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OQ Review > BCSC 7. Orbit, Eyelids, and Lacrimal System > Flashcards

BCSC 7. Orbit, Eyelids, and Lacrimal System Flashcards

1
Q

Nasolacrimal duct opens into ->

A

inferior meatus

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2
Q

sphenoid sinus drains ->

A

sphenoethmoidal recess

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3
Q

Frontal sinus, maxillary sinus, anterior and middle ethmoid air cells drain into ->

A

middle meatus

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4
Q

posterior ethmoid air cells drain ->

A

superior meatus under superior turbinate

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5
Q

Largest paranasal sinus

A

Maxillary

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6
Q

Anatomical layer that the temporal (frontal) branch of cranial nerve VII is found

A

temporoparietal fascial (superficial temporalis fascia)

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7
Q

Wider-than-normal separation between medial orbital walls

A

Hypertelorism (Bone, increased IPD, increased OCD)

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8
Q

Wide intercanthal distance

A

Telecanthus (Normal IPD, normal OCD) ‘T - tissue’

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9
Q

Angle between lateral orbital walls greater than 90 degrees, may have shallow orbital depth.

A

Exorbitisim

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10
Q

Proptosis of eye associated with TED

A

Exophthalmos

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11
Q

Failure of what embryonal developmental process results in microphthalmia with orbital cyst

A

Choroidal fissure closure

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12
Q

Failure of what embryonal developmental process results in anophthalmia

A

Primary optic vesicle fails to grow out from cerebral vesicle at 2-mm stage of embryonic development.

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13
Q

Etiology of craniofacial clefts

A

Developmental arrest (failure of neural crest cell migration) and mechanical disruption of development

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14
Q

4 yo M with lytic bony changes on CT and superotemporal orbtial mass. Histology shows fibrous connective tissue and infiltrate of eosinophils and histiocytes. Dx and systemic condition ->

A

Eosinophilic granuloma - Diabetes insipidus

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15
Q

Best way to diagnose pleomorphic adenoma?

A

Complete excision

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16
Q

Le Fort fractures always involve ->

A

Pterygoid plates - must extend posterior through these plates with possible orbital and nasal involvment

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17
Q

Tx for traumatic optic neuropathy

A

Controversial - observation alone is acceptable. Recent multicenter prospective nonrandomized trial failed to show benefit from corticosteroids or surgical treatment.

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18
Q

Best surgical approach for mass in lacrimal gland region

A

eyelid crease incision - excellent exposure, good cosmesis

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19
Q

Best surgical approach for inferior mass

A

“swinging eyelid” approach

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20
Q

Best approach to minimize scarring for mass in medial subperiosteal space

A

Transcaruncular incision

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21
Q

Good access to superior orbital rim and periosteum

A

eyelid crease incision

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22
Q

Typically does not contribute to socket contraction

A

Wearing conformer or prosthesis 24 hours day

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23
Q

Name 3 things that contribute to socket contraction

A

Radiation, multiple socket operations, extrusion of orbital implant

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24
Q

In non-asians, where does the orbital septum of the upper eyelid fuse with the levator aponeurosis

A

2-5 mm above the superior tarsal border

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25
Q

Where does the levator aponeurosis attach to the tarsus

A

inferior third of the tarsus

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26
Q

Fusion of the periosteum of facial bones, periorbita and orbital septum

A

arcus marginalis

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27
Q

Acts as a pulley for the force of the levator muscle and provides suspensory support for the upper eyelid and superior orbital tissues

A

Whitnall ligament

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28
Q

Congenital eyelid condition more common in asian children that may contribute to mechanical entropion of lower eyelid margin

A

Epiblepharon - lower eyelid pretarsal muscle and skin ride above the lower eyelid margin to form horizontal fold of tissue that causes cilia to assume vertical position. May improve w/o surgical intervention.

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29
Q

Horizontal widening of palpebral fissure due to inferior insertion of lateral canthal tendon

A

Euryblepharon - a/w ectropion of lateral 1/3 of lid

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30
Q

Fusion of part or all of eyelid margins

A

Ankyloblepharon - may be congenital (AD, craniofacial abnormalities) or acquired (Thermal, chemical, OCP, SJS).

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31
Q

Congenital bilateral ectropion of the upper eyelids

A

associated with Down’s syndrome, ichthyosis, and sporadic cases in newborns from black population.

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32
Q

Horizontally and vertically shortened palpebral fissures with poor levator function

A

Blepharophimosis

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33
Q

Ptosis, telecanthus, epicanthus inversus, lower lid ectropion, anteverted ears, hypoplasia of nasal bridge, sup orbital rim

A

Blepharophimosis syndrome (AD, 3q)

34
Q

Lower lid coloboma

A

Treacher collins, Goldenhar’s lateral 1/3, partial

35
Q

Upper lid coloboma

A

medial 1/3, no systemic, full thickness

36
Q

Medial canthal vertical scin folds

A

Epicanthus (Tarsalis - upper, asian; inversus - lower blepharomphimosis; Palpebralis - upper and lower equal; Supraciliaris - fold arises from eyebrow and extends to lacrimal sac)

