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PHOTO QUIZ
Year : 2019  |  Volume : 57  |  Issue : 3  |  Page : 263-265

Answers to orbit and oculoplasty quiz


Department of Orbit and Oculoplasty, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India

Date of Submission19-Aug-2019
Date of Acceptance27-Aug-2019
Date of Web Publication11-Nov-2019

Correspondence Address:
Dr. Kavitha Ramakrishnan
Doctor's Quarters, C6, Aravind Eye Hospital, Avinashi Road, Civil Aerodrome Post, Coimbatore - 641 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_77_19

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How to cite this article:
Ramakrishnan K. Answers to orbit and oculoplasty quiz. TNOA J Ophthalmic Sci Res 2019;57:263-5

How to cite this URL:
Ramakrishnan K. Answers to orbit and oculoplasty quiz. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2019 Dec 10];57:263-5. Available from: http://www.tnoajosr.com/text.asp?2019/57/3/263/270708




  Question 1 Top




  • Identify the condition
  • What is the cause
  • What is the treatment?



  Answer Key 1 Top


  • S-shaped ptosis in a young child
  • Suggestive of dermoid cyst – external angular dermoid
  • A dermoid cyst is a congenital choristoma of the orbit
  • When fetal suture lines close during embryogenesis, embryonic epithelial nests may become entrapped and form a cyst
  • After ruling out intracranial extensions, total excision of the cyst.



  Question 2 Top




  • What is the differential diagnosis
  • Treatment options
  • Prognosis.



  Answer Key 2 Top


  • Differential diagnosis


    1. Orbital fat prolapse
    2. Conjunctival cyst
    3. Pseudotumor
    4. Conjunctival lymphoma


  • Diagnosis is conjunctival lymphoma
  • Incisional biopsy to confirm the diagnosis
  • Oncologist referral
  • Rule out distant metastasis
  • External beam radiotherapy is the treatment of choice
  • 20–50 Gy are used, with fractionated treatment over 15 sessions
  • Overall, prognosis is generally good, with 90% of patients not experiencing progression or recurrence during 1-year follow-up periods.



  Question 3 Top




  • What is the diagnosis
  • What is the name of the radiological sign
  • What are the treatment options?



  Answer Key 3 Top


  • Blow-out fracture of the orbit
  • Occurs when a blunt object greater in diameter than the orbital rim such as fist, cricket, or tennis ball hits the orbit with force
  • Mechanisms proposed are hydraulic and buckling theory
  • Teardrop or hanging drop sign – Discontinuation of the orbital floor with herniation of soft tissue into the maxillary antrum
  • Early period can consider oral steroids, if persistent diplopia and enophthalmos after 2 weeks surgical treatment, release muscle entrapment, and use implants such as medpore and titanium.



  Question 4 Top




  • Identify this condition
  • What is the cause
  • What is the treatment?



  Answer Key 4 Top


  • Canaliculitis, which is an infection of the lacrimal canaliculus, typically occurs in individuals over 40 years of age
  • Actinomyces israelii (an anaerobic filamentous Gram-positive bacteria) is the most common pathogen
  • Less common pathogens include Candida albicans, Nocardia asteroides, Aspergillus, herpes simplex virus, and varicella-zoster virus
  • Infection causes small dacryoliths, or stones, to form, which are concretions consisting of sulfur granules
  • Three-snip ampullotomy with curettage and concretion removal with or without intubation.



  Question 5 Top




  • Diagnose this condition
  • Hallmark radiological finding
  • Treatment options.



  Answer Key 5 Top


  • Orbital venous-lymphatic malformation (lymphangiomas)
  • Key diagnostic features
  • A multilobulated, septated, trans-spatial cystic appearing lesion is seen. Fluid–fluid levels suggestive of intralesional hemorrhage can be seen. Enhancement is variable. No flow voids are associated with this lesion
  • Differential diagnosis – Hemangioma
  • Surgery for decompression and cosmetic purposes
  • Recent therapy is sclerotherapy, commonly using intralesional injection bleomycin.



  Question 6 Top




  • Identify the systemic condition
  • Hallmark radiological feature
  • Treatment of choice.



  Answer Key 6 Top


  • Dysthyroidism
  • Associated most commonly with hyperthyroidism and less commonly with hypothyroidism and euthyroid status
  • Proptosis with enlargement of muscles. A key feature to differentiate from myositis is sparing of tendinous insertion of the muscle
  • Supportive measures and conservative treatment in mild and mild-to-moderate thyroid eye disease along with endocrinologist management
  • Pulse steroid therapy with intravenous methyl prednisolone in moderate-to-severe and severe thyroid eye disease according to the EUGOGO Recommendations.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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