Eye Disorders Diagnosis

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Questions and Answers

What is the sign of orbital varices?

  • A transient proptosis induced by increasing the cephalic venous pressure (correct)
  • Binocular diplopia
  • A gradual proptosis
  • Enophthalmos

What is suggested by the presence of pain in an orbital disease?

  • Orbital varices
  • Infection (correct)
  • Caroticocavernous fistula
  • Benign tumour

What is the characteristic of an orbital blowout fracture?

  • Enophthalmos (correct)
  • Exophthalmos
  • Proptosis
  • Diplopia

What is the term for a backward displacement of the globe?

<p>Enophthalmos (C)</p> Signup and view all the answers

What is the characteristic of a caroticocavernous fistula?

<p>Florid engorgement of the conjunctival vessels (C)</p> Signup and view all the answers

What is the difference between orbital cellulitis and preseptal cellulitis?

<p>Eye movements are full in preseptal cellulitis (A)</p> Signup and view all the answers

What can cause binocular diplopia?

<p>Direct involvement of the muscles in myositis and dysthyroid eye disease (B)</p> Signup and view all the answers

What is the term for a rapidly progressing tumour of the orbit?

<p>Malignant tumour (C)</p> Signup and view all the answers

What is the effect of thickened inferior rectus in thyroid eye disease?

<p>Restriction of upgaze (B)</p> Signup and view all the answers

Which of the following is a cause of diplopia in paralytic squint?

<p>Gaze into the field of action of the affected muscle (A)</p> Signup and view all the answers

What is a potential complication of severe proptosis?

<p>Exposure keratopathy (D)</p> Signup and view all the answers

Which of the following can cause distortion of the macula?

<p>Compression of the globe by a posterior space-occupying lesion (D)</p> Signup and view all the answers

What is the primary role of CT and MRI scans in orbital disease?

<p>Localized the site of the lesion (B)</p> Signup and view all the answers

What is a rare cause of rapidly developing proptosis in children?

<p>Rhabdomyosarcoma of the extraocular muscles (D)</p> Signup and view all the answers

What is the potential complication of orbital cellulitis?

<p>Blindness and brain abscess (B)</p> Signup and view all the answers

What is the purpose of additional systemic tests in the investigation of orbital disease?

<p>To diagnose the primary site of a secondary tumor (A)</p> Signup and view all the answers

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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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