1. Adnexa/Orbit/External
20 min

2. Baby picture of the day!

4. Preseptal Cellulitis Infection anterior to the orbital septum
Swelling, ptosis, warmth
(-) Pain, (-) congestion

5. Orbital Cellulitis Infection posterior to the orbital septum
Fever, pain on eye movement, decreased VA, EOM restrictions, proptosis
Most common cause – sinus infection (ethmoid sinusitis)

6. Thyroid Eye Disease / Grave’s Ophthalmopathy
Female, 30s-40s
#1 cause of proptosis
Autoimmune disease
Thickening of EOMs  proptosis & upper lid retraction
Exophthalmometry norm for Caucasians: mm

8. Carotid-Cavernous Fistula (CCF)
Abnormal artery-vein communication
#1 cause – trauma
Chemosis, pulsatile proptosis, ocular bruit
Cavernous sinus:
3, 4, 6, V1, V2
V3 & 7 do not go through

9. Orbital Tumors Cavernous hemangioma Capillary hemangioma
Rhabdomyosarcoma
Neuroblastoma
Optic nerve glioma
Meningioma
Lymphoma
Neurofibroma
Neurilemma (Schwannoma)

10. Cavernous Hemangioma
#1 benign orbital tumor in adults

11. Capillary Hemangioma
#1 benign orbital tumor in children

12. Rhabdomyosarcoma
#1 primary pediatric orbital malignancy

13. Neuroblastoma
#1 secondary pediatric orbital malignancy

14. Optic nerve glioma
#1 intrinsic tumor of the optic nerve

15. Meningioma
#1 benign brain tumor

16. Lymphoma
50s-60s
Proptosis in older patients (younger patients, think TED)

17. Neurofibroma
Benign astrocyte tumor

18. Neurilemma (Schwannoma)
Benign Schwann cell tumor

19. Orbital Pseudotumor Idiopathic Inflammation of the orbit
Unilateral painful proptosis
Unilateral chemosis (allergy would be bilateral)

20. Tolosa-Hunt Syndrome Idiopathic Inflammation of the orbit
Bilateral painful proptosis

21. Eyeball Abnormalities
Phthisis bulbi
Anophthalmos
Microphthalmos
Enophthalmos

22. Phthisis bulbi Small globe (atrophy)
Causes – disease, trauma, infection, surgery
Blind eye

23. Anophthalmos
No ocular tissue within globe

24. Microphthalmos
Small globe (congenital)

25. Enophthalmos
Globe retraction
Cause – trauma

26. Ocular prosthesis Enucleation – remove globe
Evisceration – remove contents within sclera
Exenteration – remove orbital contents (globe, EOMs, fat)

27. Ocular Rosacea Chronic ocular surface disease Sebaceous glands
Middle-age
Telangiectasia, rhinophyma, malar/butterfly rash

28. Contact Dermatitis Type 4 hypersensitivity 24-72 hour delay
Ex: cosmetics & meds
Acute redness, swelling, chemosis

29. Ocular Cicatricial Pemphigoid
Systemic mucous membrane disorder
Idiopathic
Signs – symblepharon, ankyloblepharon

30. Stevens-Johnson Syndrome
Type 3 hypersensitivity
Mucous membrane disorder
#1 cause – drug-induced (sulfonamides)
Prodrome – flu-like
Pseudomembranes
Symblepharon