The orbit is a pyramidal space located between the anterior cranial fossa and the maxillary sinuses. It is formed by seven bones and contains the eyeball as well as nerves, blood vessels and extraocular muscles. Proptosis refers to forward displacement of the eyeball. It can be caused by infections, inflammation, vascular abnormalities, tumors or trauma based on characteristics like age of onset and laterality. Evaluation involves inspection of periorbital region and eye examination along with imaging studies and biopsy as needed to identify the cause which guides treatment.
This document discusses diseases of the orbit, including its anatomy and contents. It describes several common orbital conditions:
- Orbital cellulitis is an acute infection behind the orbital septum that can lead to abscesses or complications like cavernous sinus thrombosis if not treated promptly with antibiotics.
- Cavernous sinus thrombosis is a serious infection of the veins around the eye that can cause vision loss and nerve palsies if the infection spreads. It requires intensive IV antibiotics.
- Thyroid eye disease is an autoimmune condition associated with Graves' disease where the muscles and fat behind the eye become inflamed, causing proptosis, eye movement issues, and eyelid changes. It is classified based
- Proptosis refers to forward displacement of the eyeball beyond the orbital rim, usually due to an increased mass or volume within the orbit. Common causes include tumors, inflammation, trauma, thyroid eye disease, and vascular lesions.
- Examination involves measuring exophthalmometry, inspecting for signs of mass effect, pulsation or displacement of the globe, and evaluating for neurologic deficits. Imaging with CT or MRI is important to characterize the lesion causing proptosis.
A complete unit of the various diseases involving the orbit and the surrounding structures. It involves the unilateral and bilateral proptosis conditions. Also, the various proptosis etiologies involved in adults and children along with various tumors involving the orbit is also dealt with.
1. A 38-year-old man presented with unilateral right eye proptosis and downward displacement following frontal sinus surgery. He was diagnosed with invasive aspergillosis secondary to the surgery.
2. Clinical evaluation of proptosis involves assessing signs such as eyelid position, eye movement, visual acuity and pupillary reaction. Imaging with CT or MRI is useful to identify the cause, which can include tumors, infections, fractures or vascular lesions.
3. The most common childhood orbital tumor causing proptosis is neuroblastoma, which commonly metastasizes to the orbit. Evaluation and diagnosis involves a full history, examination of proptosis characteristics and signs, and imaging tests.
1. A 38-year-old man presented with unilateral right eye proptosis and downward displacement following frontal sinus surgery. He was diagnosed with invasive aspergillosis secondary to the surgery.
2. Clinical evaluation of proptosis involves assessing signs like lid swelling, ptosis, eye movement limitations, visual acuity changes, and optic nerve involvement through tests like visual field and fundoscopy. Imaging with CT or MRI is useful to identify the cause.
3. Common causes of proptosis include thyroid eye disease, orbital tumors, trauma like blowout fractures, and infectious etiologies like orbital cellulitis secondary to sinusitis. Evaluation and diagnosis involves a thorough history, exam and appropriate imaging.
anatomy of orbital spaces, tumours and its importanceShashank Agarwal
1. The document summarizes the anatomy of the orbital spaces and their clinical importance. It describes the four main anatomical spaces in the orbit - subperiosteal, peripheral orbital, central, and sub-Tenon's space.
2. The spaces are important because benign tumors typically remain within their space of origin, while large, malignant, or infiltrative tumors can spread beyond their original space. Understanding the orbital anatomy helps determine the surgical approach for orbitotomy or local anesthesia techniques.
3. Common pathologies are described for each space, such as dermoid cysts in the subperiosteal space and cavernous hemangiomas in the central space. Imaging features and clinical presentations of select conditions are
1) Cavernous sinus thrombosis is a blood clot that forms within the cavernous sinus, which is a venous channel within the skull.
2) It can be aseptic (caused by trauma, tumors, or hypercoagulable states) or septic (caused by bacterial infection spreading from nearby areas like the face, sinuses, or ears).
3) The most common symptoms are headaches, signs of sepsis, and ocular issues like proptosis, ophthalmoplegia, ptosis, and blurred vision. Complications can include orbital abscesses, meningitis, or extensions of the clot or infection.
This document discusses the anatomy and functions of the 12 pairs of cranial nerves. It provides details on each nerve including their origin, course, functions for sensory, motor and autonomic fibers. It discusses various cranial nerve palsies and related clinical signs that help localize lesions in the brainstem or surrounding structures. Specific syndromes and diseases that can cause cranial nerve involvement are also outlined. Visual field defects, nystagmus, Horner's syndrome and bulbar signs are explained in relation to underlying anatomical locations.
This document discusses diseases of the orbit, including its anatomy and contents. It describes several common orbital conditions:
- Orbital cellulitis is an acute infection behind the orbital septum that can lead to abscesses or complications like cavernous sinus thrombosis if not treated promptly with antibiotics.
- Cavernous sinus thrombosis is a serious infection of the veins around the eye that can cause vision loss and nerve palsies if the infection spreads. It requires intensive IV antibiotics.
- Thyroid eye disease is an autoimmune condition associated with Graves' disease where the muscles and fat behind the eye become inflamed, causing proptosis, eye movement issues, and eyelid changes. It is classified based
- Proptosis refers to forward displacement of the eyeball beyond the orbital rim, usually due to an increased mass or volume within the orbit. Common causes include tumors, inflammation, trauma, thyroid eye disease, and vascular lesions.
- Examination involves measuring exophthalmometry, inspecting for signs of mass effect, pulsation or displacement of the globe, and evaluating for neurologic deficits. Imaging with CT or MRI is important to characterize the lesion causing proptosis.
A complete unit of the various diseases involving the orbit and the surrounding structures. It involves the unilateral and bilateral proptosis conditions. Also, the various proptosis etiologies involved in adults and children along with various tumors involving the orbit is also dealt with.
1. A 38-year-old man presented with unilateral right eye proptosis and downward displacement following frontal sinus surgery. He was diagnosed with invasive aspergillosis secondary to the surgery.
