Diseases of the Orbit

What makes up the medial wall of the orbit?

maxilla, lacrimal, ethmoid, sphenoid

What makes up the floor of the orbit?

maxillary, palatine, zygomatic

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?

pain with eye movement

diplopia

What is the presentation of orbital myositis?

lid edema

ptosis

proptosis

chemises + hyperemia over affect EOM(s)

restricted motility in chronic cases

What is the work up for orbital myositis??

MRI or CT scan

What is the treatment for orbital myositis?

oral NSAIDs (mild)

oral steroids (severe)

What causes an orbital fracture?

blunt trauma

What are the types of orbital fractures?

1. orbital floor

2. medial wall

What are the symptoms of an orbital floor fracture?

pain with eye movement

diplopia

numbness

What is the presentation of an orbital floor fracture?

lid bruising and edema

subcutaneous crepitus

anesthesia of infraorbital nerve

limited IR + IO motility

bone step-off

proptosis

endophthalmos (if severe)

What is endophthalmos?

posterior displacement of globe

What is the presentation of orbital medial wall fractures?

periorbital bruising

subcutaneous crepitus

medial rectus entrapment, limited adduction

CSF rhinorrhea

What is the workup for an orbital fracture?

CT scan

What is the treatment for an orbital fracture?

nasal decongestants

systemic abx

systemic steroids (severe edema)

surgical repair

What is an infraorbital foreign body?

foreign body inside orbit but outside globe

What causes an infraorbital foreign body?

high velocity injury

What is the presentation of infraorbital foreign body?

orbital mass:

proptosis if mass is large

ptosis if mass is superior

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 infraorbital foreign body?

observe if small and deep

tetanus prophylaxis

oral abx

surgery

What is an intraocular foreign body?

foreign body in globe

What causes an intraocular foreign body?

metal on metal tasks

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

conj injection

conj chemosis

heme @ entry site

laceration if not self sealing

deep anterior chamber if not self sealing

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 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?

endophthalmitis

vitreous heme

retinal detachment

corneal scar

cataract

glaucoma

sympathetic ophthalmitis

siderosis bulbi

chalocisis

What is siderosis bulbi caused by?

retained foreign body containing iron

What is the presentation of siderosis bulbi?

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?

chronic endophthalmitis

sunflower cataract

blue-green deposits on descemets

copper particles in anterior chamber

reversible retinal toxicity

What is the workup for an intraocular foreign body?

CT or MRI

What is the treatment for intraocular foreign body??

FB removed within 24 hours

systemic abx

surgical removal

What is phthisis bulbi?

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

What causes phthisis bulbi?

trauma

infection

malignancy

retinal detachment

vascular lesion

What is the presentation of phthisis bulbi?

square shaped eye

thick + opaque cornea that you cannot see through

iris neovascularization

scleral thickening

cataract

retina detachment

What is the treatment for phthisis bulbi?

prosthetic

pain management