25. Pathological positions of the lids.

Question 1

what is the inward turning of the lid called ?

Answer 1

entropion

Question 2

what is the cause for entropion?

Answer 2

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

Question 3

involutional entropian is also associated with what morphological changed of the eyelids ?

Answer 3

upward migration of perceptual orbicularis muscle

disinsertion of the lower eye lid retractor

Question 4

what is the complication of entropion?

Answer 4

misdirection of eyelashes towards the cornea

- corneal irritation - blink frequently making the condition worst

Question 5

what is a treatment for trichiasis corneal inflammation ?

Answer 5

cyrotherapy - eliminating the lashes by freeing them

Question 6

what is the outward turning off the lid margin called ?

Answer 6

ectropian

Question 7

what re the causes for ectropion lids?

Answer 7

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

Question 8

what are the symptoms of ectropion?

Answer 8

tearing
irritation

all because of exposure

Question 9

what is a complication of ectropion?

Answer 9

keratitis

Question 10

what is the treatment for ectropion?

Answer 10

horizontal shortening of eyelid

Question 11

what is epicanthus?

Answer 11

vertical folding of the skin over the medial canthi - often large enough to cover parts of the nasal sclera

Question 12

in whom is epicathus seen most ?

Answer 12

asians

Question 13

when the skin folding of epicanthus covers the nasal sclera what does it look like?

Answer 13

pseudostrabismus - alignment of the eye is straight but they appear to be crossed

Question 14

what is a non congential cause of epicanthus ?

Answer 14

acquired after surgery or trauma to medial eyelid or nose

Question 15

what is blepharochalasis

Answer 15

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

Question 16

what is ptosis

Answer 16

one or both upper eyelid assume an abnormally low position

Question 17

ptosis is classified into ? and why is this important ?

Answer 17

congenital and acquired

differentiation in treatment

Question 18

what is the cause for congenital MYOGENIC ptosis?

Answer 18

isolated dystrophy of the of the levatator muscle

Question 19

what are the signs for congenital myogenic ptosis ?

Answer 19

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

Question 20

in 25 percent of the cases for dystrophic changes in levitator pallbearer superior what other muscle is also involved ?

Answer 20

superioir rectus muscle

Question 21

want is congenital neurogenic ptosis ?

Answer 21

occulomotor nerve palsy - partial or icomplete

Question 22

in congenital neurogenic ptosis what are the other signs involved ?

Answer 22

inability to elevate , depress , adduct the eye

mydriasis

Question 23

if the lid is completely and permanently closed due to congenital neurogenic ptosis what is this called ?

Answer 23

amblyopia - lazy eye

Question 24

what congenital diseases do congenital neurogenic ptosis associated with ?

Answer 24

congenital horner syndrome

Question 25

what causes acquired myogenic ptosis ?

Answer 25

myasthenia gravis - also diplopia occurs

Question 26

what is a diagnostic sign of myasthenia graves ?

Answer 26

lid fatigue
increasing ptosis on prolonged up gazing

PTOSIS REVERSED in rest or local application of ice

Question 27

what causes acquired neurogenic ptosis?

Answer 27

occulmotor nerve plays due to ischemia - microvascular disease
secondary to atherosclerosis
aneurysm
tumors
acquired horner syndrome - disruption of sympathetic innervation

Question 28

what also accompanies ptosis in acquired neurogenic ptosis ?

Answer 28

impaired adduction , depression , elevation of globe

Question 29

acquired horner syndrome in acquired neurogenic ptosis has what signs ?

Answer 29

mild ptosis
mild elevation of lower eye lid - appearance of enopthalmus
miosis

Question 30

how do we know in acquired horner syndrome is the lesion is proximal to the superior cervical ganglion ?

Answer 30

accompanying anhidrosis of ipsilateral face and neck

Question 31

what is the treatment of ptosis ?

Answer 31

exclusion of myasthenia graves all ptosis treated surgical

early surgery in children - prevent amblyopia

Question 32

what are the pathological position of the eyelids

Answer 32

entropian
ectropian
epicanthus
blepharochalasis
ptosis