2. Clinical evaluation of proptosis involves assessing signs such as eyelid position, eye movement, visual acuity and pupillary reaction. Imaging with CT or MRI is useful to identify the cause, which can include tumors, infections, fractures or vascular lesions.
3. The most common childhood orbital tumor causing proptosis is neuroblastoma, which commonly metastasizes to the orbit. Evaluation and diagnosis involves a full history, examination of proptosis characteristics and signs, and imaging tests.
1. A 38-year-old man presented with unilateral right eye proptosis and downward displacement following frontal sinus surgery. He was diagnosed with invasive aspergillosis secondary to the surgery.
2. Clinical evaluation of proptosis involves assessing signs like lid swelling, ptosis, eye movement limitations, visual acuity changes, and optic nerve involvement through tests like visual field and fundoscopy. Imaging with CT or MRI is useful to identify the cause.
3. Common causes of proptosis include thyroid eye disease, orbital tumors, trauma like blowout fractures, and infectious etiologies like orbital cellulitis secondary to sinusitis. Evaluation and diagnosis involves a thorough history, exam and appropriate imaging.
anatomy of orbital spaces, tumours and its importanceShashank Agarwal
1. The document summarizes the anatomy of the orbital spaces and their clinical importance. It describes the four main anatomical spaces in the orbit - subperiosteal, peripheral orbital, central, and sub-Tenon's space.
2. The spaces are important because benign tumors typically remain within their space of origin, while large, malignant, or infiltrative tumors can spread beyond their original space. Understanding the orbital anatomy helps determine the surgical approach for orbitotomy or local anesthesia techniques.
3. Common pathologies are described for each space, such as dermoid cysts in the subperiosteal space and cavernous hemangiomas in the central space. Imaging features and clinical presentations of select conditions are
1) Cavernous sinus thrombosis is a blood clot that forms within the cavernous sinus, which is a venous channel within the skull.
2) It can be aseptic (caused by trauma, tumors, or hypercoagulable states) or septic (caused by bacterial infection spreading from nearby areas like the face, sinuses, or ears).
3) The most common symptoms are headaches, signs of sepsis, and ocular issues like proptosis, ophthalmoplegia, ptosis, and blurred vision. Complications can include orbital abscesses, meningitis, or extensions of the clot or infection.
This document discusses the anatomy and functions of the 12 pairs of cranial nerves. It provides details on each nerve including their origin, course, functions for sensory, motor and autonomic fibers. It discusses various cranial nerve palsies and related clinical signs that help localize lesions in the brainstem or surrounding structures. Specific syndromes and diseases that can cause cranial nerve involvement are also outlined. Visual field defects, nystagmus, Horner's syndrome and bulbar signs are explained in relation to underlying anatomical locations.
The document provides an overview of orbital anatomy and diseases. It describes the bones that make up the walls of the orbit, as well as the contents of the orbit such as the eyeball, muscles, nerves and blood vessels. Common orbital diseases are discussed including thyroid eye disease, infections, tumors and cysts, and trauma. Clinical evaluation involves assessing features like proptosis, extraocular motility, and imaging studies. Specific conditions like dermoid cysts, hemangiomas and fractures are also outlined.
This document provides information on various tumors that can affect nerves and muscles in the oral cavity. It summarizes different types of benign and malignant nerve tumors, including traumatic neuromas, palisaded encapsulated neuromas, neurofibromas, neurilemmomas (schwannomas), malignant peripheral nerve sheath tumors, and others. For each tumor type, it describes clinical features, histologic characteristics, associated syndromes, treatment approaches, and other relevant details.
This document provides an overview of orbital anatomy and diseases. It describes the major anatomic components of the orbit including the globe, optic nerve, extraconal and intraconal areas. Common pathologies are discussed for each anatomic structure, such as retinoblastoma affecting the globe and optic neuritis involving the optic nerve. Imaging techniques for evaluating the orbit including MRI and CT are also reviewed. Key anatomical structures like the superior orbital fissure and its contents are defined.
Vestibular schwannoma, also known as acoustic neuroma, is a benign tumor of the vestibular nerve sheath cells. It accounts for 6% of all intracranial tumors and 80-90% of cerebellopontine angle tumors. The tumor grows medially from the Schwann cells of the vestibular nerve and presents in stages ranging from isolated otological symptoms to brainstem compression. Diagnosis involves radiological investigations like CT, MRI and MRA. Treatment options include observation, surgery, and stereotactic radiosurgery depending on tumor size and patient factors.
This document summarizes various neuro-ophthalmic manifestations of cerebrovascular diseases. It discusses atherosclerosis, strokes, raised intracranial pressure, cerebral aneurysms, cerebral venous thrombosis, migraines, embolisms, cervical arterial dissections, and effects on the internal carotid and vertebrobasilar arterial systems. Key signs involve visual field defects, transient vision loss, optic disc edema, retinal artery occlusions, and cranial nerve palsies. Imaging such as MRI and MRA are important for diagnosis and treatment involves managing risk factors, anticoagulation, and surgical intervention in some cases.
The document discusses the anatomy and development of the orbit and its contents. It provides details on:
1) The bones that form the walls of the orbit - the frontal, ethmoid, maxillary, lacrimal, zygomatic, sphenoid and palatine bones.
2) The contents of the orbit which include the eyeball, extraocular muscles, nerves, vessels, lacrimal gland and orbital fat.
3) The development of the orbit which begins as a ring around the eyeball derived from cranial neural crest cells and expands during the third month to form the orbital walls.
This document provides an overview of skull pathologies that can be detected on plain skull radiographs. It begins by listing the major indications for skull radiographs, such as dysplasias, trauma, infections, and tumors. It then describes the approach to interpreting skull X-rays, categorizing abnormalities into density changes, contour abnormalities, intracranial volume changes, calcifications, bone thickness changes, lucent defects, sclerotic areas, and more. Specific pathologies are then discussed in-depth within each category. In summary, the document serves as a guide for radiologists to recognize and understand various skull abnormalities visible on plain radiographs.
