Orbital and Ocular Adnexal Disorders with Red Eyes
|
|
- Emory Burns
- 6 years ago
- Views:
Transcription
1 Orbital and Ocular Adnexal Disorders with Red Eyes Jason Lee Associate Consultant Department of Ophthalmology and Visual Sciences Practical Ophthalmology for the Family Physician 21 Jan 2017
2 No financial disclosures 2
3 Overview Case Scenarios Not an exhaustive list of conditions Important orbital and ocular adnexal conditions to recognise 3
4 Orbit 4
5 Ocular adnexae 5
6 Scenario 1 30yo male presents with a 1 day history of left periorbital swelling, blurring of vision, fever and headache. 6
7 Scenario 1
8 Orbital Cellulitis OCULAR EMERGENCY!!! Occur at any age but more common in children Inflammation of orbital soft tissues behind the orbital septum Extension from preseptal cellulitis Direct inoculation Local spread from periorbital infection / sinuses ORBITAL CELLULITIS Haematogenous spread 8
9 Preseptal vs Orbital Cellulitis Chandler s Classification Preseptal cellulitis(i) Orbital cellulitis (II) Subperiosteal abscess (III) Orbital abscess (IV) Cavernous sinus thrombosis (V) Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. The Laryngoscope ;80:
10 Orbital Cellulitis Signs Eyelid oedema and erythema Increased orbital pressure Decreased vision RAPD Proptosis Soft tissue inflammation Ophthalmoplegia Intracranial sequelae: Cavernous sinus thrombosis Meningitis Cerebral abscess 10
11 Orbital Cellulitis Management CT Orbits and Sinuses Hospital Admission Serological investigations Blood cultures, FBC, wound swab if applicable Broad spectrum IV antibiotics Conversion to oral antibiotics when cellulitis improving (depending on culture and sensitivity) May require surgical drainage if presence of abscess 11
12 Scenario 2a 37yo male presents after falling onto his right after an RTA. Complaining of diplopia on upgaze Vision normal and optic nerve function normal. Right infraorbital anaesthesia 12
13 CT Orbits 13
14 Scenario 2a 14
15 Orbital Blow-out fracture Fracture of orbital walls but orbital rim intact from a blunt trauma to the orbit 2 proposed mechanisms: Hydraulic Theory Buckling theory Sequelae? 15
16 Orbital Blow-out fracture Signs: Periorbital haematoma Restricted EOM Subcutaneous emphysema Infraorbital anaesthesia Enophthalmos 16
17 Orbital Blow-out fracture Work-up: Exclude injuries to other parts of body and face Full ophthalmic examination to rule out globe rupture, traumatic optic neuropathy CT orbits and face 17
18 Orbital Blow-out fracture Management: Cold compress No nose blowing Broad spectrum oral antibiotics for 1 week Short course of oral steroids 18
19 Orbital Blow-out fracture Surgical repair: Immediate repair muscle entrapment Repair in 1 2 weeks (Indications) Large orbital floor fractures of >50% Enophthalmos of 2mm or more Persistent, symptomatic diplopia on primary gaze 19
20 Beware of the White-eyed Blow-out fracture Young patients (<18yo) Inferior trapdoor orbital floor fractures with muscle and soft tissue incarceration Entrapment of inferior rectus muscle can produce an oculocardiac reflex: Bardycardia Nausea Syncope 20
21 Scenario 2b 55yo male presents after falling onto his left face. He is unable to spontaneously open his eye. Examination reveals a very tense orbit with a left RAPD. 21
22 Retrobulbar haemorrhage Ocular emergency! Signs: Diffuse subconjunctival haemorrhage without a posterior margin Tense proptosis with resistance to retropulsion Very elevated intraocular pressure Very limited extraocular motility Compressive optic neuropathy 22
23 Retrobulbar haemorrhage Management Timely and aggressive decompression If optic neuropathy is present, need to release orbital pressure with lateral canthotomy and cantholysis 23
24 Scenario 3 47yo male presents with a 1 month history swelling over right lower lid and medial canthal region. He had 7 previous less severe episodes all of which recovered with oral antibiotics. 24
25 Dacryocystitis Inflammation of the lacrimal sac 25
26 Pathophysiology Trauma Increased Age Female Infection Idiopathic Inflammatory Stenosis (Primary Acquired) Secondary Acquired Inflammation Neoplasm Obstruction of nasolacrimal duct Mechanical obstruction Stagnation of tears and infection 26
27 History to ask Epiphora Previous similar episodes History of trauma to medial canthal region History of systemic disease: Lymphoma / Neoplasms Granulomatosis with polyangiitis (Wegener s Granulomatosis) Sarcoidosis 27
28 Clinical findings Pain, redness and oedema Pus expressed from punctum Fistula may be present if sac ruptures through skin Conjunctival injection and preseptal cellulitis Can progress to orbital cellulitis 28
29 To note Not all masses in medial canthal area arise from lacrimal sac Ruptured dermoid cyst Acute skin infection Acute ethmoiditis Swellings below the medial canthal tendon are typical of dacryocystitis 29
30 To note Signs in favour of a lacrimal sac tumor include: Mass above medial canthal ligament Telangiectasia in the skin overlying the mass Serosanguinous discharge or bloody reflux with atraumatic irrigation 30
31 Dacryocystitis Management Oral antibiotics (commonly gram positive) May require percutaneous drainage of abscess, small risk of fistula formation Imaging (CT orbits and Sinuses) may be required if atypical findings Dacryocystorhinostomy (DCR) few weeks after acute infection resolves 31
