Oculoplastics and Orbital Disease
Core concepts
Know eyelid anatomy (skin, orbicularis, tarsus, conjunctiva) and the lacrimal system. Understand common conditions: chalazion, hordeolum, blepharitis, ptosis, ectropion, entropion, and eyelid tumours (basal cell carcinoma most common; sebaceous carcinoma aggressive).
Orbital disease: recognise orbital cellulitis (pain, proptosis, fever, restricted movement) versus preseptal cellulitis (skin only). Know thyroid eye disease (bilateral proptosis, lid retraction, restrictive myopathy) and orbital tumours. Understand that orbital cellulitis in children often follows sinusitis and needs urgent antibiotics.
Traps
- Confusing preseptal with orbital cellulitis; orbital involvement needs urgent imaging and IV antibiotics.
- Assuming all eyelid lesions are benign; basal cell carcinoma is common.
- Forgetting that thyroid eye disease can cause optic neuropathy.
- Missing that a painless orbital mass may be lymphoma.
Rule of thumb
Proptosis + restricted eye movement + fever = orbital cellulitis; obtain imaging and start IV antibiotics.
Worked example
A child with sinusitis develops proptosis and pain on eye movement. Diagnose orbital cellulitis; admit for IV antibiotics and CT imaging.