Tumors of middle and inner ear dr.sithanandha kumar 14.03.2016ophthalmgmcri
This document discusses tumors of the cerebellopontine angle and middle ear. It begins by defining the cerebellopontine angle and its boundaries. The most common tumors of this area are then described, including acoustic neuromas, meningiomas, and schwannomas. Symptoms, investigations, and management are outlined for these lesions. The document also discusses glomus tumors, the most common middle ear neoplasm, describing its pathology, spread, clinical features, and treatment.
This document discusses proptosis (forward displacement of the eyeball), its causes, signs, symptoms, and evaluation. Proptosis can be unilateral or bilateral, acute or intermittent. It may be caused by congenital defects, trauma, infections, vascular lesions, cysts, tumors, or endocrine disorders like Graves' disease. Evaluation involves inspection, palpation, tests of eye movement and vision, exophthalmometry to measure protrusion, and diagnostic imaging or biopsy when indicated based on suspected etiology.
The orbital cavity contains the eyeball and associated structures. It is formed by 7 bones and has dimensions of approximately 50mm deep, 40mm wide, and 35mm high. There are several openings including the superior and inferior orbital fissures, optic canal, and ethmoidal foramina. The walls are lined with periosteum and consist of a roof, floor, medial and lateral walls. Knowledge of the orbital anatomy is important for understanding orbital pathology and surgical planning.
The document discusses spinal tuberculosis, noting that it causes delays in diagnosis, long recovery periods, and high costs. Key points include:
- Paralysis occurs in up to 50% of spinal tuberculosis patients.
- Early diagnosis, expedient treatment, aggressive surgery, and preventing deformity lead to the best outcomes.
- Diagnosis relies on tests like tuberculin skin tests, imaging like MRI to identify bone destruction and abscesses, and microscopy and culture of samples.
- Patterns of bone involvement include paradiscal, central, anterior, and appendiceal lesions.
- Complications include paralysis, cold abscesses, deformities, and secondary infections.
The document discusses various orbital diseases including orbital cellulitis, thrombosis of the cavernous sinus, proptosis, pseudo proptosis, and enophthalmos. It describes the anatomy of the orbit, signs and symptoms of orbital cellulitis and thrombosis of the cavernous sinus, classifications and treatments of proptosis, and causes and treatments of endocrine exophthalmos and enophthalmos. Potential complications of orbital diseases are also outlined.
The document provides an overview of the anatomy of the eye and orbit. It describes the seven bones that make up the bony orbit, including the frontal, zygomatic, maxillary, ethmoidal, sphenoid, lacrimal and palatine bones. It details the structures forming each wall of the orbit, such as the medial orbital wall formed by the frontal process of maxillary, lacrimal bone, orbital plate of ethmoid and lesser wing of sphenoid. Key orbital foramina and fissures transmitting nerves and vessels are also outlined, along with the blood supply and venous drainage pathways. Sinuses related to the orbit including the frontal, ethmoid, sphenoid and maxillary sinuses
This document provides information on bone tumors. It begins with defining a bone tumor as an abnormal growth found in bone that can be either benign or malignant. It then classifies bones and describes the anatomy of long bones. The document discusses the histology of bone tissue and the four main cell types. It provides details on specific benign and malignant primary bone tumors that form bone, cartilage or other tissues. It describes characteristics, locations, histology and variants of tumors like osteoma, osteoid osteoma, osteoblastoma, osteosarcoma and chondroma. The document is an extensive reference on bone tumors, their classification, presentation and pathological features.
1. The petrous apex is a pyramid-shaped structure within the temporal bone that contains several vascular and neural channels.
2. Cholesterol granulomas are the most common petrous apex lesions, appearing hyperintense on T1- and T2-weighted MRI. Other developmental lesions include cholesteatomas, mucoceles, and cephaloceles.
3. Inflammatory, neoplastic, vascular, and osseous dysplasia lesions can also involve the petrous apex. Large or cranial nerve-compressing lesions may cause symptoms like hearing loss, facial weakness, or trigeminal nerve dysfunction.
This document summarizes key anatomical variations of the sphenoid sinus that can impact trans-sphenoid pituitary surgery. It describes variations in pneumatization degree, type of pneumatization, sellar bulge prominence, septation, and intercarotid distance that are evaluated on preoperative CT and MRI to assess surgical complexity. Examples of imaging findings of each variation are also provided.
1) The document discusses various pathologies that can affect the clivus region, including congenital malformations, acquired conditions, and primary and secondary neoplasms.
2) Examples of discussed pathologies include proatlas segmentation failure, neuroenteric cysts, basilar invagination, fibrous dysplasia, chordoma, plasmacytoma, and meningioma.
3) The pathologies are described in terms of their etiology, clinical presentation, diagnostic evaluation, and treatment options.
Retinal dystrophies are a group of degenerative retinal disorders with genetic and clinical heterogeneity. They can affect rods, cones, or both photoreceptors. Retinitis pigmentosa is the most common form of inherited retinal dystrophy and is characterized by rod degeneration followed by cone loss. It presents with night blindness, progressive peripheral vision loss, attenuation of retinal vessels, waxy pallor of the optic disc, and bone spicule pigmentation. Electroretinography shows a rod-cone pattern of dysfunction. Genetic testing can identify mutations in over 270 associated genes.
The document provides an overview of orbital anatomy and diseases. It describes the bones that make up the walls of the orbit, as well as the contents of the orbit such as the eyeball, muscles, nerves and blood vessels. Common orbital diseases are discussed including thyroid eye disease, infections, tumors and cysts, and trauma. Clinical evaluation involves assessing features like proptosis, extraocular motility, and imaging studies. Specific conditions like dermoid cysts, hemangiomas and fractures are also outlined.
This document provides information on various tumors that can affect nerves and muscles in the oral cavity. It summarizes different types of benign and malignant nerve tumors, including traumatic neuromas, palisaded encapsulated neuromas, neurofibromas, neurilemmomas (schwannomas), malignant peripheral nerve sheath tumors, and others. For each tumor type, it describes clinical features, histologic characteristics, associated syndromes, treatment approaches, and other relevant details.
This document provides an overview of orbital anatomy and diseases. It describes the major anatomic components of the orbit including the globe, optic nerve, extraconal and intraconal areas. Common pathologies are discussed for each anatomic structure, such as retinoblastoma affecting the globe and optic neuritis involving the optic nerve. Imaging techniques for evaluating the orbit including MRI and CT are also reviewed. Key anatomical structures like the superior orbital fissure and its contents are defined.
