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Plastic Surgery( Grabb)Ali jasim > Blepharoplasty > Flashcards

Blepharoplasty Flashcards

1
Q

Complications following upper lid surgery are rare but
include lagophthalmos and dry eye

A

T

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2
Q

the lateral canthus may become lax, causing lid malposition and rounding of the lateral commissure with aging process

A

T

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3
Q

The goal of blepharoplasty is to
restore a mor� youthful appearance without any compromise of phys-
10log1c function

A

T

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4
Q

margin of the upper eyelid should cover the superior 1 to 2 mm of the
cornea whereas the margin of the lower eyelid is usually within 2 mm
of the inferior border of the cornea

A

T

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5
Q

The pretarsal portion is important for voluntary blinking

A

F The pretarsal portion is important for involuntary blinking The preseptal and orbital
portions of the orbicularis are involved with voluntary blinking and
forced eyelid closure

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6
Q

Which part of orbicularis can cause brow depression

A

The orbital portion of the orbicularis can cause
brow depression in the upper lid, and attenuation of this muscle can
contribute to festoons in the lower lid

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7
Q

the central and
medial (or nasal) fat pad, separated by the superior oblique extraocular muscle

A

T

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8
Q

The medial fat pad is lighter in color than the central fat pad
and sits near the supratrochlear nerve and vessels

A

T

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9
Q

the ligaments that connect the lacrimal glands to the bone
(Sommering ligaments) attenuate, the palpebral lobe can cause a prominent fullness in the lateral upper lid fold

A

T

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10
Q

The levator is innervated
by cranial nerve III and Muller muscle is innervated by the sympathetic nervous system.

A

T

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11
Q

The lid crease is higher in men .

A

F The lid crease is generally lower in men (6-8 mm) than women
(8-10 mm;

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12
Q

The superior tarsal conjunctiva contains an abundant number of
goblet cells responsible for forming the mucous layer of the tear film.

A

T

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13
Q

The tarsal plate of the lower eyelid is shorter,
only 3 to 4 mm in height

A

T

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14
Q

The medial
and central fat pads are divided by the inferior oblique extraocular
muscle.

A

T

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15
Q

The lower eyelid retractors

A

the capsulopalpebral fascia and inferior tarsal muscle,

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16
Q

Extend of the tear trough

A

nasojugal groove and extends inferolaterally from the medial canthus to
approximately the midpupillary lin

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17
Q

represents the lower edge of the orbicularis

A

zygomatical-facial (or cutaneous) ligament, which forms attachments from the bone to the dermis.
This usually represents the lower edge of the orbicularis

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18
Q

The lateral canthus t has a deep limb that attaches to a tubercle 1.5 mm posterior to the lateral orbital rim (Whitnall tubercle)
as well as a superficial limb, which inserts on the rim.

A

T

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19
Q

The medial canthus has a large
anterior limb and a small posterior limb, inserting on the anterior or
posterior lacrimal crest, respectively. They surround the lacrimal sac

A

T

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20
Q

The Asian eyelid differs significantly from Caucasian anatomy HOW ?

A

The upper lid crease may be absent, low, or present only laterally
because of a lack of connections between the skin and levator.
A medial epicanthal fold may be present,
the upper tarsus may be shorter.
The Asian upper lid has more fullness because of preaponeurotic fat
that extends more caudally,
There is an upward lateral canthus tilt.

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21
Q

unrealistic self-image or who are not capable of understanding the
limitations of the procedure are poor surgical candidates.

A

T

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22
Q

Blepharoplasty should
not be considered within 6 months of refractive surgery as this predisposes the patient to dry eyes.

