There are frequently abscesses present BJO 14. Adults..trauma is involved, and in children sinusitis. Protocol.
- strep is often present
Invasive fungal disease of the sinus and orbit
Ig 4 disease
- BJO 15
- muscle and nerve enlargement
- lateral rectus enlarge
- Inferior rectus
- tendons enlarged
- middle age, male, any site
- Systemic health: pancreatitis, liver, bile duct, lymph node and orbital mass, salivary gland masses or fibrosis.
- It causes painless proptosis, responds a little to steroids, other salivary gland are affected,
- chronic inflammation noted on biopsy
- Previous biopsies may have missed the IG 4 findings: previously idiopathic, sometimes multi-organ, sometimes lymphoma in addition
- Raised ig 4 serum
- need to exclude ted and sarcoid with thyroid antibody and ACE test.
- Nerves involved, lacrimal gland, eg trigeminal nerve enlargement ...biopsy nerve
- also termed Anca vasculitis,
- local or systemic
- cough, haemoptysis, mastoiditis, sinus disease, deaf, nldo ( nasolacrimal duct obstruction with watery eye) renal failure, otitis media, proptosis, destructive inflammatory mass, scleritis, ulcerative keratitis, optic neuropathy
- bilateral, do well with treatment
- Ranlangans cell histocytosis or tutuons giant cells,
- 4 types
- Erdheim chester, necrobiotic, asthma, solitary
- Sometimes children
- Slowly progressive proptosis
- Retroperitonal fibrosis, heart
- Periocular skin, paraproteinaemia...myeloma, lymphoma, leukaemia
- Repeat biopsy
Lymphangioma of conjunctiva
- can present as chronic conjunctivitis, or as cellulitis or mass.
- Children may notice rapid changes.
- Breast, no history, men lung,
- Dacroadenitis, bacterial viral, inflammatory, history or injury...foreign body.
Adenoid cystic lacrimal gland
- female 40y
- eom reduced
- no inflammation
- Mass..excision biopsy and include track of biopsy to prevent seeding.
Orbit compartment syndrome due to retrobulbar haemorrhage
- local anaesthetic
- divide lateral canthal tendonhorizontal cut blunt scissors
- divide restricting bands of septum between lower lid and rim, then lid becomes mobile
Trapdoor orbital fracture
- dont blow nose
- dont eat/drink
- beware oculocardic reflex..upgaze causes bradycardia, nausea, vomiting, syncope, arrythmia, assystole
- refer urgent/ct scan