Vestibular schwannoma, also known as acoustic neuroma, is a benign tumor of the vestibular nerve sheath cells. It accounts for 6% of all intracranial tumors and 80-90% of cerebellopontine angle tumors. The tumor grows medially from the Schwann cells of the vestibular nerve and presents in stages ranging from isolated otological symptoms to brainstem compression. Diagnosis involves radiological investigations like CT, MRI and MRA. Treatment options include observation, surgery, and stereotactic radiosurgery depending on tumor size and patient factors.
This document summarizes various neuro-ophthalmic manifestations of cerebrovascular diseases. It discusses atherosclerosis, strokes, raised intracranial pressure, cerebral aneurysms, cerebral venous thrombosis, migraines, embolisms, cervical arterial dissections, and effects on the internal carotid and vertebrobasilar arterial systems. Key signs involve visual field defects, transient vision loss, optic disc edema, retinal artery occlusions, and cranial nerve palsies. Imaging such as MRI and MRA are important for diagnosis and treatment involves managing risk factors, anticoagulation, and surgical intervention in some cases.
The document discusses the anatomy and development of the orbit and its contents. It provides details on:
1) The bones that form the walls of the orbit - the frontal, ethmoid, maxillary, lacrimal, zygomatic, sphenoid and palatine bones.
2) The contents of the orbit which include the eyeball, extraocular muscles, nerves, vessels, lacrimal gland and orbital fat.
3) The development of the orbit which begins as a ring around the eyeball derived from cranial neural crest cells and expands during the third month to form the orbital walls.
This document provides an overview of skull pathologies that can be detected on plain skull radiographs. It begins by listing the major indications for skull radiographs, such as dysplasias, trauma, infections, and tumors. It then describes the approach to interpreting skull X-rays, categorizing abnormalities into density changes, contour abnormalities, intracranial volume changes, calcifications, bone thickness changes, lucent defects, sclerotic areas, and more. Specific pathologies are then discussed in-depth within each category. In summary, the document serves as a guide for radiologists to recognize and understand various skull abnormalities visible on plain radiographs.
Tumors of middle and inner ear dr.sithanandha kumar 14.03.2016ophthalmgmcri
This document discusses tumors of the cerebellopontine angle and middle ear. It begins by defining the cerebellopontine angle and its boundaries. The most common tumors of this area are then described, including acoustic neuromas, meningiomas, and schwannomas. Symptoms, investigations, and management are outlined for these lesions. The document also discusses glomus tumors, the most common middle ear neoplasm, describing its pathology, spread, clinical features, and treatment.
This document discusses proptosis (forward displacement of the eyeball), its causes, signs, symptoms, and evaluation. Proptosis can be unilateral or bilateral, acute or intermittent. It may be caused by congenital defects, trauma, infections, vascular lesions, cysts, tumors, or endocrine disorders like Graves' disease. Evaluation involves inspection, palpation, tests of eye movement and vision, exophthalmometry to measure protrusion, and diagnostic imaging or biopsy when indicated based on suspected etiology.
The orbital cavity contains the eyeball and associated structures. It is formed by 7 bones and has dimensions of approximately 50mm deep, 40mm wide, and 35mm high. There are several openings including the superior and inferior orbital fissures, optic canal, and ethmoidal foramina. The walls are lined with periosteum and consist of a roof, floor, medial and lateral walls. Knowledge of the orbital anatomy is important for understanding orbital pathology and surgical planning.
The document discusses spinal tuberculosis, noting that it causes delays in diagnosis, long recovery periods, and high costs. Key points include:
- Paralysis occurs in up to 50% of spinal tuberculosis patients.
- Early diagnosis, expedient treatment, aggressive surgery, and preventing deformity lead to the best outcomes.
- Diagnosis relies on tests like tuberculin skin tests, imaging like MRI to identify bone destruction and abscesses, and microscopy and culture of samples.
- Patterns of bone involvement include paradiscal, central, anterior, and appendiceal lesions.
- Complications include paralysis, cold abscesses, deformities, and secondary infections.
The document discusses various orbital diseases including orbital cellulitis, thrombosis of the cavernous sinus, proptosis, pseudo proptosis, and enophthalmos. It describes the anatomy of the orbit, signs and symptoms of orbital cellulitis and thrombosis of the cavernous sinus, classifications and treatments of proptosis, and causes and treatments of endocrine exophthalmos and enophthalmos. Potential complications of orbital diseases are also outlined.
The document provides an overview of the anatomy of the eye and orbit. It describes the seven bones that make up the bony orbit, including the frontal, zygomatic, maxillary, ethmoidal, sphenoid, lacrimal and palatine bones. It details the structures forming each wall of the orbit, such as the medial orbital wall formed by the frontal process of maxillary, lacrimal bone, orbital plate of ethmoid and lesser wing of sphenoid. Key orbital foramina and fissures transmitting nerves and vessels are also outlined, along with the blood supply and venous drainage pathways. Sinuses related to the orbit including the frontal, ethmoid, sphenoid and maxillary sinuses
This document provides information on bone tumors. It begins with defining a bone tumor as an abnormal growth found in bone that can be either benign or malignant. It then classifies bones and describes the anatomy of long bones. The document discusses the histology of bone tissue and the four main cell types. It provides details on specific benign and malignant primary bone tumors that form bone, cartilage or other tissues. It describes characteristics, locations, histology and variants of tumors like osteoma, osteoid osteoma, osteoblastoma, osteosarcoma and chondroma. The document is an extensive reference on bone tumors, their classification, presentation and pathological features.
1. The petrous apex is a pyramid-shaped structure within the temporal bone that contains several vascular and neural channels.
2. Cholesterol granulomas are the most common petrous apex lesions, appearing hyperintense on T1- and T2-weighted MRI. Other developmental lesions include cholesteatomas, mucoceles, and cephaloceles.