A

T

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23
Q

Examination of the lid laxity

A

Snap pack
lid distractiion test

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24
Q

A lid distraction test pulls the lower lid from the globe anteriorly, and a distance of greater than 6 mm is considered abnormal

A

t

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25
Q

the ocular surface for dryness examination

A

Schirmer test
fluorescein dye test

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26
Q

Schirmer test

A

placing a 5 by 35 mm strip of filter paper in the lateral conjunctiva!
cul-de-sac, and waiting 5 minutes. Normal eyes show 10 or more mm
of wetting of the filter paper

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27
Q

In clinical practice, Schirmer testing is
infrequently used

A

T

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28
Q

fluorescein dye

A

Staining of the ocular surface with fluorescein dye
and examination under blue light reveals punctate staining corneal
erosions in patients with dry eyes. This examination is more efficient
in identifying patients with dry eye and is preformed routinely in
ophthalmology offices.

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29
Q

A. squint test delineates the function of the upper orbicularis

A

F A. squint test delineates the function of the lower orbicularis

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30
Q

the Bell phenomenon

A

This is done by forcibly holding the eyelids open as the patient
tries to close them, and seeing if the globe rolls up to protect the cornea. Absence of this reflex puts the eye at risk for dryness and ulceration if postoperative lagophthalmos is present

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31
Q

Modern
techniques rely on a careful diagnosis of the patient, restoration of
more youthful anatomy, and preservation of fat

A

T

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32
Q

The lateral edge of the mark
should be extended to the orbital rim along a crow’s foot crease, but
no more than l O mm beyond the canthus

A

T

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33
Q

The medial marking should not extend beyond the
punctum to avoid webbing

A

T

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34
Q

There should
always be at least 10 mm of skin left below the brow.

A

T

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35
Q

A safe rule of thumb is that skin resection should preserve a brow to margin distance of at least 20 mm

A

T

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36
Q

Great care is taken to avoid any traction on the fat as
this can lead to bleeding posterior to the septum and a retro-orbital
hemorrhage

A

T

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37
Q

Minimal conservative fat removal is recommended

A

T

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38
Q

Patients with
fat prolapse or tear trough deformity and minimal excess skin can
be approached with a transconjunctival lower lid blepharoplasty
with fat excision or redraping

A

T

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39
Q

The incision is then stairstepped so that the muscle incision is made
5 mm below the lashes to spare the pretarsal orbicularis

A

T

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40
Q

Vicryl suture is used to resuspend the orbicularis
to the soft tissue and periosteum in the area of the lateral orbital
rim to provide mechanical support for the lower lid and prevent
ectropion.

A

T

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41
Q

If the patient was found to have significant lower eyelid laxity during
the preoperative evaluation, they are at higher risk for ectropion with
any skin resection

A

T and a lateral canthal tightening procedure should be
performed

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42
Q

A canthopexy can be used for mild laxity.

A

T

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43
Q

canthoplasty or lateral tarsal strip addresses moderate to severe
lower lid laxity.

A

T

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44
Q

Lateral canthal support is generally not needed
in a transconjunctival approach, as the orbicularis is not weakened by
division.

A

T

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45
Q

Severe festoons treatment

A

muscle
resection, redraping, or suspension along with midface lift, liposuction, or direct excision.

46
Q

Patients should avoid strenuous activity or bending below the waist
for 2 weeks

A

T

47
Q

presents as severe pain, pressure, and decreased
vision. in first 24 hours indicate what

A

retroseptal hematoma

48
Q

Examination is diagnostic as there is proptosis, limitation of
extraocular movements, and increased intraorbital pressure

A

T

49
Q

In the case of vision threatening hematomas

A

t urgent opening of the incision for evacuation of the hematoma. A
lateral canthotomy can be performed to relieve intraorbital pressure.
If the patient has developed vision loss, high-dose IV steroids should
be initiated to maximize visual recovery.

50
Q

Persistent lagophthalmos is usually the
result of aggressive skin removal or scarring of the orbital septum

A

T

51
Q

Erythema and purulent discharge should be treated with antibiotics and culture, and computed tomography may be necessary to
evaluate for an orbital abscess.

A

T

52
Q

Diplopia is usually transient and
is managed conservatively.