32 Dacryocystorhinostomy Can be performed externally or endoscopically 32
33 Scenario 4 50yo Chinese male, smoker, with a known history of Grave s disease presented with a 20 year history of prominent eyes. He now complains of a 1 week history of L>R eye redness and tightness with left eye blurring of vision. 33
34 Thyroid Eye Disease (TED) Diagnosed if eyelid retraction occurs with: Thyroid dysfunction or; Exophthalmos or; Optic nerve dysfunction or; Restrictive myopathy If no eyelid retraction present, then TED can be diagnosed if exophthalmos, optic nerve dysfunction or restrictive myopathy is associated with thyroid dysfunction Bartley GB, Gorman CA. Diagnostic criteria for Graves' ophthalmopathy. American journal of ophthalmology 1995;119:
35 Thyroid Eye Disease (TED) Affects 25-50% of patients with Graves disease, of which 5% have severe involvement Ancestry Caucasians > Asians Radioactive Iodine Therapy Thyroid Dysfunction Active or Passive Smoking Development or Progression of TED Gender Women more frequent Men more severe 35
36 Extraocular signs Proptosis Lid signs Lid retraction Lid lag Lid swelling Lid erythema Restrictive Myopathy 36
37 Intraocular Anterior segment Conjunctival injection and chemosis Superior limbic keratoconjunctivitis Exposure keratopathy Glaucoma Posterior segment Optic neuropathy Choroidal folds 37
38 Clinical assessment of patients with TED Clinical Activity CAS (Clinical Activity Score) VISA (Vision, Inflammation, Strabismus, Appearance) Clinical Severity NOSPECS (No signs and symptoms, Only signs, Soft tissue involvement, Proptosis, EOM involvement, Corneal involvement, Sight loss) EUGOGO (European Group on Graves Orbitopathy 38
39 Clinical Activity Score (First visit) 1. Ocular pain at rest 2. Ocular pain on attempted up, side or down gaze 3. Eyelid erythema 4. Eyelid swelling 5. Conjunctival injection 6. Chemosis of the conjunctiva 7. Chemosis of the caruncle 3/7 indicates active disease Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clinical endocrinology 1997;47:
40 Clinical Activity Score (Repeat visits) Ocular pain at rest Ocular pain on attempted up, side or down gaze Eyelid erythema Eyelid swelling Conjunctival injection Chemosis of the conjunctiva Chemosis of the caruncle Plus (during a period of 1 3 months): Increase in proptosis by 2mm Decrease in eye movement in any direction by 5 4/10 indicates active disease Decrease in best corrected visual acuity by one line on the Snellen chart Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clinical endocrinology 1997;47:
41 Severity of TED (EUGOGO) Classified into: 1) Mild TED <2mm eyelid retraction Mild soft tissue involvement <3 mm exophthalmos Transient or no diplopia Corneal exposure responsive to lubrication 41 Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. European journal of endocrinology 2008;158:
42 Severity of TED (EUGOGO) 2) Moderate-to-severe TED 2mm Moderate or severe eyelid retraction Moderate or severe soft tissue involvement 3mm exophthalmos Inconstant or constant diplopia 3) Sight-threatening (or very severe) TED Dysthyroid optic neuropathy Corneal breakdown 42 Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. European journal of endocrinology 2008;158:
43 Management of TED 43 Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. European journal of endocrinology 2008;158:
44 References 1. Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. The Laryngoscope 1970;80: Gerstenblith AT, Rabinowitz MP. The Wills eye manual : office and emergency room diagnosis and treatment of eye disease. 6th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; Kanski JJ. Clinical ophthalmology : a systematic approach. 6th ed. Edinburgh ; New York: Butterworth-Heinemann/Elsevier; American Academy of Ophthalmology. Orbit, eyelids, and lacrimal system, San Francisco, Calif.: American Academy of Ophthalmology; Bartley GB, Gorman CA. Diagnostic criteria for Graves' ophthalmopathy. American journal of ophthalmology 1995;119: Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clinical endocrinology 1997;47: Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. European journal of endocrinology 2008;158:
45
Emergency Ocular Motility Disorders Hassan Eisa Swify FRCS Ed (Ophthalmology) Air Force Hospital
Emergency Ocular Motility Disorders Hassan Eisa Swify FRCS Ed (Ophthalmology) Air Force Hospital 1 Emergency Ocular Motility Disorders Cranial nerves palsies (oculomotor, Trochlear & abducent) Orbital
More information! Women greater than men (4:1)» Typical of other autoimmune diseases
1 2 3 4 : Overview and Diagnosis Suzanne K. Freitag, M.D. Director, Ophthalmic Plastic Surgery Massachusetts Eye and Ear Infirmary Harvard Medical School! I have no financial disclosures. Learning Objectives!
More informationJames A. Garrity MD Department of Ophthalmology. Marius N. Stan MD Division of Endocrinology. Mayo Clinic Rochester, MN
James A. Garrity MD Department of Ophthalmology Marius N. Stan MD Division of Endocrinology Mayo Clinic Rochester, MN Epidemiologic and diagnostic considerations for Graves orbitopathy (GO) 1. How common?