37
Q

Associations of telecanthus

A

FAS, Waardenburg’s blepharophimosis

38
Q

A/w Muir-Torre syndrome and visceral malignancies

A

Sebaceous hyperplasia

39
Q

Reconstruction of lacrimal system after BCC of lacrimal sac or NLD s/p tumor removal should occur

A

after 5 years to minimize tumor spread

40
Q

Repair for defect >50% of lower eyelid

A

Hughes flap (eyesharing) combined with skin grafting of anterior lamella

41
Q

Repair for defect >50% of upper eyelid

A

Cutler-Beard

42
Q

Characteristic finding in blepharophimosis-ptosis-epicanthus inversus syndrome (BPES)

A

Telecanthus, epicanthus inversus, severe ptosis, limited levator function (+/- hypertelorism, ectropion, hypoplasia of superior orbital rims)

43
Q

Typical feature of cicatricial ectropion of lower eyelid

A

Anterior lamellar deficiency

44
Q

Finding often a/w cicatricial entropion of lower eyelid

A

posterior lamellar shortening

45
Q

Lower eyelid retractor disinserition, lower eyelid laxity, overriding preseptal orbicularis muscle

A

involutional entropion

46
Q

Finding seen in involutional ptosis

A

higher than normal eyelid crease, normally functioning levator >15 mm, ipsilateral compensatory eyebrow elevation

47
Q

Deep superior sulcus

A

Aponeurotic disinsertion resulting in superior migration of orbital septum and underlying preaponeurotic fat

48
Q

Absent or poorly formed eyelid

A

congenital ptosis

49
Q

inability to close the eyelids completely

A

Lagophthalmos

50
Q

Levator function <6mm

A

Frontalis sling

51
Q

Sign of hemifacial spasm

A

Unilateral sx that persist at night

52
Q

Bilateral involvement of eyelid protractors, abate at night

A

BEB - benign essential blepharospasm

53
Q

BEB benign essential blepharospasm may progress to

A

Meige syndrome

54
Q

Rare neurological movement disorder characterized by involuntary and often forceful contractions of the muscles of the jaw and tongue (oromandibular dystonia) and involuntary muscle spasms and contractions of the muscles around the eyes (blepharospasm)

A

Meige syndrome,

BEB benign essential blepharospasm may progress to this

55
Q

Vessel that lies anterior to the lacrimal sac

A

Angular artery and vein

56
Q

Extension of orbicularis in the deep head of the medial canthal tendon

A

Horner muscle

57
Q

Why does lacrimal sac distend inferiorly in dacryocystitis

A

Superior portion of sac is fibrinous

58
Q

Valve of rosenmuller

A

mucosal fold located at junction of common canaliculus and lacrimal sac. 1-way valve to prevent reflux of tears into common canaliculus during lacrimal pump cycle.

59
Q

Valve of hasner

A

Distal end of NLD, inferior meatus

60
Q

Most cases of symptomatic congenital NLDO resolve by

A

12 months

61
Q

B/L congenital NLDO occurs in

A

1/3 of cases

62
Q

When is surgical indication necessary for congenital NLDO

A

dacryocystitis

63
Q

Helps distinguish between true epiphora resulting from NLDO and other conditions causing excessive tearing

A

Dye disappearance test (first test to perform)

64
Q

Procedure with highest likelihood of creating an intact lacrimal drainage system.

A

CDCR - conjunctivodacryocystorhinostomy (DCR will not address problem at canaliculus)

65
Q

Most crucial step in successful external DCR

A

osteotomy through the lacrimal sac fossa and into nose

66
Q

First line treatment for adult with acute erythrematous, tender medial canthal mass inferior to the medial canthal tendon

A

Dx - acute dacryocystitis 1. give oral abx 2. I&D if no improvement with abx or relief of acute pain is necessary. 3. External DCR after acute infection resolves.

67
Q

Vascular congestion over the insertions of the rectus muscle (particularly the LR)

A

TED

68
Q

Corkscrew conjunctival vessels

A

AV fistula

69
Q

S-shaped eyelid

A

Plexiform neurofibroma or lacrimal gland mass

70
Q

Eczematous lesions of eyelids

A

Mycosis fungoides (T-cell lymphoma)

71
Q

Ecchymosis of eyelid skin

A

Metastatic neuroblastoma, leukemia, or amyloidosis

72
Q

Prominent temple

A

Shenoid wing meningioma or metastatic neuroblastoma

73
Q

Edematous swelling of lower eyelid

A

Meningioma, inflammatory tumor, metastasis

74
Q

Frozen globe

A

Mets or zygomycosis

75
Q

Black crusted lesions in nasopharynx

A

Phacomycosis

76
Q

Facial asymmetry

A

Fibrous dysplasia or neurofibromatosis

77
Q

Eyelid retraction and lid lag

A

TED

78
Q

Protruding contents of meninges

A

Meningocele

79
Q

Protruding contents of brain

A

encephalocele

80
Q

protruding contents of brain and meninges

A

meningoencephalocele

81
Q

Mechanism of TED

A

Circulating immunoglobulin (IgG) recognizes and activates insulin like growth factor I receptor expressed on surface of fibroblasts (origin NCC), stimulating to secrete GAGs, cytokines, chemoattractants.

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