Neuro-Ophthalmology and Orbit Flashcards

What is the most common cause of both unilateral and bilateral proptosis in adults?

Answer: Thyroid eye disease

Thyroid eye disease is the leading cause of proptosis in adults, whether one-sided or bilateral.

Which extraocular muscle is most commonly enlarged in thyroid eye disease?

Answer: Inferior rectus

Muscles are involved in the order inferior > medial > superior > lateral rectus, and the tendons are typically spared.

Teprotumumab for thyroid eye disease targets which receptor and is notably associated with which adverse effect?

Answer: IGF-1 receptor; hearing impairment

Teprotumumab is an IGF-1R inhibitor, and hearing impairment and hyperglycemia are important adverse effects.

What is the most common benign primary orbital mass in adults, which is usually a well-circumscribed intraconal lesion?

Answer: Cavernous venous malformation

The cavernous venous malformation (cavernous hemangioma) is a slow-growing, encapsulated, intraconal lesion that usually affects middle-aged women.

What is the first-line treatment for a periocular infantile hemangioma that threatens amblyopia?

Answer: Oral propranolol

Oral propranolol is now first-line for vision-threatening infantile hemangiomas.

Which statement about orbital rhabdomyosarcoma is correct?

Answer: It is the most common primary orbital malignancy of childhood, and the embryonal type is most common

Rhabdomyosarcoma is the most common pediatric primary orbital malignancy, usually embryonal, and is treated mainly with chemotherapy and radiation.

Why should a suspected lacrimal gland pleomorphic adenoma be removed by complete excision without prior incisional biopsy?

Answer: Breaching the capsule risks recurrence and malignant transformation

Capsule violation seeds the tumor, which raises the risk of recurrence and transformation to carcinoma ex pleomorphic adenoma.