More informationOphthalmic Trauma Update
Ophthalmic Trauma Update Richard S. Davidson, M.D. Professor of Ophthalmology Vice Chair for Quality and Clinical Affairs UCHealth Eye Center University of Colorado School of Medicine August 5, 2017 Financial
More informationOrbital facia. Periororbital facia Orbital septum Bulbar facia Muscular facia
Anatomy Orbital facia Periororbital facia Orbital septum Bulbar facia Muscular facia Physiology of symptoms 1) Proptosis ( exophthalmos) Pseudoproptosis Axial Non axial Pulsating Positional Intermittent
More informationCLINICAL ASSESSMENT OF PATIENTS WITH GRAVES ORBITOPATHY
44 MEDICINSKI GLASNIK / str. 44-48 Biljana Nedeljković-Beleslin 1 CLINICAL ASSESSMENT OF PATIENTS WITH GRAVES ORBITOPATHY Abstract: Clinical examination is the basis of a good assessment of a patient with
More informationA Case of Carotid-Cavernous Fistula
A Case of Carotid-Cavernous Fistula By : Mohamed Elkhawaga 2 nd Year Resident of Ophthalmology Alexandria University A 19 year old male patient came to our outpatient clinic, complaining of : -Severe conjunctival
More informationOrbital cellulitis. Archives of Emergency Medicine, 1992, 9,
Archives of Emergency Medicine, 1992, 9, 143-148 Orbital cellulitis D. P. MARTIN-HIRSCH, S. HABASHI, A. H. HINTON & B. KOTECHA University Department of ENT Surgery, Manchester Royal Infirmary, Manchester
More informationLearn Connect Succeed. JCAHPO Regional Meetings 2017
Learn Connect Succeed JCAHPO Regional Meetings 2017 Financial Disclosure Evaluation and Treatment of Orbital Cellulitis Thomas E. Johnson, M.D. Bascom Palmer Eye Institute University of Miami School of
More informationValidation of VISA classification for Thyroid Associated Orbitopathy
25 Original Article Validation of VISA classification for Thyroid Associated Orbitopathy Dr M. Subrahmanyam 1, Dr P. Modini 2, Dr K.J. Sivacharan 3, Dr B. Kavya 4 Abstract Aim : To Validate the VISA classification
More informationSix Things That Changed How I Manage Graves Disease
Six Things That Changed How I Manage Graves Disease Anthony DeWilde, OD FAAO Kansas City VAMC 6 Things 1. Thyroid status 2. Pathogenesis 3. Ocular signs/symptoms 4. Labs 5. Smoking 6. Mental Health Graves
More informationOrbital cellulitis. Archives of Emergency Medicine, 1992, 9,
Archives of Emergency Medicine, 1992, 9, 143-148 Orbital cellulitis D. P. MARTIN-HIRSCH, S. HABASHI, A. H. HINTON & B. KOTECHA University Department of ENT Surgery, Manchester Royal Infirmary, Manchester
More informationLower Eyelid Malposition
Oculoplastic Surgeon s DDX for the Red Eye Geeta Belsare Been,MD The Center for Facial Plastic Surgery Barrington, IL Lower Eyelid Malposition Ectropion Involutional Cicatricial Paralytic Entropion Involutional
More informationOcular Urgencies and Emergencies
Ocular Urgencies and Emergencies Pam Boyce, O.D., F.A.A.O. Boyce Family Eye Care, Ltd. 528 Devon Ave. Park Ridge, IL 60068 847-518-0303 Somebody s going to lose an eye Epidemiology 2.4 million ocular and
More informationGraves Ophthalmopathy Overview. Graves Disease Hyperthyroidism TSIgs (anti-tsh-receptor-abs) Graves Disease 10/22/2010
Graves Disease Robert Graves Graves Ophthalmopathy Overview Robert C. Kersten Dept. of Ophthalmology UCSF Triad Hyperthyroidism Eye findings Pretibial Myxedema (phalangeal acropachy-1%) Most common auto-immune
More informationUC SF. g h. Eye Trauma. Martha Neighbor, MD Emergency Services San Francisco General Hospital University of California
UC SF Eye Trauma sf g h Martha Neighbor, MD Emergency Services San Francisco General Hospital University of California Goals Recognize vision threatening eye emergencies Treat them when we can Know when
More informationOcular warning signs in GP practice: Paediatric Eye Pointers
Ocular warning signs in GP practice: Paediatric Eye Pointers Dr Benjamin Chang MB, BCh, BAO, MMedSci, FRCS(Irel), FRCS(Edin), FRCOphth(Lond) Senior Consultant Ophthalmology and Visual Sciences Khoo Teck
More informationAnatomy: There are 6 muscles that move your eye.