3. Inflammatory, neoplastic, vascular, and osseous dysplasia lesions can also involve the petrous apex. Large or cranial nerve-compressing lesions may cause symptoms like hearing loss, facial weakness, or trigeminal nerve dysfunction.
This document summarizes key anatomical variations of the sphenoid sinus that can impact trans-sphenoid pituitary surgery. It describes variations in pneumatization degree, type of pneumatization, sellar bulge prominence, septation, and intercarotid distance that are evaluated on preoperative CT and MRI to assess surgical complexity. Examples of imaging findings of each variation are also provided.
1) The document discusses various pathologies that can affect the clivus region, including congenital malformations, acquired conditions, and primary and secondary neoplasms.
2) Examples of discussed pathologies include proatlas segmentation failure, neuroenteric cysts, basilar invagination, fibrous dysplasia, chordoma, plasmacytoma, and meningioma.
3) The pathologies are described in terms of their etiology, clinical presentation, diagnostic evaluation, and treatment options.
Retinal dystrophies are a group of degenerative retinal disorders with genetic and clinical heterogeneity. They can affect rods, cones, or both photoreceptors. Retinitis pigmentosa is the most common form of inherited retinal dystrophy and is characterized by rod degeneration followed by cone loss. It presents with night blindness, progressive peripheral vision loss, attenuation of retinal vessels, waxy pallor of the optic disc, and bone spicule pigmentation. Electroretinography shows a rod-cone pattern of dysfunction. Genetic testing can identify mutations in over 270 associated genes.
ECTROPION^JENTROPION AND THEIR MANAGEMENT 2.pptxHarshika Malik
This document discusses ectropion and entropion of the eyelids, including their causes, types, clinical evaluation, and management. Ectropion is the outward turning of the eyelid margin, while entropion is the inward turning. Involutional ectropion most commonly affects the lower eyelids in elderly patients due to gravitational changes. Management depends on the type but may include procedures to shorten the eyelid or correct underlying issues like laxity of the medial or lateral canthal tendons. Prompt treatment is important to prevent complications such as dry eye or corneal damage.
This document discusses episcleritis and scleritis. Episcleritis involves inflammation of the episclera and is typically benign and self-limiting. Scleritis involves inflammation of the sclera and can be more serious, potentially causing vision loss if untreated. Scleritis is classified as anterior (non-necrotizing or necrotizing) or posterior. Treatment involves topical steroids and NSAIDs for mild cases and systemic steroids and immunosuppressants for more severe or necrotizing forms. Both conditions require treatment of any underlying systemic diseases.
The document discusses the history and evolution of corneal transplantation (keratoplasty) from early experiments in the 18th-19th centuries to modern techniques. Some key events include the first successful human corneal transplant being performed by Eduard Zirm in 1906, the introduction of antibiotics and steroids improving outcomes in the 1940s, and recent advances with femtosecond lasers and other technologies. The document also reviews the various surgical techniques used for corneal transplantation and postoperative care considerations.
The document discusses lamellar keratoplasty, which involves replacing diseased corneal tissue while retaining normal tissue. It describes anterior lamellar keratoplasty (ALKP) and posterior lamellar keratoplasty (PLKP). ALKP replaces varying amounts of anterior corneal tissue, while PLKP replaces the Descemet's membrane and endothelium. The document also discusses indications, surgical techniques like the Anwar bubble technique, and complications for anterior lamellar keratoplasty. Posterior lamellar keratoplasty techniques like DSAEK are described to replace dysfunctional endothelium.
This document provides an overview of retinopathy of prematurity (ROP), including:
1) ROP is a disorder of the developing retina in premature infants that can lead to blindness if left untreated. It occurs when the retina is incompletely developed and blood vessels grow abnormally.
2) Risk factors include prematurity, low birth weight, excess oxygen exposure, and other medical complications. The pathogenesis involves abnormal vasoproliferation and retinal neovascularization due to disrupted retinal vascular development.
3) ROP is classified based on location within zones of the retina, stage of disease progression from mild to severe, and presence of "plus disease" indicating worse prognosis. Timely screening and treatment can
This document provides an overview of thyroid ophthalmopathy (TED), also known as Graves' ophthalmopathy. It discusses the epidemiology, etiology, risk factors, pathogenesis, clinical signs and symptoms, diagnosis, and management of the autoimmune disease. TED is caused by inflammation and accumulation of fluids in the orbit, raising pressure and causing enlargement of the extraocular muscles and adipose tissue. Symptoms include eye bulging, double vision, and dryness. Management involves treating any thyroid abnormalities, using corticosteroids, radiation, or surgery to address eye involvement and symptoms.
Mechanical ocular trauma can cause a wide range of eye injuries from relatively minor to vision threatening. The document defines standard terminology for different types of eye injuries using the Birmingham Eye Trauma Terminology (BETT) system. It describes closed globe injuries which involve no penetration of the eyewall, open globe injuries which involve penetration of the eyewall, and different types of open globe injuries including globe rupture, penetrating injuries, and perforating injuries. It provides details on mechanisms of injury, clinical findings, examination techniques, and treatment approaches for different injury types.
Retinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. There are three main types: rhegmatogenous retinal detachment caused by a retinal break, tractional retinal detachment caused by vitreous traction, and exudative retinal detachment caused by fluid accumulation beneath the retina. Rhegmatogenous retinal detachment is usually associated with a retinal break and treated surgically by sealing the break with photocoagulation or cryotherapy and using scleral buckling or vitrectomy to reattach the retina. Tractional and exudative retinal detachments are generally treated with vitrectomy but may also be treated medically or with laser in some cases
The document discusses the anatomy and physiology of ocular muscles. It describes:
1. The intrinsic and extrinsic muscles that control eye movement and pupil size/lens shape.
2. The origins, insertions, innervation and actions of individual muscles.
3. Principles of binocular vision including fusion, stereopsis, prerequisites for development and anomalies like suppression and amblyopia.
4. Types of strabismus like tropia, phoria, pseudostrabismus and their characteristics. Heterophoria is defined and compensated vs decompensated types discussed.
