25. Pathological positions of the lids. Flashcards
what is the inward turning of the lid called ?
entropion
what is the cause for entropion?
mostly conjunctival or tarsal scar formation with chronic inflammatoion trachoma - involve upper and lower eyelid
due to aeging - involutional - always affecting the lower eyelid
congential - lid margin rotated towards cornea
involutional entropian is also associated with what morphological changed of the eyelids ?
upward migration of perceptual orbicularis muscle
disinsertion of the lower eye lid retractor
what is the complication of entropion?
misdirection of eyelashes towards the cornea
- corneal irritation - blink frequently making the condition worst
what is a treatment for trichiasis corneal inflammation ?
cyrotherapy - eliminating the lashes by freeing them
what is the outward turning off the lid margin called ?
ectropian
what re the causes for ectropion lids?
involutional - aeging
paralytical - facila nerve palsy
scar- contracture of skin of the lid from trauma or chronic inflammtion
mechanical - bulky tumors of the lid
congential
what are the symptoms of ectropion?
tearing
irritation
all because of exposure
what is a complication of ectropion?
keratitis
what is the treatment for ectropion?
horizontal shortening of eyelid
what is epicanthus?
vertical folding of the skin over the medial canthi - often large enough to cover parts of the nasal sclera
in whom is epicathus seen most ?
asians
when the skin folding of epicanthus covers the nasal sclera what does it look like?
pseudostrabismus - alignment of the eye is straight but they appear to be crossed
what is a non congential cause of epicanthus ?
acquired after surgery or trauma to medial eyelid or nose
what is blepharochalasis
inflammation of the eyelid
characterised by exacerbation and remission of eyelid edema
result in eyelid being stretched and atrophy of the eyelid
formation of redundant folds over lid margins
what is ptosis
one or both upper eyelid assume an abnormally low position
ptosis is classified into ? and why is this important ?
congenital and acquired
differentiation in treatment
what is the cause for congenital MYOGENIC ptosis?
isolated dystrophy of the of the levatator muscle
what are the signs for congenital myogenic ptosis ?
reduced lid movement in upward gaze
and incomplete closure of eyelids
- lagging of the lid - important diagnostic clue for levitator maldevelopment
strabismus may also be present
in 25 percent of the cases for dystrophic changes in levitator pallbearer superior what other muscle is also involved ?
superioir rectus muscle
want is congenital neurogenic ptosis ?
occulomotor nerve palsy - partial or icomplete
in congenital neurogenic ptosis what are the other signs involved ?
inability to elevate , depress , adduct the eye
mydriasis
if the lid is completely and permanently closed due to congenital neurogenic ptosis what is this called ?
amblyopia - lazy eye
what congenital diseases do congenital neurogenic ptosis associated with ?
congenital horner syndrome
what causes acquired myogenic ptosis ?
myasthenia gravis - also diplopia occurs
what is a diagnostic sign of myasthenia graves ?
lid fatigue
increasing ptosis on prolonged up gazing
PTOSIS REVERSED in rest or local application of ice
what causes acquired neurogenic ptosis?
occulmotor nerve plays due to ischemia - microvascular disease
secondary to atherosclerosis
aneurysm
tumors
acquired horner syndrome - disruption of sympathetic innervation
what also accompanies ptosis in acquired neurogenic ptosis ?
impaired adduction , depression , elevation of globe
acquired horner syndrome in acquired neurogenic ptosis has what signs ?
mild ptosis
mild elevation of lower eye lid - appearance of enopthalmus
miosis
how do we know in acquired horner syndrome is the lesion is proximal to the superior cervical ganglion ?
accompanying anhidrosis of ipsilateral face and neck
what is the treatment of ptosis ?
exclusion of myasthenia graves all ptosis treated surgical
early surgery in children - prevent amblyopia
what are the pathological position of the eyelids
entropian ectropian epicanthus blepharochalasis ptosis