Thyroid Eye Disease Your doctor thinks you have thyroid orbitopathy. This is an autoimmune condition where your body's immune system is producing factors that stimulate enlargement of the muscles that
More informationOcular and periocular trauma
Ocular and periocular trauma No financial disclosures. Tina Rutar M.D. Assistant Professor of Clinical Ophthalmology and Pediatrics Director, Visual Center for the Child University of California San Francisco
More informationC. Douglas Phillips MD FACR Director of Head and Neck Imaging Weill Cornell Medical College/NewYork-Presbyterian Hospital
C. Douglas Phillips MD FACR Director of Head and Neck Imaging Weill Cornell Medical College/NewYork-Presbyterian Hospital Disclosures Neither I nor any family members have any pertinent financial relations
More informationPERIORBITAL SWELLING - COMPLICATION FROM ADJACENT STRUCTURES CASE REPORTS AND REVIEW OF LITERATURE
VOLUME 26, NO. 3 JUNE 1985 PERIORBITAL SWELLING - COMPLICATION FROM ADJACENT STRUCTURES CASE REPORTS AND REVIEW OF LITERATURE K Sukumaran S Chandran N Janakarajah P K Garg Department of Ophthalmology Faculty
More informationLids and Orbits A Patient s Perspective. Dr. Paul Cauchi Consultant Ophthalmologist Southern General and Gartnavel General Hospitals, Glasgow
Lids and Orbits A Patient s Perspective Dr. Paul Cauchi Consultant Ophthalmologist Southern General and Gartnavel General Hospitals, Glasgow Overview Pathophsiology. Symptoms. Signs. Management. Pathophysiology
More informationMRI masterfile Part 5 WM Heme Strokes.ppt 1
Ocular and Orbital Trauma Eye Trauma: Incidence 1.3 million eye injuries in the US per year. 40,000 of these injuries lead to blindness in the US. Patrick Sibony, MD March 23, 2013 Ophthalmic Emergencies
More informationCondition: Lid Swelling
Condition: Lid Swelling Description Eyelid swelling (oedema) is a non-specific feature of a number of ocular conditions, including orbital and pre-septal cellulitis, thyroid eye disease, ocular allergy,
More informationPaediatric acute ophthalmology. Harry Bradshaw
Paediatric acute ophthalmology Harry Bradshaw Approach Red eye Leukocoria Neurological Trauma Visual loss Red eye Orbital Eyelid Conjunctiva Cornea Uvea Orbital Orbit fixed volume Contiguous with sinuses,
More informationOcular and Periocular Trauma. Tina Rutar, MD. Assistant Professor of Ophthalmology and Pediatrics. Director, Visual Center for the Child
Ocular and Periocular Trauma Tina Rutar, MD Assistant Professor of Ophthalmology and Pediatrics Director, Visual Center for the Child University of California, San Francisco Phone: 415-353-2560 Fax: 415-353-2468
More information10 Congresso Nazionale Associazione Italiana della Tiroide Cagliari, dicembre 2016 Orbitopa)a basedowiana acuta
10 Congresso Nazionale Associazione Italiana della Tiroide Cagliari, 15-17 dicembre 2016 Orbitopa)a basedowiana acuta Luigi Bartalena Università dell Insubria a Varese Prevalence of Graves orbitopathy
More informationEUGOGO FOLLOW-UP assessment
EUGOGO FOLLOW-UP assessment Please complete non-italicized boxes except where indicated, plus relevant italicized ones. F1. Date follow-up (dd mm yyyy) Visit # Year of birth ( yyyy ) Randomization code
More information13/02/1440 بسم ا هلل ا لرحمن ا لر حيم
بسم ا هلل ا لرحمن ا لر حيم 1 Slowly progressive versus rapidly progressive proptosis by Ali M ISMAIL professor of ophthalmology @SOHAG U H Occuloplastic fellow @NNUH Occuloplastic fellow @Cambridge UH
More informationManagement of Children with Preseptal and Orbital Cellulitis
Management of Children with Preseptal and Orbital Cellulitis Trust Ref: B24/2017 1. Introduction Periorbital infections are infections involving the soft tissues surrounding the globe of the eye. Chandler
More informationAssessment and Management of Ocular Trauma. Disclosure I have no direct financial interests in today s subject matter. 3/25/2019. Normal Eye Anatomy
Assessment and Management of Ocular Trauma Samiksha Fouzdar Jain, MD,FRCS Department of Ophthalmology & Visual Sciences Truhlsen Eye Institute Disclosure I have no direct financial interests in today s
More informationEUGOGO INITIAL ASSESSMENT
EUGOGO INITIAL ASSESSMENT Please complete non-italicised boxes except where indicated, plus relevant italicised ones. 1. Date of inclusion Year of birth Sex male female dd mm yyyy Race Caucasian Black
More informationSUMMARY OF RANDOMIZED CONTROLLED TRIALS COMPARING DIFFERENT ORBITAL RADIOTHERAPY REGIMENTS AND ORBITAL RADIOTHERAPY TO PLACEBO OR CORTICOSTEROIDS
TABLE e4. SUMMARY OF RANDOMIZED CONTROLLED TRIALS COMPARING DIFFERENT ORBITAL RADIOTHERAPY REGIMENTS AND ORBITAL RADIOTHERAPY TO PLACEBO OR CORTICOSTEROIDS Study Treatment Groups Primary Outcome Measure
More informationCase Report Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral
Case Reports in Emergency Medicine Volume 2013, Article ID 376564, 4 pages http://dx.doi.org/10.1155/2013/376564 Case Report Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment
More informationRisk Factors Associated with the Severity of Thyroid-Associated Orbitopathy in Korean Patients
pissn: 1011-8942 eissn: 2092-9382 Korean J Ophthalmol 2010;24(5):267-273 DOI: 10.3341/kjo.2010.24.5.267 Risk Factors Associated with the Severity of Thyroid-Associated Orbitopathy in Korean Patients Original
More informationGraves Ophthalmopathy Advances in Diagnosis and Treatment CONSTANCE L. FRY, MD ASSOCIATE PROFESSOR OF OPHTHALMOLOGY UT HEALTH SAN ANTONIO
Graves Ophthalmopathy Advances in Diagnosis and Treatment CONSTANCE L. FRY, MD ASSOCIATE PROFESSOR OF OPHTHALMOLOGY UT HEALTH SAN ANTONIO Ophthalmic Manifestations GO is the #1 cause of unilateral and
More informationOcular Emergencies. What is an emergency to the patient is not necessarily an emergency to the staff
OCULAR EMERGENCIES Ophthalmic Photographers Society November 15, 2013 Michael A. DellaVecchia MD PhD FACS Wills Eye Emergency Department Philadelphia PA Ocular Emergencies What is an emergency to the patient
More informationClinical ophthalmology: a systematic approach. Jack Kanski Chapters 1, 2 and 17. Between lesser and greater wings of sphenoid.
