Toric Lecture

TORIC Supplementary Notes

CHALAZION MONOGRAPH  http://www.ophthalmologyrounds.ca/crus/130-062%20English.pdf

ORBITAL TUMOUR MONOGRAPH

http://www.ophthalmologyrounds.ca/crus/130-040%20english.pdf

Add IgG4 disease to monograph

Solitary fibrous tumour and Hemangioperictyoma overlap

 

ORBITAL CELLULITIS (vs. preseptal cellulitis):  Vision loss, RAPD, Dyschromatopsia, Dysmotility, Fever, Sinus opacification

ORBITAL INFLAMMATORY SYNDROME:  myositis, scleritis, dacryoadenitis.  Very sensitive to systemic steroid

IgG4:  formerly “chronic pseudotumour”

NON-HODGKINS LYMPHOMA:  putty like moulding, salmon patch.  Incisional biopsy.  Send fresh.  Can often radiate local disease.

PLEMORPHIC ADENOMA LACRIMAL GLAND (slowly progressive, painless, scalloping of bone) vs. ADENOID CYSTIC CARCINOMA LACRIMAL GLAND (quick progression, painful, bony erosion)

OPTIC NERVE GLIOMA (sagitall kinking, NF1, horrible prognosis if adult onset)   SHEATH MENINGIOMA (“tram tracking”, typically adult females, radiate if vision loss)

CAPILLARY HEMANGIOMA:  Rx beta blocker

“LYMPHANGIOMA”:  cystic dark blood, worse with colds, cannot completely surgically excise, ?sildenafil

TESTING FOR NASOLACRIMAL OBSTRUCTION:  If there is no inflamed nasolacrimal sac mucocele, massage the medial canthal area.  If there is purulent reflux then you have your diagnosis.  If no reflux, you can consider nasolacrimal irrigation.

DACRYOCYSTITIS REFERENCE
http://www.ehu.eus/OftalmoBiologiaExperimental/documentos/dacryocystitis-systematic-approach-to-diagnosis-and-therapy.pdf

 

DOSAGE GUIDELINES FOR COMMONLY USED ANTIBIOTICS

Adults

Children

 

META-ANALYSIS ENDOSCOPIC VS. EXTERNAL DCR http://www.researchgate.net/profile/Richard_Harvey4/publication/259393021_Systematic_Review_and_Meta-Analysis_on_Outcomes_for_Endoscopic_Versus_External_Dacryocystorhinostomy/links/02e7e53435f8c88cb4000000.pdf

 

INFORMED CONSENT Mnemonic that corroborates informed consent in oculoplastic surgery.  Ing EB. Ophthal Plast Reconstr Surg. 2014 Jan-Feb;30(1):83

PRACTICE MULTIPLE CHOICE QUESTIONS
1. Which of the following is NOT usually seen in a patient with true proptosis?
a) Lid retraction
b) Variable ptosis
c) Hyperopic shift in refraction
d) Chorioretinal striae
 
 
2. Which of the following is usually NOT useful in the work-up of ptosis?
a) documentation of anisocoria, and alternate cover test (to exclude hypotropia)
b) variability in the lid height
c)  the presence or absence of corneal anesthesia
d)  lid eversion
e)  all of the above are useful
 
 
3. What is the most common cause of ectropion and entropion in North America?
a)  involutional upper lid
b)  cicatricial
c) paralytic / spastic / paralytic
d) mechanical (mass lesion)
e) involutional lower lid
 
 
4.  In a patient with dacryocystitis and an inflamed medial canthal abscess, which of the following is the LEAST appropriate?
a)  ask about a history of nasal or sinus trauma / surgery 
b)  the medial canthal mass is usually below the medial canthal tendon
c)  if the abscess is prominent and “pointing”, incision, drainage and stent can be performed
d)  nasolacrimal irrigation or pushing on the nasolacrimal sac
 
 
ANSWERS:  
1b) variable ptosis is associated with myasthenia 
2) e patients with corneal anesthesia have higher risk of corneal compromise post ptosis repair
3) e
4) d irrigating or massaging an inflamed medial canthal abscess will not add information, and will only cause pain