Diabetic retinopathy is a progressive dysfunction of the retinal blood vessels caused by chronic hyperglycemia. It can cause vision loss and blindness if not treated. The risk and severity of retinopathy increases with the duration of diabetes and poor blood sugar control. Early stages are characterized by microaneurysms and hemorrhages, while proliferative stages involve new blood vessel growth. Macular edema can occur at any stage and is a leading cause of vision loss. Treatment includes laser photocoagulation, anti-VEGF injections, and vitrectomy surgery depending on the severity of retinopathy and presence of macular edema. Strict blood sugar and blood pressure control can help prevent and slow the progression of diabetic ret
Optic Neuritis, Papilledema document discusses optic nerve conditions. It defines optic neuritis as inflammation of the optic nerve impairing nerve conduction that can be caused by demyelination, infection, or autoimmunity. Papilledema is defined as bilateral, non-inflammatory swelling of the optic disc due to increased intracranial pressure. The document covers causes, signs, symptoms, diagnostic tests, treatment, and prognosis for both conditions.
The retina is the innermost layer of the eye that contains photoreceptor cells. Retinoblastoma is a malignant tumor that arises from these photoreceptor cells in the retina, most commonly affecting young children under 5 years old. It can be hereditary if caused by a mutation in the RB1 gene, resulting in bilateral and multifocal tumors, or non-hereditary if caused by somatic mutations, usually presenting as a unilateral tumor. Treatment depends on tumor size and extent but may include chemotherapy, local therapies like cryotherapy or brachytherapy, and enucleation of the eye for advanced cases. Early diagnosis and treatment can help preserve vision and life.
Secondary glaucoma is caused by an underlying ocular or systemic disease that leads to increased intraocular pressure and potential vision loss. It can be classified based on the mechanism of pressure rise into open-angle or angle-closure glaucoma. Common causes include lens-induced glaucoma, pigmentary glaucoma, neovascular glaucoma due to retinal ischemia, inflammatory glaucoma, traumatic glaucoma, steroid-induced glaucoma, pseudoexfoliative glaucoma, and glaucoma following cataract surgery. Treatment depends on the underlying cause but may include medications, laser treatment, or surgery to lower pressure and prevent further optic nerve damage.
This document discusses approaches to treating paediatric cataracts. It notes that paediatric cataract accounts for 7.4-15.3% of paediatric blindness worldwide. Etiologies include genetic factors, intrauterine infections, metabolic disorders, trauma, and prematurity. A thorough history, ocular exam, and laboratory tests are required to evaluate the cataract and check for associated ocular or systemic abnormalities. Surgical removal is indicated for visually significant cataracts. Challenges of paediatric cataract surgery include performing accurate biometry and intraocular lens power calculations due to the developing eye, achieving a stable anterior chamber, and addressing post-operative aphakia or amblyopia management.
This document discusses various types of ischemic optic neuropathies including anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). It describes the differences between arteritic AION (caused by giant cell arteritis) and non-arteritic AION, with the former affecting older patients and often causing bilateral simultaneous vision loss. Risk factors for NAION include hypertension, diabetes, and sleep apnea. The document provides details on clinical evaluation, imaging, and management of these vision-threatening conditions.
This document provides information on diseases of the lacrimal apparatus. It describes the anatomy of the lacrimal gland and drainage system. It discusses conditions such as dacryocystitis, which is inflammation of the lacrimal sac. Dacryocystitis can be congenital in infants due to blockage, or adult onset due to infection. Chronic dacryocystitis is more common and can lead to a lacrimal mucocele or pyocoele if left untreated. Surgical treatments like dacryocystorhinostomy are described to repair blockages and restore tear drainage.
The document discusses diseases of the lens, including its anatomy, transparency mechanisms, and types of cataracts. It describes the lens's structure and functions. For cataracts, it covers the differential diagnosis, etiological classification including congenital vs acquired cataracts, and morphological classification. Evaluation, indications for surgery, timing of surgery, intraocular lens power calculation and material selection, surgical techniques, and post-operative rehabilitation are summarized.
The document provides information on diseases of the uveal tract, which includes the iris, ciliary body, and choroid. It describes the anatomy, microscopic structure, blood supply, and functions of each part of the uveal tract. Uveitis, or inflammation of the uveal tract, is also discussed. The signs, symptoms, classifications, complications, and investigations for uveitis are summarized.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
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Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
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The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
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Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
2. • Quadrangular pyramids situated
between the anterior cranial fossa
and the maxillary sinuses below.
• 40 mm in height, width and depth
• Formed by 7 seven bones:
Frontal, Maxilla, Zygomatic,
Sphenoid, Palatine, Ethmoid and
Lacrimal.
• Has 4 walls - medial, lateral,
superior and inferior.
3. WALLS OF ORBIT
• Medial - 2 orbits are parallel, common for #.
• Inferior - (floor) triangular, commonly involved in blow--out #.
• Lateral - triangular, covers posterior half.
• Roof - formed by orbital plate of frontal bone.
• Apex - posterior end where 4 walls converge, 2 orifices, the
optic canal which transmits optic nerve and ophthalmic artery
and Superior orbital fissure which transmits arteries, veins and
nerves.
4.
5. CONTENTS OF ORBIT
• Volume: 30 cc.
• 1/5th is occupied by eyeball.
• Part of optic nerve, Extraocular
muscles, lacrimal gland, lacrimal
sac, ophthalmic artery and its
branches, 3rd, 4th and 6th cranial
nerves and ophthalmic & maxillary
divisions of cranial nerves,
sympathetic nerve and fascia.
7. Definition
• Forward movement of globe in
relation to skull.
• It is measured by protrusion of
apex of cornea from outer orbital
rim.
8. Clinical Evalution
History
• Onset (acute, gradual)
• Duration(days, years or since childhood)
• Progression Rapid (infection/inflammation/hemorrhage/malignant transformation)
Intermediate(Periodic orbital edema, recurrent orbital hemorrhage/chocolate cyst and
highly vascular tumor, orbital varices, capillary hemangiomas)
Slow( tumor)
• Associated ( decreased in vision, pain, redness, diplopia or squint and limitation of
eyeball)
• Variable ( increasing or decreasing with Valsalva maneuverer)
9. Causes of decreased vision astigmatism, exposure keratopathy, optic
nerve compression, murcormycosis can cause CRVO.