1 Orbital Disease Dr Sarah Osborne Learning objectives Knowledge of the anatomy of the normal nasolacrimal system Understand the causes of epiphora Identify common skin tumours Recognise the signs of thyroid
More informationAcute Eyes for ED. Enis Kocak. The Alfred Ophthalmology
Acute Eyes for ED Enis Kocak The Alfred Ophthalmology The problem with eyes Things to cover Ocular anatomy Basic assessment Common presentations Eye first aid and procedures Ophthalmic emergencies What
More informationEYE INJURIES OBJECTIVES COMMON EYE EMERGENCIES 7/19/2017 IMPROVE ASSESSMENT OF EYE INJURIES
EYE INJURIES BRITTA ANDERSON D.O. DMC PRIMARY CARE SPORTS MEDICINE ASSOCIATE TEAM PHYSICIAN DETROIT TIGERS OBJECTIVES IMPROVE ASSESSMENT OF EYE INJURIES UNDERSTAND WHAT IS CONSIDERED AN EMERGENCY DEVELOP
More informationDiagnostic Imaging in Patients with Orbital Cellulitis and Inflammatory Pseudotumor. Fumiyuki Uehara, M.D. Norio Ohba, M.D.
Diagnostic Imaging in Patients with Orbital Cellulitis and Inflammatory Pseudotumor Fumiyuki Uehara, M.D. Norio Ohba, M.D. We have had the opportunity, at an eye clinic, to examine and treat a patient
More informationMRI masterfile Part 5 WM Heme Strokes.ppt 2
Imaging of Orbital Trauma Corneal Abrasion CT scan is preferable to MRI Bone, Rapid, Easy to monitor patient Foreign bodies, air, hemorrhage Fractures Cost Needed for an MRI MRI Globe and intraocular injuries
More informationSepideh Tara Rousta, MD FAAO Robert Wood Johnson University Hospital Saint Peter s University Hospital Wills Eye Hospital
Sepideh Tara Rousta, MD FAAO Robert Wood Johnson University Hospital Saint Peter s University Hospital Wills Eye Hospital 14 mo old w R eye cross (parents) 9 mo old R eye crossing getting worse for past
More informationOrbita. Ivan Haefliger, MD, FEBO. Holbeins-PraxisKlinik Basel & School of Medicine, University of Basel, Basel
Orbita Ivan Haefliger, MD, FEBO Holbeins-PraxisKlinik Basel & School of Medicine, University of Basel, Basel Anatomy Anatomy Orbita is a pear-shaped cavity, the stalk of this pear is the optic canal Within
More informationOcular Lecture. Sue Bednar NP Ali Atwater PA-C
Ocular Lecture Sue Bednar NP Ali Atwater PA-C Triaging Ocular Complaints Painful Eye/Red eye +/-blurry vision +/-visual loss +/-floaters +/-fevers If any of the above findings exist, pt is likely to have
More informationOphthalmology. Corneal Abrasion. History
Ophthalmology Corneal Abrasion - Usually clear history of very recent trauma - Foreign Body Sensation - Pain +++ - Lacrimation - Photophobia Fig. 1 Corneal Abrasion - Abrasion stains yellow / green with
More informationNASOLACRIMAL DUCT OBSTRUCTION (BLOCKED TEAR DUCT) AND TEARY EYE - PATIENT INFORMATION
NASOLACRIMAL DUCT OBSTRUCTION (BLOCKED TEAR DUCT) AND TEARY EYE - PATIENT INFORMATION What is lacrimal sac and nasolacrimal duct? The lacrimal apparatus is composed of a lacrimal gland (tear producing
More informationGrave s orbitopathy an approach to clinical evaluation and management
Grave s orbitopathy an approach to clinical evaluation and management T W N Karunasena 1, M W S Niranjala 2 Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2012; 2: 106-110 Abstract Grave s
More informationResults of Transmedial-Canthal Ethmoidal Decompression for Severe Dysthyroid Optic Neuropathy
Results of Transmedial-Canthal Ethmoidal Decompression for Severe Dysthyroid Optic Neuropathy Kenji Ohtsuka and Yasushi Nakamura Department of Ophthalmology, Sapporo Medical University School of Medicine,
More informationClues of a Ruptured Globe
Definition any eye that has sustained a full thickness traumatic disruption of the cornea or sclera Overwhelmingly, rupture accidents occur in young men, small children and the elderly Corneal laceration
More informationEYE TRAUMA: INCIDENCE
Introduction EYE TRAUMA: INCIDENCE 2.5 million eye injuries per year in U.S. 40,000 60,000 of eye injuries lead to visual loss Introduction Final visual outcome of many ocular emergencies depends on prompt,
More informationEndoscopic transnasal orbital decompression for thyrotoxic orbitopathy
Key words: Endoscopes; Exophthalmos; Keratitis; Orbital diseases; Thyrotoxicosis "# " APW Yuen KYW Kwan E Chan AWC Kung KSL Lam Hong Kong Med J 2002;8:406-10 Queen Mary Hospital, 102 Pokfulam Road, Hong
