1 / 38

Differential Diagnosis of Orbital Disease

Differential Diagnosis of Orbital Disease . Optometry 8570 Fall, 2008 Edward S. Jarka , O.D., M.S. Anatomy of Importance:. Intraorbital part of the optic nerve is longer than the distance between the back of the globe and the optic foramen.

vui
Télécharger la présentation

Differential Diagnosis of Orbital Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Differential Diagnosis of Orbital Disease Optometry 8570 Fall, 2008 Edward S. Jarka, O.D., M.S.

  2. Anatomy of Importance: • Intraorbital part of the optic nerve is longer than the distance between the back of the globe and the optic foramen. • The roof of the orbit is adjacent to the frontal sinus & the anterior cranial fossa. • Floor is adjacent to the maxillary sinus. • Medial wall is thin and adjacent to the ethmoid sinus. • What passes through the orbital fissurres?

  3. Orbit Anatomy:

  4. Clinical Signs 9 General Signs – Name them

  5. Signs of Orbital Disease • Soft tissue signs • Proptosis • Enophthalmos • Ophthalmoplegia • Dynamic signs • Optic disc changes • Choroidal folds • Retinal vascular changes • Vision reduction

  6. General Causes of Orbital Disease • Thyroid disease • Infections in/around the Orbit • Inflammatory • Vascular malformations • Space occupying lesions • Craniosynostoses

  7. A Quick Graves Disease Review • Autoimmune • EOM enlargement • Increase in orbital contents • Signs: • Dalrymple • Von Graefe • Kocher

  8. von Graefe Sign:

  9. Preseptal: No Proptosis F.R.O.M. of EOM’s Normal Pupils Normal Visual Acuity Orbital: Proptosis Ophthalmoplegia + APD Reduced Visual Acuity Infections in/around the Orbit

  10. Preseptal or Orbital?

  11. Preseptal or Orbital?

  12. Orbital Mucormycosis • Rare, but seen in diabetics and immunosuppressed patients. • Spores check-in but the patient checks-out. • Sinuses to orbit to brain. • Treatment?

  13. Inflammatory Orbital Disease Idiopathic Acute Dacryoadenitis Orbital Myositis Tolusa-Hunt Syndrome

  14. Orbital inflammation: • Can affect any or all structures within the orbit. • Can be nonspecific, granulomatous, or vasculitic. • The inflammation can be part of an underlying medical disorder or can exist in isolation.

  15. Idiopathic Orbital Inflammatory Disease (Orbital Pseudotumor) • Inflammation can involve any or all or the orbital soft tissues. • Unilateral in adults, can be bilateral in children. • Spontaneous remission in about 3 weeks, but prolonged cases may lead to fibrosis of the EOM’s leading to a “frozen orbit”.

  16. Mild to moderate IOID

  17. Idiopathic Orbital Inflammatory Disease (Orbital Pseudotumor) Treatment: • Observation in mild cases. • Steroids are effective in 50% to 75% of cases that are moderate to severe.

  18. Acute Dacryoadenitis • Can be seen along with IOID • Patient presents with sudden discomfort around the lacrimal gland. • S-shaped ptosis • Displacement of the globe down and in • Lacrimal secretion decreased. • Rule out infection and space occupying lesions of the lacrimal gland.

  19. Acute Dacryoadenitis

  20. Orbital Myositis • Inflammation of one or more EOMs. • Usually a young adult with acute pain worsened by eye movements and diplopia. • Injection over the involved muscle.

  21. Tolosa-Hunt Syndrome • Non-specific granulomatous inflammation of the cavernous sinus, superior orbital fissure and/or the orbital apex. • Diplopia with severe headache pain on the involved side

  22. Vascular Malformations Carotid-cavernous fistula

  23. Carotid-Cavernous Fistula (CCF) • When the carotid arterial blood flows anteriorly into the ophthalmic veins, ocular signs may occur because of venous and arterial stasis around the eye and orbit. • Increased episcleral venous pressure • Decrease in arterial flow to the CN in the cavernous sinus

  24. The Cavernous Sinus: In Wall: 1 = Oculomotor; 2 = Trochlear; 4 = V1; 5 = V2 In Sinus: 3 = Abducens; 6 = Autonomic Plexus; 7 = Internal Carotid

  25. Classification of CCF’s 1) Etiology • Spontaneous • Traumatic 2) Blood flow Dynamics • High flow • Low flow 3) Anatomy • Direct • Indirect

  26. High-flow CCF • Represents 70% to 90% of all CCF’s • Blood from the carotid artery flows directly into the cavernous sinus • Defect is in the internal carotid artery • Trauma (most common) • Spontaneous rupture • Classical Signs: • Pulsatileproptosis, Chemosis, Intracranial noise

  27. Other Ocular Signs from High-flow CCFs • Ocular Bruit • Reduced with carotid compression in the neck • IOP • Anterior segment ischemia • Ophthalmoplegia • Fundus signs

  28. High-flow CCF:

  29. Low-flow CCF • The arterial blood of the carotid arteries indirectly flows into the cavernous sinus via the meningeal branches. • More subtle symptoms • Causes: • Spontaneous (after trauma) • Congenital malformations

  30. Ocular Signs of Low-flow CCFs • Gradual, chronic redness due to episcleral venous engorgement. • Greater than the normal pulsation seen during applanationtonometry • All signs of high-flow CCFs (milder)

  31. Low-flow CCF:

  32. Space Occupying Lesions

  33. Cystic lesions and Tumors • Displacement of the globe • Seen in all ages • Must be differentiated by CT/MRI/Biopsy

  34. So – What’s important to know? • Given that a patient presents with proptosis, what guides you to the diagnosis? • Diplopia? • Pain? • Time of onset? • Severity of symptoms? • Red eye? • Chemosis? • Dynamic symptoms?

  35. What is the Optometrists Role? • Identify the signs and symptoms • Help initiate the diagnosis • Follow-up • Managing the patient after surgery • Diplopiamanagement Scared?

  36. It could be worse. “Halloween is gonna suck this year”

  37. Advice for Test and Boards • Work hard • Put time into understanding • You will succeed…

  38. … Eventually Wait till next year!

More Related