Cognition & Senses 2: Eyelids Flashcards
PALPEBRAE definition
= EYELIDS
BLEPHARON definition
= EYELIDS
ADNEXA definition
= TISSUES around the eye, including the LIDS & SKIN within 1 CM around the eye
which MUSCLE in the eye is primarily involved in BLINKING?
what CRANIAL NERVE innervates it?
ORBICULARIS OCULI
innervated by FACIAL nerve (CN VII)
animals tend to have CILIA only on…
THE UPPER EYELID
name 3 functions of the EYELIDS?
- PROTECTION of the eye & MAINTENANCE of OCULAR SURFACE HEALTH
- BLINKING to ENTRAP/REMOVE DEBRIS & help with TEAR FILM DISTRIBUTION
- GLANDULAR SECRETIONS of LIPID portion of the PRE-CORNEAL TEAR FILM to give NUTRITION to CORNEA & OCULAR SURFACE
LAGOPHTHALMOS definition
this is seen frequently in WHAT BREEDS of dog?
INABILITY to CLOSE THE EYELIDS over the GLOBE OF THE EYE
frequent in SMALL BREEDS that have EXOPHTHALMOS
MOST of the eyelid disease that we see is ___
SURGICAL
how LONG does it take for EYES TO OPEN IN DOGS/CATS?
what if the lids open PREMATURELY?
what if the lids DO NOT OPEN? (name the term & clinical signs)
how LONG? = 10-14 days in DOGS/CATS
lids open PREMATURELY…
= DAMAGE TO THE OCULAR SURFACE
lids DO NOT OPEN = OPHTHALMIA NEONATORUM, causing CONJUNCTIVITIS/INFECTION
in SMALL ANIMAL PRACTICE, we MAINLY see eye diseases that affect the ____ ____, which can result in ____ ____ disease, such as… (2)
EYELID MARGIN, OCULAR SURFACE disease, such as…
1. CORNEAL ULCERS
2. SCARRING
what are the 4 main CATEGORIES of EYE DISEASE we’ll see in small animal practice?
- EYELID MARGIN INTEGRITY
- MEIBOMIAN GLANDS (tarsal glands)
- PERIOCULAR SKIN
- BLINKING
4 most common DISEASES that COMPROMISE eyelid margin integrity
- TRAUMA causing EYELID LACERATION (ex = running through bushes)
- CONFORMATIONAL/BREED-RELATED from ENTROPION
- EYELID NEOPLASMS
- DEVELOPMENTAL abnormalities where PARTS OF EYELID ARE ABNORMAL or MISSING
TRAUMA to the EYELIDS…
requires what 2 things? why?
what is the GOAL? why?
requires…
1. SURGERY
2. REPAIR ASAP
why? –> if the eye is left to heal on its own by SECONDARY INTENTION, could cause FIBROSIS & IRREGULAR EYELID MARGIN leading to OCULAR DZ
GOAL = to RESTORE SMOOTH EYELID MARGIN
EYELID SURGERY…
how does the eye tend to heal? risk of infection?
what 4 things are REQUIRED to do the surgery?
how do PREP around the eye?
eye tends to heal QUICKLY due to GOOD BLOOD SUPPLY & LOW RISK OF INFECTION
what 4 things are REQUIRED to do the surgery?
1. good MAGNIFICATION 2-4 X
2. HIGH INTENSITY, FOCAL LIGHT
3. SMALL SUTURE often VICRYL (absorbable) or SILK (needs to be removed)
4. APPROPRIATE INSTRUMENTATION specific for eyelids
PREP = must use DILUTE BETADINE, we CANNOT USE ALCOHOL OR CHLORHEXIDINE because it can CAUSE A CORNEAL ULCER
SURGICAL RESTORATION of EYELID MARGIN…
3 steps?
steps?