More informationSurgery for Exophthalmos
Surgery for Exophthalmos Frederick S. Rosen, MD, Faculty Advisor: Matthew W. Ryan, MD The University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation April 7, 2004 1 Introduction
More informationWhat was going on. Thyroid Related Orbitopathy. Pathophysiology. Definition GALLO EYE AND FACIAL PLASTIC SURGERY 3/16/2017
GALLO EYE AND FACIAL PLASTIC SURGERY What was going on A. She found out the increase to her Premium and Deductible for employee health care next year B. She is getting an over agressive Physical Exam by
More informationCT of Maxillofacial Fracture Patterns. CT of Maxillofacial Fracture Patterns
CT of Maxillofacial Fracture Patterns CT of Maxillofacial Fracture Patterns Stuart E. Mirvis, M.D., FACR Department of Radiology University of Maryland School of Medicine Viking 1 1976 MGS 2001 Technology
More informationLower Eyelid Blepharoplasty. Mid-Year Seminar AOCOO-HNS Foundation September 21 st, 2013
Lower Eyelid Blepharoplasty Mid-Year Seminar AOCOO-HNS Foundation September 21 st, 2013 The beauty of a woman must be seen from in her eyes, because that is the doorway to her heart, the place where love
More informationSILA THONGLAI MD. Bangkok Eye center Bangkok Hospital Thailand
SILA THONGLAI MD. Bangkok Eye center Bangkok Hospital Thailand Ocular Anatomy Bony Components of Orbit 1 1. Frontal bone 4 5 7 6 2. Zygomatic bone 3. Maxillary bone 4. Sphenoid bone 5. Ethmoid bone 2 3
More informationImaging Orbit/Periorbital Injury
Imaging Orbit/Periorbital Injury 9 th Nordic Trauma Radiology Course 2016 Stuart E. Mirvis, M.D., FACR Department of Radiology University of Maryland School of Medicine Fireworks Topics to Cover Struts
More informationCarotid Cavernous Fistula
Chief Complaint: Double vision. Carotid Cavernous Fistula Alex W. Cohen, MD, PhD; Richard Allen, MD, PhD May 14, 2010 History of Present Illness: A 46 year old female patient presented to the Oculoplastics
More informationPRESEPTAL AND ORBITAL CELLULITIS IN CHILDREN- CLINICAL GUIDELINE V3.0
PRESEPTAL AND ORBITAL CELLULITIS IN CHILDREN- CLINICAL GUIDELINE V3.0 Page 1 of 8 1. Aim/Purpose of this Guideline 1.1. This guideline applies to medical and nursing staff caring for a child with Preseptal
More informationOcular Emergencies. Pisit Preechawat, MD Department of Ophthalmology, Ramathibodi Hospital
Ocular Emergencies Pisit Preechawat, MD Department of Ophthalmology, Ramathibodi Hospital Ocular Anatomy Bony Components of Orbit 1 1. Frontal bone 4 5 7 6 2. Zygomatic bone 3. Maxillary bone 4. Sphenoid
More informationEye Trauma. Lid Laceration. Orbital Fracture
Eye Trauma Lid Laceration The presence of a lid laceration, however insignificant, mandates careful exploration of the wound and examination of the globe. 1. Superficial lacerations parallel to the lid
More informationCryptogenic Enlargement Of Bilateral Superior Ophthalmic Veins
ISPUB.COM The Internet Journal of Radiology Volume 18 Number 1 Cryptogenic Enlargement Of Bilateral Superior Ophthalmic Veins K Kragha Citation K Kragha. Cryptogenic Enlargement Of Bilateral Superior Ophthalmic
More informationOrbital Cellulitis: A Rare Complication after Orbital Blowout Fracture
Orbital Cellulitis: A Rare Complication after Orbital Blowout Fracture Guy J. Ben Simon, MD, 1 Steven Bush, MBBS, 1 Dinesh Selva, FRANZCO, 2 Alan A. McNab, FRANZCO 1 Purpose: To report the incidence of
More informationTHYROID EYE DISEASE ORBITAL DECOMPRESSION SURGERY
THYROID EYE DISEASE ORBITAL DECOMPRESSION SURGERY What is thyroid eye disease (TED)? TED is an autoimmune condition where the body s own immune system attacks the tissues of the thyroid gland and the eye
More informationMaxillofacial and Ocular Injuries
Maxillofacial and Ocular Injuries Objectives At the conclusion of this presentation the participant will be able to: Identify the key anatomical structures of the face and eye and the impact of force on
More informationTHE PROTECTIVE SYSTEM OF THE EYE
THE PROTECTIVE SYSTEM OF THE EYE Introduction The eye is offered the same type of protection as the brain being enclosed in a cavity in the skull called the bony orbit (figs1, 2). Fig 1: the bony orbit.