Causes of pain infection, inflammation, neoplasia when bone and nerve is
involved and acute pressure change (orbital haemorrhage).
Causes of redness infection, inflammation
Causes of diplopia restriction of muscles
1. Orbital mass
2. Myositis
3. Thyroid eye disease
4. Tethering (# of floor of orbit)
5. Direct nerve involvement( SOF/CSS)
10. CAUSES OF PROPTOSIS BASED ON THE AGE OF ONSET
Newborn Children Young adults Middle age Senile
• Orbital cellulits
• Orbital
neoplasm
• Rhabdomyosarc
oma
• Hemangioma
• Dermoid cyst
• Orbital cellulitis
• Optic nerve
glioma
• Carniosynostosis
lymphomas
• Thyroid
ophthalmopathy
• Pseudotumor
• Orbital cellulits
• Osteomas
• Infiltrative
tumors
• Pseudotumor
• Endocrine
• Malignant
lymphomas/leuk
emias
• Optic nerve
sheath
meningiomas
• mucocele
• Malignant and
metastatic
tumor of orbit
• Pseudotumor
• Leukemia
• Lymphomas
• Sarcomas
11. CAUSES OF UNILATERAL PROPTOSIS
Pathology Eitiologies
Congential Dermoid
Teratoma
Traumatic Orbital hemorrhage
Emphysema
Inflammation Orbital cellulitis/ abscess
Cavernous sinus thrombosis
Pseudotumor
Tuberculosis
Sarcoidosis
Vascular Orbital varix
cysts parasitic
Tumor Primary or secondary
17. AXIAL
• Axial both eyeballs are coming out in centre
• Common causes
• Thyroid eye disease
• Optic nerve tumour
• Cavernous haemangioma
18. • NON-AXIAL
• Non axial it can come out in any direction.
• Down and out: dermoid, frontal and ethmoidal glands
• Down and in: lacrimal gland tumor
• Upwards : maxillary sinus tumor
• Outwards: lesion of anterior ethmoidal sinus, nasopharngeal tumor.
19. 1. Periorbital margin
• Fullness
• Ecchymosis
• Scars
2. Eyelid shape like S shape seen in neurofibromatosis and
dacryoadenitis.
retraction of lid – thyroid eye disease
Eyelid changes (mass)
lesion surface
Prominent vessels
nodules
ulceration
Pulsation
Pulsatile proptosis ( cortico- cavernous fistula)
20. Fracture of roof of orbit
Sphenoid dysplasia
Meningocele
Pulsation increasing with Valsalva mauver ( orbital varix) it causes
intermittent proptosis
Transmitted
pulsations
21. Conjunctiva
• Congestion (infection or inflammation)
• Chemosis
• Arterialization of vessels ( increase episcleral venous pressure) seen
in thyroid eye disease, Sturge weber syndrome, cartico cavernous
fistula.
• Previous photograph ( orbital varix)
25. PALPATION
• Orbital margin temperature, tenderness
• Mass size, shape, surface localised/diffuse, mobile, fixed
to bone, consistency and reducibility.
• Retropulsion test (retrobulbar tumours)
• Mild pulsations slit lamp examination ( applanation
tonometer)
26. • Thyroid eye disease
lid lag sign
convergence (decreased)
jaw fore sign( forehead wrinkles lost)
27. Auscultation
Bruit (bell part of stethoscope) – present in carito cavernous fistula
Negative varices will have negative burit
In thyroid patients
Lymph nodes
Neck swelling + - do palpation and ask to drink water
30. Systemic Examination
• Pulse
• Temperature
• Tremors (Fine)
• Skin changes(Café-au-lait
spots) seen in NF or any
inflammatory condition like
sarcoidosis or Tuberculosis.
31. IMAGING
• CECT – Bones/ Mass
• MRI- soft tissue, involving the orbital apex , inflammatory disease ,
intracranial extension and vascular
• USG – Vascular tumours and cyst
• Invasive procedures
• Orbital venography: orbital varix
• Carotid angiography: pulsatile proptosis
• Biopsy
• FNAC
• Systemic test peripheral smear
32. Prominent Eyeball
Rule out pseudo-proptosis
True proptosis
CT/MRI
Mass +
Neoplasia
Vascular
Neural
Bony
Lacrimal gland
Fibrous/
mesenchymal
metastasis
Infective
Orbital
cellulitis
Abscess
Cystic
Dermoid cyst
etc
Vascular
CC fistula
No inflammation
Trauma/structural
Fracture,
craniosynostosis
Vasculitis
Wegner's Churg-
Strauss
Inflammation
Inflammatory
disorder
TED
IgG4 related
Infections
Orbital cellulitis-
preseptal
1st we will take history and sart with onset, it can be acute or gradua lprogress rapid means hours to days, intermediate weeks to months slow from months to years now ask whether this proptosis is associated with other things or not like
Usually pain rule out neoplasia or it can be some bone involvement or nerve involvement
Rescrition of muscle because of orbital mass because it is so big it is restricting the muscle, muscle involvement like in myositis ththering like fracture of floor of orbit like muscle is stuck than eyeball is not able to move bcoz of direct injury to nerve , nerve can be involved like for example the sof/css and this can be ruled out by forced duction test which will be negeative in paralytic squint and + in restriction
In drugs ask for thyroid drugs,
Before inspection we need to rule out pseudoproptosis see this patient looks like left eye has proptosis but it is not it is looking proptosis because there is scleral show below and what is happening actually this is right eye ball this is left eyeball left is bigger there is difference in size of eyeball refractive error can be more in the left enisometric can be there left eyeball is high myopic or eyelid retraction which also looks like proptosis other can be contralateral ptosis in this other eye looks like slightly proptotic or if there is shallow orbit
1st we have to know the asymmetry of the patient facial asymmetry can be seen LIKE IN TEMPORAL FOSSA FULLNESS
Now take out troch and do Hirshberg test to see the prominence of the eyeball and than u look the eyeball is in which direction known as dystropia it can be done by nafgigger view in which u stand behind the patient and see which eyeball we see 1st or which is more prominent and if we see from front than it is worms view
Direction of dystropia can be axial or non axial optic nerve tumor like glioma, mengioma and retrobulbar tumor like cavernous hemangioma
In lacrimal gland tumors eyeball will go down and out will cause inferior dystropias
Periorbital changes Or any eyelid changes
Any Scar from the perivous surgery
If there is any mass on eyelid than u have to see surface
Carotico cavernous fistula is when there is fistula b/w the cavernous sinus and ICA the blood will go into the cavernous sinus and there will be pulsation bcoz the blood is in ICA is impulses.
