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</p> Signup and view all the answers

    What is the characteristic of a caroticocavernous fistula?

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

    What can cause binocular diplopia?

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

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

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

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

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

    What is a potential complication of severe proptosis?

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

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

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

    What is the potential complication of orbital cellulitis?

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

    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.

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