Adnexa/Orbit

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External

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Preseptal Cellulitis

Infection anterior Infection anterior to the orbital to the orbital septumseptum

Swelling, ptosis, Swelling, ptosis, warmthwarmth

(-) Pain, (-) (-) Pain, (-) congestioncongestion

Orbital Cellulitis

Infection posterior Infection posterior to the orbital septumto the orbital septum

Fever, pain on eye Fever, pain on eye movement, decreased movement, decreased VA, EOM restrictions, VA, EOM restrictions, proptosisproptosis

Most common cause – Most common cause – sinus infection sinus infection (ethmoid sinusitis)(ethmoid sinusitis)

Thyroid Eye Disease / Grave’s Ophthalmopathy

Female, 30s-40sFemale, 30s-40s

#1 cause of proptosis#1 cause of proptosis

Autoimmune diseaseAutoimmune disease

Thickening of EOMs Thickening of EOMs proptosis & upper lid proptosis & upper lid retractionretraction

Exophthalmometry norm Exophthalmometry norm for Caucasians: 12-for Caucasians: 12-22mm22mm

Carotid-Cavernous Fistula (CCF)

Abnormal artery-vein Abnormal artery-vein communicationcommunication

#1 cause – trauma#1 cause – trauma

Chemosis, pulsatile Chemosis, pulsatile proptosis, ocular bruitproptosis, ocular bruit

Cavernous sinus: Cavernous sinus:

3, 4, 6, V1, V23, 4, 6, V1, V2

V3 & 7 do not go V3 & 7 do not go throughthrough

Orbital Tumors

Cavernous hemangiomaCavernous hemangioma

Capillary hemangiomaCapillary hemangioma

RhabdomyosarcomaRhabdomyosarcoma

NeuroblastomaNeuroblastoma

Optic nerve gliomaOptic nerve glioma

MeningiomaMeningioma

LymphomaLymphoma

NeurofibromaNeurofibroma

Neurilemma Neurilemma (Schwannoma)(Schwannoma)

Cavernous Hemangioma

#1 benign orbital tumor in adults#1 benign orbital tumor in adults

Capillary Hemangioma

#1 benign orbital tumor in children#1 benign orbital tumor in children

Rhabdomyosarcoma

#1 primary pediatric orbital malignancy#1 primary pediatric orbital malignancy

Neuroblastoma

#1 secondary pediatric orbital #1 secondary pediatric orbital malignancymalignancy

Optic nerve glioma

#1 intrinsic tumor #1 intrinsic tumor of the optic nerveof the optic nerve

Meningioma

#1 benign brain #1 benign brain tumortumor

Lymphoma

50s-60s50s-60s

Proptosis in older patients (younger Proptosis in older patients (younger patients, think TED)patients, think TED)

Neurofibroma

Benign astrocyte Benign astrocyte tumortumor

Neurilemma (Schwannoma)Benign Schwann cell tumorBenign Schwann cell tumor

Orbital Pseudotumor

IdiopathicIdiopathic

Inflammation of the Inflammation of the orbitorbit

Unilateral painful Unilateral painful proptosisproptosis

Unilateral chemosis Unilateral chemosis (allergy would be (allergy would be bilateral)bilateral)

Tolosa-Hunt Syndrome

IdiopathicIdiopathic

Inflammation of the orbitInflammation of the orbit

Bilateral painful proptosisBilateral painful proptosis

Eyeball Abnormalities

Phthisis bulbiPhthisis bulbi

AnophthalmosAnophthalmos

MicrophthalmosMicrophthalmos

EnophthalmosEnophthalmos

Phthisis bulbi

Small globe Small globe (atrophy)(atrophy)

Causes – disease, Causes – disease, trauma, infection, trauma, infection, surgerysurgery

Blind eyeBlind eye

Anophthalmos

No ocular tissue No ocular tissue within globewithin globe

Microphthalmos

Small globe Small globe (congenital)(congenital)

Enophthalmos

Globe retractionGlobe retraction

Cause – traumaCause – trauma

Ocular prosthesis

Enucleation – remove Enucleation – remove globeglobe

• Evisceration – Evisceration – remove contents remove contents within sclerawithin sclera

• Exenteration – Exenteration – remove orbital remove orbital contents (globe, contents (globe, EOMs, fat)EOMs, fat)

Ocular Rosacea

• Chronic ocular Chronic ocular surface diseasesurface disease

• Sebaceous glandsSebaceous glands

• Middle-ageMiddle-age

• Telangiectasia, Telangiectasia, rhinophyma, rhinophyma, malar/butterfly rashmalar/butterfly rash

Contact Dermatitis

• Type 4 Type 4 hypersensitivityhypersensitivity

• 24-72 hour delay24-72 hour delay

• Ex: cosmetics & medsEx: cosmetics & meds

• Acute redness, Acute redness, swelling, chemosisswelling, chemosis

Ocular Cicatricial Pemphigoid• Systemic mucous Systemic mucous

membrane disordermembrane disorder

• IdiopathicIdiopathic

• Signs – Signs – symblepharon, symblepharon, ankyloblepharonankyloblepharon

Stevens-Johnson Syndrome• Type 3 Type 3

hypersensitivityhypersensitivity

• Mucous membrane Mucous membrane disorderdisorder

• #1 cause – drug-#1 cause – drug-induced (sulfonamides)induced (sulfonamides)

• Prodrome – flu-likeProdrome – flu-like

• PseudomembranesPseudomembranes

• SymblepharonSymblepharon