causes:
- Direct involvement of muscles in myositis and dysthyroid eye disease (Graves' disease)
- Involvement of nerve supply to extraocular muscles (paralytic squint)
Visual Acuity
- Reduced by:
- Exposure keratopathy from severe proptosis
- Optic nerve involvement by compression or inflammation
- Distortion of the macula due to compression of the globe by a posterior space-occupying lesion
Investigation of Orbital Disease
- CT and MRI scans help diagnose orbital disease by localizing the site of the lesion and demonstrating enlarged intraocular muscles
- Additional systemic tests depend on the differential diagnosis
Differential Diagnosis of Orbital Disease
- Traumatic orbital disease discussed in Chapter 16
- Disorders of extraocular muscles:
- Dysthyroid eye disease and ocular myositis present with symptoms and signs of orbital disease
- In children, rapidly developing proptosis may be caused by rhabdomyosarcoma of the extraocular muscles
- Infective disorders:
- Orbital cellulitis is a serious condition that can cause blindness and may spread to cause a brain abscess
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Description
Diagnosing proptosis and enophthalmos, including causes and symptoms of different orbital disorders.
