diseases of the orbit

What makes up the medial wall of the orbit?

1. maxilla

2. lacrimal

3. ethmoid

4. sphenoid

What makes up the floor of the orbit?

1. maxillary

2. palatine

3. zygomatic

What makes up the roof of the orbit?

1. frontal bone

2. lesser wing of the sphenoid bone

What makes up the temporal wall of the orbit?

1. zygomatic

2. greater wing of sphenoid

What is orbital myositis?

inflammation of the EOMs

Who gets orbital myositis? what age?

females in their 30s

What are the symptoms of orbital myositis?

1. pain with eye movement

2. diplopia

What is the presentation of orbital myositis?

1. lid edema and ptosis

2. proptosis

3. chemosis

4. injection over affected muscle

5. restricted motility

What is the work up for orbital myositis?

MRI or CT scan

What is the treatment for orbital myositis?

1. oral NSAIDs (mild)

2. oral steroids (severe)

What causes an orbital fracture?

blunt trauma

What are the types of orbital fractures?

1. orbital floor (48%)

2. medial wall

force is displaced inferior and transmits energy from impact

What is the presentation of an orbital floor fracture?

1. lid bruising and edema

2. subcutaneous crepitus (crackling)

3. anesthesia of infraorbital nerve

4. limited IR & IO motility

5. bone step-off

6. proptosis

7. enophthalmos (if severe) - posterior displacement

What is the presentation of orbital medial wall fractures?

1. periorbital bruising

2. subcutaneous crepitus (crackling)

3. medial rectus entrapment, limited adduction

4. CSF rhinorrhea

What is the workup for an orbital fracture?

CT scan

What is the treatment for an orbital fracture?

1. nasal decongestants - no blowing nose (orbital cellulitis)

2. systemic abx

3. systemic steroids (severe edema)

4. surgical repair

What is an intraorbital foreign body?

foreign body inside orbit but outside globe

What causes an intraorbital foreign body?

high velocity injury

What is the presentation of intraorbital foreign body?

orbital mass:

1. proptosis if mass is large

2. ptosis if mass is superior

3. restricted EOM movement if mass is near EOM

What is the workup for infraorbital foreign body?

CT scan or MRI (no metal)

What is the treatment for an intraorbital foreign body?

observe if small and deep

1. tetanus prophylaxis

2. oral abx

3. surgery

What is an intraocular foreign body?

foreign body in globe

What causes an intraocular foreign body?

metal from metal tasks

What is the presentation of a scleral entry intraocular foreign body?

depends on entry and foreign body:

1. scleral - may lead to deep anterior chamber

2. corneal - corneal edema & a positive Seidel sign

3. iris - transillumination defect & heterochromia

What is the presentation of a corneal entry intraocular foreign body?

corneal edema @ entry site

+ or - Seidel sign

What is the presentation of iris entry intraocular foreign body?

transillumination

heterochromia

peaked pupil (peaked toward entry site)

What is the presentation of EOM entry intraocular foreign body?

restriction

What is the presentation of an anterior chamber entry (corneal) intraocular foreign body?

focal corneal edema over foreign body

What is the presentation of a lens entry intraocular foreign body?

focal lens opacities

What is the presentation of a retinal entry intraocular foreign body?

FB rests on retina

What are the complications seen with an intraocular foreign body?

1. endophthalmitis

2. vitreous heme

3. retinal detachment

4. corneal scar

5. cataract

6. glaucoma

7. sympathetic ophthalmitis

8. siderosis bulbi

9. chalicosis

What is siderosis bulbi caused by?

retained foreign body containing iron

the pigmentary, degenerative process of the eye following chronic retention of an iron-containing intraocular foreign body (IOFB)

What is the presentation of siderosis bulbi?

the pigmentary, degenerative process of the eye following chronic retention of an iron-containing intraocular foreign body (IOFB)

iris heterochromia

mydriasis

cataract

glaucoma

retinal pigment changes

What is a complication of siderosis bulbi ??

irreversible blindness

What is chalcosis due to?

retained foreign body containing copper

What is the presentation of chalcosis?

1. chronic endophthalmitis

2. sunflower cataract

3. blue-green deposits on descemets

4. copper particles in anterior chamber

5. reversible retinal toxicity

What is the workup for an intraocular foreign body?

CT or MRI (no MRI if metallic!)

What is the treatment for intraocular foreign body?

1. FB removed within 24 hours

2. systemic abx

3. surgical removal

What is phthisis bulbi?

shrinkage and disorganization of the eye, resulting in loss of function

What causes phthisis bulbi?

1. trauma

2. infection

3. malignancy

4. retinal detachment

5. vascular lesion

What is the presentation of phthisis bulbi?

1. square shaped eye

2. thick & opaque cornea that you cannot see through

3. iris neovascularization

4. scleral thickening

5. cataract

6. retina detachment

What is the treatment for phthisis bulbi?

1. prosthetic

2. pain management