A

T

53
Q

Tearing is usually transient

A

T

54
Q

Acute Complications

A

Orbital Hematoma
Corneal Abrasion
Lagophthalmos
Chemosis
Infection
Corneal Exposure/Dry Eye
Diplopia
Epiphora

55
Q

Long-Term Complications

A

Asymmetry
Lid Malposition
Dry Eye Syndrome
Unsightly Scars

56
Q

Lower lid surgery carries more risk

A

T

57
Q

Blepharoplasty the 4th leading cosmetic procedure for plastic surgeons

A

T

58
Q

The tarsus, or tarsal plate, is the cytoskeleton structure of the eyelid. It is made up of connective tissue and Meibomian glands, which
secrete an oil that prevents evaporation of the eye’s tear film

A

T

59
Q

The orbital fat pads behind the septum are separated from the
inferior fat pad by the orbitomalar ligament, in lower eyelid

A

T

60
Q

Beneath the orbitomalar ligament is the prezygomatic space
where the suborbicularis oculi fat resides

A

T

61
Q

Malar mounds are
defined as chronic soft tissue edema between the infraorbital rim and
the midcheek. If chronically and severely swollen, then the skin and
muscle in this area may elongate and form permanent cascades called
festoons

A

T

62
Q

The lateral canthus is approximately 10 mm in length

A

T

63
Q

The marginal arcade is usually found 2 to 3 mm from the lid margin on the
anterior surface of the tarsus

A

T

64
Q

The upper lid has an additional peripheral arcade, found on the anterior surface of the Miiller muscle

A

T

65
Q

Inferior to
the zygomatic-facial ligament, the malar fat is present anterior to the facial muscles

A

T

66
Q

Dry eye history is elicited by asking about blurry
vision that clears with blinking,

A

T

67
Q

always some degree of asymmetry present in human eye

A

T

68
Q

The margin to
reflex distance (MRDl) Measurement

A

This is the measurement
in millimeters from the light reflex on the patient’s cornea to the level
of the center of the upper eyelid margin, with the patient gazing in
the primary position. Ifthe margin to reflex distance is 2 mm or less,
the patient is considered to have visually significant ptosis

69
Q

The amount of
excess skin ofthe upper eyelid (dermatochalasis) should be assessed.

A

t

70
Q

lower eyelid blepharoplasty is generally functional.

A

F In contrast to upper eyelid blepharoplasty, lower eyelid blepharoplasty is generally cosmetic.

71
Q

The position of the globe relative to the orbital rim in noted. If the
globe is more anterior than the orbital rim, this is called a positive
vector and may suggest thyroid disease or a patient prone to dry eye
problems. If the globe is posterior to the rim, this is called a negative
vector

A

T

72
Q

capsulopalpebral fascia (a fibrous extension from the inferior rectus that inserts onto the inferior tarsus)

A

T

73
Q

Whitnall tubercle

A

Small elevation ofthe zygomatic bone just inside the lateral orbital rim that serves as the attachment point for the lateral canthaI
tendon, the lateral horn ofthe levator aponeurosis, the check ligament ofthe lateral rectus and Lockwood ligament

74
Q

Retro-orbicularis oculi fat (ROOF)-Fat pad deep to the brow, which may also descend with aging

A

T

75
Q

Dermatochalasis-Excess skin ofthe upper or lower eyelid, and may obstruct the upper visual field

A

T

76
Q

Blepharochalasis-Excess skin caused by repeated episodes ofedema

A

T

77
Q

Steatoblepharon-Excess or protruding fat

A

T

78
Q

Functional benefits are noted for an MRD I
of 2 mm or less measured in primary gaze, superior visual field loss
of 12 degrees or 24%,

A

T

79
Q

The medial and lateral crease is generally 4 to 5 mm
above the lid margin.

