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
Ptosis management
- mild/mod
- severe
- procedures (3)
Repair can be delayed several years - esp if have chin up position
Early correction required to prevent deprivation amblyopia
Levator resection
Levator tuck
Frontalis suspension
Marcus Gunn jaw winking
Congenital synkinesis of the jaw and levator muscles
Ptotic lid elevates with opening of mouth or jaw movement
Seen with infants suck bottle/pacifier
Tx: ptosis repair, combo of surgery with frontalis suspension
Chalazion
Blocked meibomian gland
Evolved from hordeolum
Hardened, painless
Hordeolum
Block meibomian gland
Acute, painful
Treatment for chalazion/hordeolum
Wam compress, blepharitis management, surgery for large/painful/chronic
Concerned if infant, eye is covered (amblyogenic)
Pyogenic granuloma
Pink growth of granulation tissue rapidly from conj over a chalazion or site of trauma
Nothing was ever done about the chalazion
Lumpy/bumpy appearance
Moves when touched
Snipped off
Molluscum contagiosum
Caused by DNA poxvirus
Shiny, dome-shaped, waxy, umbilicated skin papule
At/near lid margin
Can release viral particles onto conj -> follicular conj-itis
Most resolve spontaneously
-up to months/years
Neoplasms, other non-infectious lid lesions
- more common in what pop
- in less likely pop, when is it found
Adults»_space;> children
Neoplasms in children more likely with systemic disorders (e.g. xeroderma pigmentosum)
- easily bruise, bleed
- follow with dermatology
- cornea also scars up
Capillary malformation
Aka port-wine stain
Congenital malformation Flat red/pink cutaneous lesion Could fade, but more likely to darken More nodular/hardened with time Assoc with sturge-weber (vascular syndrome) Glaucoma could occur
Congenital nevus of skin
Could cause depriv amblyopia or have malignant transformation
-transf risk incr with size = importance of adequate measurements, referal to derm
Observe small/moderate lesions
- small <1.5mm
- mod <20mm
Trichotillomania
Pulling of one’s own hair
Assoc with OCD
Psych eval indicated
