1. Hisham Khairy MD FRCS Ed Ophthalmology Department
Ophthalmic Science
Hisham Khairy MD FRCS Ed
Ophthalmology Department

2. This presentation is not intended to fulfill the full curriculum of dental surgery related eye anatomy, physiology, and/ or related ophthalmic diseases and disorders
For further reading refer to books like: Review of Ophthalmolgy (available at Faculty of Medicine Library)

3. Anatomy ( Eye & Adnexa)
Physiology
Visual
Eye and vision related neural reflexes
Extra Ocular Muscles
Lacrimal
Ocular diseases
Lid
Conjunctiva
Cornea
Lens
Uveal tract
Glaucoma
Orbit

4. Neuro-ophthalmology
Ocular motility disorders
Visual acuity disorders
Orbital
Trauma
Tumors

5. Anatomy Bone (Bony Orbit) The globe Adnexa Lid Conjunctiva Lacrimal
Extra ocular muscles

6. Blood Supply Arterial

7. Orbital arterial supply

8. Venous drainage

9. The bony orbit, globe, and adnexa

13. Orbital Nerves

14. Anatomical info and clinical relevance
Orbital septum divides structures to intra orbital and extra orbital
Inflammation anterior to septum is extra orbital . An example of extra orbital inflammations is lid infection, dacryocystitis ,and preseptal cellulitis.
Orbital cellulitis occurs posterior to orbital septum

15. The GlobeOuter Sclero cornea

16. Middle Uvea tract (Iris, ciliary body, choroid)

17. Inner Retina

20. Visual physiology

21. Ocular and visual reflexes

23. Extra ocular muscles

25. Lid

27. External land marks and lacrimal system

28. Lacrimal apparatus

29. Diseases of the eye lid Congenital Inflamatory Lid malpositions Tumors
Preseptal cellulitis
Blepharitis
Stye
Chalazion
Lid malpositions
Ptosis
Entropion/ Ectropion/ Trichiasis
Tumors

31. The signs of dacryoadenitis include the following:
Soft tissue swelling that is greatest at the lateral portion of the upper lid margin[49]
Deformation of the upper lid into a characteristic S shape[5]
If caused by a viral infection, the area is modestly tender; bacterial causes result in more severe tenderness[25]
Decreased Schirmer score
Dacryocystitis
Erythema, swelling, warmth, and tenderness may be noted over the lacrimal sac at the inferior aspect of the medial canthus. Application of pressure to the area overlying the lacrimal sac may cause expression of purulent material from the lacrimal puncta. (See the image below.)
Canaliculitis
Signs of canaliculitis include the following:
Edematous, "pouting" punctum
Erythema of adjacent conjunctiva
Mattering of the eyelid
Mucous regurgitation from punctum on application of pressure
Yellowish concretions may be expressed from the punctum; these are sulfur granules produced by Actinomyces israelii

32. Differential Diagnoses
Angioedema
Bites, Insects
Cavernous Sinus Thrombosis
Chalazion
Hordeolum and Stye
Orbital Infections

33. Other unusual causes of periorbital cellulitis include the following:
When associated with trauma, periorbital cellulitis can be caused by the following bacterial species:
Staphylococcus aureus - This may include methicillin-resistant S aureus[10] ; treatment should be tailored to local incidence of infection
Streptococcus pyogenes (group A streptococci)
In the absence of trauma, periorbital cellulitis can be caused by the following microbes:
Streptococcus pneumoniae
Haemophilus influenzae type b - Was the predominant cause of periorbital cellulitis prior to the advent of the Hib vaccine but has now been shown to cause only rare cases[1, 11, 12, 13]
Other unusual causes of periorbital cellulitis include the following:
Neisseria gonorrhoeae[14]
Neisseria meningitidis[15, 16]
Vaccinia virus[17] - Has been reported in a laboratory worker; autoinoculation resulting in periorbital infection in patients receiving the vaccine has been reported[18]
Herpes simplex virus
Mycobacterium tuberculosis[19]
Bacillus anthracis[20]
Taenia solium – Periorbital cellulitis can develop secondary to orbital cysticercosis caused by this organism

35. Orbital diseases Congenital Hormonal Inflamatory Neoplastic
Malformation/ Proptosis/ Enophthalmos/ Cellulites/ Frozen

36. Definition
Proptosis means a forward displacement or bulging of a body part and is commonly used to describe protrusion of the eye. Exophthalmos specifically describes proptosis of the eye.

37. The direction of proptosis often indicates the location of a mass because the globe is usually displaced away from the site of the mass.

38. Unilateral proptosis in adults is also most frequently caused by Graves ophthalmopathy.

39. Bilateral proptosis in adults
Graves ophthalmopath
Idiopathic orbital inflammatory disease
Neoplasms
Wegner granulomatosis
Bilateral proptosis in children
Metastatic neuroblastoma
leukemia
Idiopathic orbital inflammatory disease.