A

T

80
Q

If the position of the lid crease is different on
each side, choose one crease height and mark symmetric incisions for
each eyelid

A

T

81
Q

Eyelashes should just evert with the pinch test

A

T

82
Q

not always needed, removal of muscle may be done to
decrease fullness or to create a crisp supratarsal fold. A strip of 3 to
5 mm is removed

A

T

83
Q

The
medial orbital fat pad typically requires debulking more often than
the central pad

A

T

84
Q

Some patients have a prominent fat fad under the lateral third
of the brow, which is below the orbicularis. This is called retro-orbicularis oculi fat and can be resected at the time of blepharoplasty

A

T

85
Q

Double armed sutures can be used to engage the
inferior tip of the gland and secure it to the periosteum just inside the
superior orbital rim at the lacrimal fossa.

A

T

86
Q

sutures are
typically removed 7 days after surgery

A

T

87
Q

The lower incision should be 5 to
7 mm inferior to the upper lid incision.

A

T

88
Q

A subciliary skin incision is marked 2 mm below the lower eyelid
lashes

A

T

89
Q

The incision is then stairstepped so that the muscle incision is made
5 mm below the lashes to spare the pretarsal orbicularis

A

T

90
Q

A skin-muscle flap is dissected inferiorly to below the orbital rim. The orbitomalar ligament is completely released so that the skin is no longer fixed
to the bone.

A

T

91
Q

conservative in the amount of skin resected because this can
cause retraction of the lower eyelid

A

T

92
Q

If the patient was found to have significant lower eyelid laxity they are at higher risk for ectropion with
any skin resection and a lateral canthal tightening procedure should be
performed

A

T

93
Q

In a lateral tarsal strip, the lid is redraped laterally.

A

T

94
Q

Transconjunctival Approach

A

A scalpel or cutting cautery is used to incise the conjunctiva just
below the tarsal plate.

95
Q

The lower eyelid retractors are divided. Dissection
proceeds inferiorly, between the septum and orbicularis, to expose the fat
pads and orbital rim

A

T

96
Q

Patients are advised to elevate their heads and apply cool compresses
or ice to the eyelids for the first 24 to 48 hours.

A

T

97
Q

Patients should expect postoperative swelling and bruising to
persist for up to 2 weeks after surgery

A

T

98
Q

Measurement to decrease the orbital hematoma

A

careful tissue handling to avoid traction of the fat pads and careful hemostasis of the base of the fat pad.
Preoperative considerations such as control of hypertension and the
avoidance of aspirin and blood thinners can decrease this risk as wel

99
Q

The patient presents immediately postoperatively with severe eye pain,
tearing, andblurredvision withaforeignbodysensation. Ophthalmology
consultation may use fluorescein and a Wood’s lamp to document an
abrasion

A

t

100
Q

Persistent lagophthalmos is usually the
result of aggressive skin removal or scarring of the orbital septum.
Reoperation with lysis of scar tissue and/or skin grafting may be
required in severe cases.

A

t

101
Q

Conjunctiva! edema is common after surgery and is usually self-limited. Artificial tears and a steroid eyedrop/ ointment can be prescribed
if the swelling is severe

A

t

102
Q

Infection is rare because of the excellent vascularity of the face.

A

t

103
Q

The superior and inferior oblique muscles are the most commonly
injured extraocular muscles in upper and lower blepharoplasty,
respectively

A

t

104
Q

Strabismus surgery or prism glasses may be used to
correct persistent diplopia.

A

t

105
Q

An altered lid position
may also cause tearing. Tearing is usually transient

A

t

106
Q

The tear trough ligament is an osteocutaneous
ligament between the palpebral and orbital portions of the
muscle.

A

t

107
Q

The inferior oblique arises from the orbital surface of the maxilla, lateral to the lacrimal sac and inserts into
the scleral surface

A

T

108
Q

A superior rectus palsy would present with
limitation ofupgaze in abduction

A

T

109
Q

superior oblique injury would have limited downgaze in adduction

A

T

110
Q

An inferior rectus
palsy would limit abducted downgaze.

A

T

111
Q

A Jones test

A

evaluates lacrimal outflow by placing fluorescein into the conjunctiva and then testing for it in the inferior nasal meatus.

Plastic Surgery( Grabb)Ali jasim (92 decks)

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