More informationPAINFUL PAINLESS Contact lens user BOV
Common Causes Allergies Infections Ocular Cornea, uveitis, endophthalmitis Orbital Orbital cellulitis Inflammation Uveitis Scleritis / episcleritis Glaucomas Trauma Foreign bodies Chemical injuries History
More informationPEDIATRIC OCULAR INJURIES. Sapna Tibrewal MD
PEDIATRIC OCULAR INJURIES Sapna Tibrewal MD 1 Learning Objectives Learn to recognize the common pediatric ocular injuries Immediate management tips to be instituted in your office/ ER Know when to call
More informationDISCLOSURES. PEDIATRIC RED EYES Rachel M. Smith, OD, FCOVD HISTORY, HISTORY, HISTORY WHY RED EYES? EXAMINE THE EYE RED FLAGS TO REFER 3/25/2019
DISCLOSURES Consultant/Speakers bureaus Research funding PEDIATRIC RED EYES Rachel M. Smith, OD, FCOVD Pediatric Optometrist Children s Hospital & Medical Center Stock ownership/corporate boards employment
More informationCase Presentation: Indications for orbital decompression in TED: Modern surgical techniques for orbital decompression in TED: Inferomedial
Case Presentation: Jonathan W. Kim, MD Director, Oculoplastic Surgery Stanford Medical Center 61 year old man with active Graves orbitopathy Visual acuity 20/30 OD 20/50 OS Left RAPD Bilateral optic disc
More informationAssessment of Quality of Life and Depression in Korean Patients with Graves Ophthalmopathy
pissn: 1011-8942 eissn: 2092-9382 Korean J Ophthalmol 2010;24(2):65-72 DOI: 10.3341/kjo.2010.24.2.65 Assessment of Quality of Life and Depression in Korean Patients with Graves Ophthalmopathy Original
More informationPatient information leaflet Thyroid Eye Disease
Patient information leaflet Thyroid Eye Disease What is Thyroid eye Disease? Thyroid Eye Disease (TED) is also known as Graves orbitopathy (GO), thyroid ophthalmopathy and thyroid-associated ophthalmopathy.
More informationAcute Ophthalmology for A&E Practice
Acute Ophthalmology for A&E Practice Dr. LEUNG Yu-lung, Dexter MBChB, BMedSci(Hons),FRCS (Glas),MRCS(Edin), DRCOphth(London),FCOphthHK, FHKAM(Ophth) Associate Consultant Clinical Assistant Professor (Honorary)
More informationSinusitis & its complication. MOHAMMED ALESSA MBBS,FRCSC Assistant Professor,Consultant Otolaryngology, Head & Neck Surgery King Saud University
Sinusitis & its complication MOHAMMED ALESSA MBBS,FRCSC Assistant Professor,Consultant Otolaryngology, Head & Neck Surgery King Saud University Definition Types Clinical manifestation Complications Diagnosis
More informationOphthalmic complications after surgery for nasal and sinus polyposis
European Journal of Ophthalmology / Vol. 11 no. 3, 2001 / pp. 218-222 Ophthalmic complications after surgery for nasal and sinus polyposis P. VASSALLO, F. TRANFA, R. FORTE, A. D APONTE, D. STRIANESE, G.
More informationISPUB.COM. An Orbital Cellulitis Demanding Multispeciality Management. N Ezhilvathani, Thiagarajan, T Cherian INTRODUCTION CASE REPORT
ISPUB.COM The Internet Journal of Ophthalmology and Visual Science Volume 8 Number 1 An Orbital Cellulitis Demanding Multispeciality Management N Ezhilvathani, Thiagarajan, T Cherian Citation N Ezhilvathani,
More informationSerum Interleukin Profile in Patients with Graves Orbithopathy
Acta Medica Marisiensis 2013;59(1):31-35 DOI: 10.2478/amma-2013-0007 RESEARCH ARTICLE Serum Interleukin Profile in Patients with Graves Orbithopathy Réti Zsuzsánna, Kun IZ, Radu Pop Corina Cristina University
More informationation is essential. Whether on the playing it is important to keep in mind that severe
JENNIFER LAIO, MD, and BRUCE M. ZAGELBAUM, MD NYU School of Medicine, Manhasset, NY North Shore University Hospital, Eye injuries sustained in sports and recreational activities are common in the United
More informationUniversity of Florida ORBIT
University of Florida ORBIT Dog Airedale Bulldog Great Dane Cat Horse bones EOM in fascial slings Periorbita: orbital septum to tarsal plate Periosteum of optic canal to optic nerve dura Tenon s capsule
More informationwith laser resurfacing, 36, 37 Cryotherapy, lower eyelid cicatricial ectropion after, 151 Cutler-Beard flap. See Fullthickness
INDEX A Abrasion, from silicone tubing, 230 Acquired immunodeficiency syndrome, eyelid tumor with, 193 AIDS. See Acquired immunodeficiency syndrome Anatomy, eyelid, 155 156 Aneurysm, cerebral, Muller s
More informationPrevalence and Severity of Ophthalmic Manifestations of Graves Disease in Mashhad. University Endocrine Clinics
Prevalence and Severity of Ophthalmic Manifestations of Graves Disease in Mashhad University Endocrine Clinics Mohammad Etezad-Razavi, MD, 1 Robabeh-Beygom Aboutorabi, MD 2 Siamak Zarei-Ghanavati, MD,
More informationThyroid eye disease: a review
CLINICAL AND EXPERIMENTAL REVIEW Thyroid eye disease: a review Clin Exp Optom 2017; 100: 20 25 Danielle L Weiler* OD FAAO *Optometry Section, Southern Arizona Veterans Affairs Health Care System, Tucson,
More informationOcular Trauma. Breaking Down Blunt. Blunt ocular trauma occurs frequently in sporting
Focus on CME at the University of Saskatchewan Breaking Down Blunt Ocular Trauma By Dan Ash, MD, BA, FRCSC, FACS, FAAO Blunt ocular trauma occurs frequently in sporting activities, as well as in industrial
More informationThis slide kit covers more complex thyroid eye disease.