40. Cause of pseudoproptosis are:
Pseudoproptosis is either the simulation of abnormal prominence of the eye or a true asymmetry that is not the result of increased orbital contents. Pseudoprotosis is diagnosed by exclusion (ie: until the possibility of a mass lesion has been ruled out).
Cause of pseudoproptosis are:
Enlarged globe
Extraocular muscle weakness or paralysis (allowing the eye to move forwared)
Contralateral enophthalmos
Asymmetric orbital size
Asymmetric palpebral fissures (usually caused by ipsilateral eyelid retraction or facial nerve paralysis or contralateral ptosis)

41. The Six P’s
It is helpful to remember the six P’s: pain, proptosis direction, progression, palpation, pulsation, and periorbital changes.

42. Arteriovenous malformation Maxillary sinus tumors
II) Proptosis direction
Axial displacement is caused by retrobullar lesions
Cavernous hemangioma
Glioma
Meningioma
Arteriovenous malformation
Metastases
Non-axial displacement is caused by lesions outside the muscle cone
Superior
Maxillary sinus tumors
Inferomedial
Deromid syst
Lacrimal gland tumor
Inferolatral
Fronto-athmoidal
Mucoceles
Abscesses.
Osteomas.
Carcinomas

43. Vesicles - If associated with herpetic infection
Periorbital cellulitis
Examination may reveal the following:
Erythema, swelling, warmth, and tenderness of the lids without evidence of orbital congestion (proptosis, decreased extraocular movement), as demonstrated in the image below
Fever
Vesicles - If associated with herpetic infection
Violaceous discoloration of the lid - More commonly associated with H influenzae but may be associated with infection with S pneumoniae.
If associated with trauma, there may be a break in the skin overlying the area of cellulitis.
Blepharitis
Anterior blepharitis
Signs of anterior blepharitis include the following:
Crusting at the base of the lash (known as scurf or collarettes), erythema of lid
Usually, no discharge
Poliosis, or depigmentation of the lash, may occurr
If associated with ocular rosacea, telangiectatic vessels may be noted on the lid margins and cheeks
In chronic cases, ulceration of the lid, lid notching (tylosis), thinning of eyelashes (madarosis), or misdirection of the eyelashes (trichiasis) may be noted[27]
Posterior blepharitis
Signs of posterior blepharitis include the following:
Decreased Schirmer score
Conjunctival hyperemia[

45. Periorbital cellulitis
Patient history may include the following:
An antecedent history of insect bite, trauma to the periorbital skin, infection of adjacent structures, upper respiratory infection, or sinusitis
A sudden increase in temperature and rapid swelling of tissue
A history of underlying illness (eg, human immunodeficiency virus [HIV], acute lymphoblastic leukemia), which would increase the patient's risk of infection
Blepharitis
Characteristics include the following:
Anterior blepharitis - Erythema, pruritus, and crusting of lid margins; typically without discharge
Posterior blepharitis – Epiphora, foreign body or burning sensation,[45] blurred vision, and photophobia

46. B) Computed Tomography
CT scanning is the most valuable technique for delineating the shape, location, extent, and character of lesions.

47. Orbit / Proptosis
Hormonal

48. Dysthyroid Ophthalmopathy
Lid retraction. Proptosis , red eye, engorged vessels, enlarged inflamed extra ocular muscles
Dysthyroid Ophthalmopathy

49. Prolactin- Pituitary -Acromegally

50. Eye
Outer Field of vision defect bilateral (Bitemporal hemianopia)

51. Orbital/ Facial trauma

53. Tumors

54. Lid disorders
Malposition
Infection

55. The Eye lid 2011; Hisham K Abdel Dayem FRCS; abdeldayem2@yahoo.com
Mechanical ptosis
The Eye lid 2011; Hisham K Abdel Dayem FRCS;

56. The Eye lid 2011; Hisham K Abdel Dayem FRCS; abdeldayem2@yahoo.com
Lt. partial ptosis.
Jaw winking synkinesis
Marcus Gun
The Eye lid 2011; Hisham K Abdel Dayem FRCS;

57. Conjunctiva Neonatal infection with mucopurulent discharge
Conjunctival redness

58. References
file:///C:/Users/Hisham%20Khairy/Documents/eye%20edu2/Macroglossia.jpg
Proptosis Prof Dr Othman Ziko

59. Acknowledgements
I wish to thank all clinicians and staff who provided information, photographs, designs, other material that helped in production of this beta-presentation

60. Quiz

63. Dacryoadenitis
The disease is characterized by swelling of upper lateral eyelid and scleral injection. If dacryoadenitis is caused by a viral infection, the area is modestly tender. Bacterial causes result in more severe tenderness.[25]
Dacryocystitis
A history of chronic conjunctivitis or recent upper respiratory infection may be present. Other signs include the following:
Epiphora
Fever
Swelling, tenderness, and erythema usually localized at the medial canthal area
Purulent discharge
Canaliculitis
Patient history may include the following:
Irritation or pruritus of medial portion of affected eyelid