TNOA Journal of Ophthalmic Science and Research

: 2019  |  Volume : 57  |  Issue : 3  |  Page : 263--265

Answers to orbit and oculoplasty quiz

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

Correspondence Address:
Dr. Kavitha Ramakrishnan
Doctor's Quarters, C6, Aravind Eye Hospital, Avinashi Road, Civil Aerodrome Post, Coimbatore - 641 014, Tamil Nadu

How to cite this article:
Ramakrishnan K. Answers to orbit and oculoplasty quiz.TNOA J Ophthalmic Sci Res 2019;57:263-265

How to cite this URL:
Ramakrishnan K. Answers to orbit and oculoplasty quiz. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2020 May 27 ];57:263-265
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Full Text

 Question 1


Identify the conditionWhat is the causeWhat is the treatment?

 Answer Key 1

S-shaped ptosis in a young childSuggestive of dermoid cyst – external angular dermoidA dermoid cyst is a congenital choristoma of the orbitWhen fetal suture lines close during embryogenesis, embryonic epithelial nests may become entrapped and form a cystAfter ruling out intracranial extensions, total excision of the cyst.

 Question 2


What is the differential diagnosisTreatment optionsPrognosis.

 Answer Key 2

Differential diagnosis

Orbital fat prolapseConjunctival cystPseudotumorConjunctival lymphoma

Diagnosis is conjunctival lymphomaIncisional biopsy to confirm the diagnosisOncologist referralRule out distant metastasisExternal beam radiotherapy is the treatment of choice20–50 Gy are used, with fractionated treatment over 15 sessionsOverall, prognosis is generally good, with 90% of patients not experiencing progression or recurrence during 1-year follow-up periods.

 Question 3


What is the diagnosisWhat is the name of the radiological signWhat are the treatment options?

 Answer Key 3

Blow-out fracture of the orbitOccurs when a blunt object greater in diameter than the orbital rim such as fist, cricket, or tennis ball hits the orbit with forceMechanisms proposed are hydraulic and buckling theoryTeardrop or hanging drop sign – Discontinuation of the orbital floor with herniation of soft tissue into the maxillary antrumEarly 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


Identify this conditionWhat is the causeWhat is the treatment?

 Answer Key 4

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

 Question 5


Diagnose this conditionHallmark radiological findingTreatment options.

 Answer Key 5

Orbital venous-lymphatic malformation (lymphangiomas)Key diagnostic featuresA 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 lesionDifferential diagnosis – HemangiomaSurgery for decompression and cosmetic purposesRecent therapy is sclerotherapy, commonly using intralesional injection bleomycin.

 Question 6


Identify the systemic conditionHallmark radiological featureTreatment of choice.

 Answer Key 6

DysthyroidismAssociated most commonly with hyperthyroidism and less commonly with hypothyroidism and euthyroid statusProptosis with enlargement of muscles. A key feature to differentiate from myositis is sparing of tendinous insertion of the muscleSupportive measures and conservative treatment in mild and mild-to-moderate thyroid eye disease along with endocrinologist managementPulse steroid therapy with intravenous methyl prednisolone in moderate-to-severe and severe thyroid eye disease according to the EUGOGO Recommendations.

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Conflicts of interest

There are no conflicts of interest.