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Eyelids and orbit flashcards

6 high-yield MRCP Part 1 cards from the Intellect Medicos Ophthalmology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. What is the first-line investigation to distinguish orbital from preseptal cellulitis?

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   CT of the orbits and sinuses with contrast.

   Why? CT shows spread behind the orbital septum, sinus disease and any subperiosteal or orbital abscess.

2. How is orbital cellulitis treated initially?

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   Emergency admission and IV antibiotics, e.g. a third-generation cephalosporin (ceftriaxone) plus metronidazole.

   Why? It can spread to the optic nerve, cavernous sinus and brain. Surgery is needed for abscess, optic nerve compression, worsening vision, or no improvement after 48 hours.

3. What is the usual oral antibiotic for uncomplicated preseptal (periorbital) cellulitis?

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   Co-amoxiclav.

   Why? Preseptal cellulitis has no orbital signs and usually follows sinusitis or skin injury (staphylococci, streptococci), so oral treatment with close review is enough. In penicillin allergy NICE suggests clarithromycin plus metronidazole.

4. What is the first-line management of blepharitis?

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   Lid hygiene: warm compresses, lid massage and cleaning the lid margins (e.g. diluted baby shampoo or sodium bicarbonate solution).

   Why? Warmth softens blocked meibomian gland secretions and cleaning removes crusts. Artificial tears help the associated dry eye. It is chronic, so this is long-term.

5. Posterior blepharitis (meibomian gland dysfunction) is most strongly associated with which skin condition?

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   Rosacea.

   Why? Abnormal meibomian lipid destabilises the tear film, causing evaporative dry eye and a frothy tear film. Anterior blepharitis is linked to seborrhoeic dermatitis and staphylococci.

6. What is the most common source of infection in orbital cellulitis?

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   Spread from adjacent sinusitis, especially the ethmoid sinuses.

   Why? Only the thin lamina papyracea separates the ethmoid sinus from the orbit. Spread can reach the cavernous sinus and brain.