An imbalance in the normal level of thyroid hormone in the body can cause thyroid eye disease. If you wish to explore information on the basics of thyroid eye diseases, please first see: https://www.excemed.org/manage-thyroid-online/resources/thyroid-eyedisease
More informationThyroid orbitopathy. Thyroid orbitopathy (TO) is an organ. CLINICAL PRACTICE: Therapeutic review
CLINICAL PRACTICE: Therapeutic review Thyroid orbitopathy Shirley Fung, MBBS, is a research resident, Oculoplastic and Orbital Unit, Department of Ophthalmology, Royal Adelaide Hospital, University of
More informationOPHTHALMIC ASSESSMENT. Nehal MANDOUR Associate Specialist Urgent Care Lead Clinician REI - PLYMOUTH
OPHTHALMIC ASSESSMENT Nehal MANDOUR Associate Specialist Urgent Care Lead Clinician REI - PLYMOUTH Patients presenting with an eye complaint may strike fear in some practitioner's hearts as they recall
More informationColour Doppler Imaging of Superior Ophthalmic Vein in Thyroid-Associated Eye Disease
Colour Doppler Imaging of Superior Ophthalmic Vein in Thyroid-Associated Eye Disease Deniz Somer*, Seyhan Bahar Özkan*, Hakan Özdemir, Serhan Atilla, Meltem Fatma Söylev* and Sunay Duman* *Department of
More informationORIGINAL ARTICLE. Group Chandler Maloney. First Inflammatory oedema Preseptal cellulitis. Second Orbital Cellulitis Subperiosteal abscess
ORBITAL MANIFESTATIONS OF SINUS DISEASE T. Jyothirmayi 1, V. Meenakshi 2, M. Deepika 3 HOW TO CITE THIS ARTICLE: T. Jyothirmayi, V. Meenakshi, M. Deepika. Orbital Manifestations of Sinus Disease. Journal
More informationClinical Study Methotrexate for the Treatment of Thyroid Eye Disease
Ophthalmology, Article ID 128903, 5 pages http://dx.doi.org/10.1155/2014/128903 Clinical Study Methotrexate for the Treatment of Thyroid Eye Disease Diego Strianese, 1 Adriana Iuliano, 1 Mariantonia Ferrara,
More informationPathophysiology. Surgery for Exophthalmos April 2000
TITLE: Surgery for Exophthalmos SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology DATE: April 2000 RESIDENT PHYSICIAN: Stephanie Cordes, MD FACULTY ADVISOR: Karen Calhoun, MD SERIES EDITOR:
More informationTraumatic eye injuries ranging from
CASE REPORT A Rare Case of Traumatic Tension Pneumo-orbitum Johnathan M. Sheele, MD, MPH; Joseph Lang, MD A 76-year-old woman presented with pain, swelling, and loss of vision in the right eye following
More informationOphthalmoplegia in carotid cavernous sinus fistula
British Journal of Ophthalmology, 1984, 68, 128-134 Ophthalmoplegia in carotid cavernous sinus fistula T. J. K. LEONARD, I. F. MOSELEY, AND M. D. SANDERS From the Departments ofneuro-ophthalmology and
More informationThyroid Associated Orbitopathy (TAO): Effects of Medical And Surgical Treatments
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 7 Ver. I (July. 2017), PP 33-38 www.iosrjournals.org Thyroid Associated Orbitopathy (TAO):
More informationAFFECTIONS OF ORBIT IN ANIMALS
AFFECTIONS OF ORBIT IN ANIMALS Anatomical considerations: The orbit is cone-shaped bony cavity and is incomplete laterally. Formed by six bones: frontal, lacrimal, sphenoid, palatine, zygomatic and maxillary.
More informationTHE STIR SEQUENCE MRI IN THE ASSESSMENT OF EXTRAOCULAR MUSCLES IN THYROID EYE DISEASE
THE STR SEQUENCE MR N THE ASSESSMENT OF EXTRAOCULAR MUSCLES N THYROD EYE DSEASE H. B. HOH! R. D. LATT 2 C. WAKELEy2 J. KABALA2 P. GODDARD 2 M. J. POTTS! and R. A. HARRAD! Bristol SUMMARY Nineteen patients
More informationAn Overview of Thyroid Eye Disease (TED), Teprotumumab and OPTIC Phase 3 Trial Topline Results
An Overview of Thyroid Eye Disease (TED), Teprotumumab and OPTIC Phase 3 Trial Topline Results February 28, 2019 Teprotumumab: fully human monoclonal antibody inhibitor of IGF-1R Forward-Looking Statements
More informationPrevalence of Graves ophthalmopathy in patients with Graves disease presenting to a referral centre in north India
Indian J Med Res 139, January 2014, pp 99-104 Prevalence of Graves ophthalmopathy in patients with Graves disease presenting to a referral centre in north India Sagili Vijaya Bhaskar Reddy, Anu Jain *,
More informationDr Casey Ung. Ophthalmologist Dunedin Hospital Eye Clinic Marinoto Clinic & Specialists Dunedin
Dr Casey Ung Ophthalmologist Dunedin Hospital Eye Clinic Marinoto Clinic & Specialists Dunedin 8:30-9:25 WS #140: Paediatric Ophthalmology 9:35-10:30 WS #150: Paediatric Ophthalmology (Repeated) Paediatric
More information