5 - Ant Seg Eyelids Flashcards
Telecanthus
> normal distance b/w inner canthi
Seen in many syndromes
Dist b/w orbital walls is normal (i.e. orbits are not displaced)
Hypertelorism
Large dist b/w medial orbital walls bc of lateralization of the orbits
Epicanthus
Crescent-shaped vertical skin folds overlying medial canthi
Seen in prominent epicanthal folds
From immature facial bones
Cryptophthalmos
Rare
Due to failed differentiation of lid and anterior eye structures
Skin fused over eye, blends into anomalous cornea
Basically no eye
Usually occurs in kids with systemic problems with short lifespans
Eyelid coloboma
Congential Fairly common Usually cleft/notching of upper lid Eyelid can fuse to the globe Unrelated to other colobomas, which are inferior Concerns = exposure keratopathy Goldenhar syndrome = smaller ear, cleft palate, lid coloboma Surgerically closed
Congentical ectropion
Eversion of margin, usually lower lid
Lateral tarshorrhaphy could be indicated
-dump a lot of artif tears, suture lids together
Skin flap/graft in more severe cases
Congential entropion
Eyelid inversion at birth
Rare
Surgery if concerns for corneal integrity
-scarring, amblyopia, strab, etc.
Ankyloblepharon
Partial/complete eyelid fusion
Epiblepharon
Common, esp in Asians Congenital redundant fold of skin at lid margin -epiblepharon due to extra fold of skin -entropion due to eyelid folded inwards Commonly lower lid Lashes turn inward, onto cornea -cornea tolerates better than entropion Could resolve spontaneously Lubricants Repair if chronic K irritation -if severe, sx to release fold
Distichiasis
Partial/complete extra row of lashes at/posterior to MGs
Thinner, shorterm less pigmented
Tx if irritation (K integrity)
Blepharophimosis/congenital eyelid syndrome
Palpebral fissure is tight, shortened horiz and vert
-so tight, looks light eyes are being pushed back in
Spordic or AD
Poor levator function - difficulty looking in upgaze
Treatment
- delay in repair bc epicanthus and telecanthus can improve with age
- ptosis repair (frontalis suspension)
- repair to allow bridge to develop fully
Congenital ptosis
Blepharoptosis = eyelid droop
Poor levator func
Can run in families
Anisometropic amblyopia and strab can develop
Ptosis evaluation
- assess (4)
- measure (2)
Upper lid crease, VF, tear function, corneal sensitivity
Palpebral fissure height
Magin reflex distance (MRD) = dist from upper lid margin to corneal reflex in primary
Ptosis evaluation
-levator function
Hold brow (block frontalis action) and measure dist upper lid can move when pt looks from up to downgaze -e.g. ~18mm in good eye, ~12mm in ptotic
Ptosis evaluation
- bell’s phenomenon
- globe assessment
Poor
Determine if microphthalmic or hypertropia is present that could be a pseudoptosis