Other causes of pulsatile proptosis are the eyeball protected from this brain and brain has pulsations but the eyeball is protected from brain by orbit but if there is herniation of the brain the brain can herniate and press onto the eyeball that be seen in the
During the inspection we will see whether it is increasing with valsva manuver which is there in orbital varix it causes intermittent proptosis if it is increasing it suggests the communication of the extra vessels with the normal circulation that happens in orbital varix
In conjunctiva we see if there is any congestion that suggest any infection or inflammation whether there is chemosis again suggests any infection and inflammation going on or whether there is Arterilization of the vessels now this suggests there is increased episceral venous pressure for ex it can be seen in thyroid eye disease sws ccf these are some example where cox crew vessels of conjunctiva is there
Ask patient for previous photographs For ex pt is having orbital varix than u see in childhood lesion was there and how it is growing with years.
Exopthalmometer is a measurement of proptosis and the most common instrument is hurtles exophthalmometer BUT THERE ARE SOME DISADVANTAGES it is done in axial proptosis only some other are Naugle which is preferred in presence of an orbital fracture or after lateral orbitotomy and in children there is luedd this is just a ruler which u put it on lateral orbital margin and u see where the eyeball is having proptosis so hertel is most common
U hv to keep the edge at the lateral orbital margin what is proptosis from the lateral orbital margin u see how much is the corneal apex of the cornea that is telling about the proptosis value it comes out to be value like this 20, 30 in hertels exophalmometr we keep the to 2 end at lateral orbital margin it is an 1 eye at a time see there are markings over here so when the 2 lateral orbital margins there will be a reading on the scale note down that reading it is very imp because in future u r seeing a progression of proptosis this has to be constent otherwise we are not doing the proptosis correctly so base setting should be noted down that should be constent in future examination above here there is a scale and there is marking there are 2 red lines u can see. To measure if u r testing left eye u have to see by ur right eye u close ur left eye and u see from ur right eye u are the same level as patient and u have remove the parallax u hv to eliminate parallax by these 2 red lines should coinside and the apex it at which level of marking what will give u correct measurement of proptosis.
U have to do this for the other eye as well if it is more than 2 mm that is a relative measurement relative means as compared to the other eye means more than 2 mm proptosis difference that is significant but there is absolute value also coming that is more than 21 mm that is taken as significant but ofcourse it depends on the race like in Asian normal is 18 mm in causacians 20mm and blacks they have shallow orbits 22 mm
In this we have to see whether as compared to other eyeball ur eyeball is how much inferior, lateral, superior and medially and ofcourse how much it is proptosed.
To start the palpation ask the patient to close his eyes and look down take ur little finger and gentaly insuniate to check for resistance we feel the orbital margins whether there is any bony defect or whether we can incuniate our finger if there is any mass in b/w mass and the bone that is incuniation u can check temperature ,tenderness and look for resistance to retropulsation resistance to retropulsation is down like this use five fingers bring the fingers close together and gently retropulse if there is any resistance felt than it is seen in retrobulbar tumors and if there is any mass + we have to note down the size, shape, temperature, tenderness we have to see whether the mass is localized or diffuse is it mobile or is it fixed to the bone or not the consistency reducibility.
lid is not going down because whenever we look down the lps muscle relax and eyelid follows the globe but in thyroid there is lid retraction. So eyeball goes down but the eyelid will not follow the globe eyelid remains behind this is called as lid lag sign. Wrinkling we ask the patient to see in superior gaze now see the wrnikles of the forehead if there is loss of wrnikles that suggests jawfore sign in thyroid eye disease.
U have to check bruit whenever there is arterilor communication u will hear the bruit check it with the bell part of stethoscope u make the patien close the eye and u hear the burit in thyroid patients check neck as well and the lymphnodes check peri auricular, submental lymph nodes , submandibular lymph nodes and u check the neck as well if there is a swelling in the neck as well that also as to be mentioned if neck swelling present than palpation has be done also ask the pt to drink water and see wheather swelling is moving or not with drnking water
Fundus there Can be swelling of the optic nerve seen in retrobulbar tumor later which can lead to optic atrophy, optocillary shunts these are enlarged pre-existing capillaries usually they are seen in the temporal part of the disc and they are tortueus vessels there is a mass there is a obstruction to the normal drainage there is a communication b/w the central retinal vein and the choroidal circulation
Should be seen in thyroid or a proptosis case differitial iop is that the difference b/w the baseline iop vs the iop in a direction in which there is a limited movability of the eyeball so iop measurement at baseline when the patient is looking straight for example in thyroid eye disease there is a inferior rectus contraction and pt has difficulity to look up now ask the pt to look up and than u measure the iop.when there is a resistance to the eyeball movement the resistance is transmitted to the eyeball and than it can cause increase intraocular pressure
Ct scan is good for bones, trauma fractures, foregin bodies , emphyemas
And for any mass we have to localise there the mass is like intraconal, extraconal exact location of mass in relation to the other structures of the orbit this will help us to plan the surgery and also in there is contrast enhacement it will tell us vascularized tumor or not
We do mri when we suspect the proptosis is due to soft tissue FNAC IS avoided in dermoid tumors, hydaited cyst plomorphic adenoma orbital varix it confirms the diagnosis and also outlines the size and extent of the lesion that helps in proper surgical planning…. Carotid angiography it helps to identify the location and extend of ophthalimic artery aneurysms, av malformations.
DIFFRENTIALS OF PROPTOSIS
Vascular tumors like orbital varix , neural tomors like schonomas neurolomas, meningoma, glioma or optic nerve tumors