1. put SUTURE THROUGH MEIBOMIAN GLANDS in a FIGURE-8 SUTURE to KEEP KNOT AWAY FROM EYE
- close the wound at eyelid margin in 2 LAYERS
- use SIMPLE INTERRUPTED sutures to FINISH THE WOUND
POST-OP CARE for EYELID SURGERY? (3)
if you use APPROPRIATE SURGICAL TECHNIQUE, MOST patients…
- E-COLLAR for 14 DAYS (or until suture removal)
- TOPICAL ANTIBIOTICS/ANTI-INFLAMMATORY (NeoPolyDex) for 14 DAYS
- EXERCISE RESTRICTION for 1-2 WEEKS
if you use APPROPRIATE SURGICAL TECHNIQUE, MOST patients have a GOOD OUTCOME
ENTROPION vs. ECTROPION?
what PART of the eyelid can be affected?
which one is MORE LIKELY to cause TEARING?
ENTROPION = eyelid margin ROLLING INTO EYE (more common)
–> MORE LIKELY TO CAUSE TEARING
ECTROPION = ROLLING OUT of the EYELID MARGIN
ONE or BOTH parts of the eyelid can be affected
ID LESION
ENTROPION
ID LESION
ECTROPION
ENTROPION…
3 causes?
if you apply TOPICAL ANESTHESIA to the eye, WHICH of the causes will see RESOLUTION?
3 causes?
1. PRIMARY = common in SOME BREEDS
–> Shar Peis
–> Bulldogs
- SPASTIC = CHRONIC SQUINTING causes EYE to be PULLED IN
- CICATRICAL ENTROPION = from CHRONIC SPASTIC ENTROPION causing SCARRING TO EYE
if we give TOPICAL ANESTHESIA, then SPASTIC & CICATRICAL ENTROPION will be RESOLVED!
BLEPHAROSPASM DEFINITION
SQUINTING
EPIPHORA definition
when TEARS SPILL OVER THE LIDS from EXCESSIVE TEAR PRODUCTION
TRICHIASIS definition
= NORMAL HAIRS that are GROWING TOWARDS THE EYE & PUSHING ON IT
KERATITIS definition
if it’s LONG-TERM, can cause formation of ____ ____
= INFLAMMATION of the CORNEA
if it’s LONG-TERM, can cause formation of GRANULATION TISSUE
PTOSIS definition
can sometimes SECONDARILY cause ___
= when the UPPER EYELID starts to SAG
can can sometimes SECONDARILY cause TRICHIASIS (normal eyelashes touching surface of eye)
TREATMENT for ENTROPION…
what 4 CLINICAL SIGNS do we need to address?
treatment depends on…
3 options?
4 signs?
1. TRICHIASIS
2. PAIN
3. TEARING
4. CORNEAL IRRITATION
treatment depends on the AGE of the ANIMAL / COMPLEXITY
3 options?
1. PUPPY = TEMPORARY TACK around the eye, sometimes FOLDS CAN EVEN OUT WITH AGE
- if MILD = LUBRICATION BID to act as BARRIER between HAIRS & EYE SURFACE
- if MODERATE to SEVERE = SURGERY
SURGERY for ENTROPION…
we should choose the ___ TECHNIQUE to CORRECT THE PROBLEM
most commonly we use WHAT technique? (2 names)
we should choose the SIMPLEST TECHNIQUE to CORRECT THE PROBLEM
most commonly, we use the HOTZ-CELSUS or SMILE technique
HOTZ-CELSUS surgical technique…
used to treat WHAT?
5 steps?
used to treat ENTROPION surgically
steps?
1. STABILIZE LID
- mark 2 LINES
–> one a couple mm from EYELID MARGIN that spans LENGTH OF ENTROPION
–> another HOW FAR YOU WANT TO ROLL OUT THE LID - make 2 INCISIONS with a BLADE at MARK
- REMOVE SKIN ONLY with SCISSORS
- close with ONE LAYER of SUTURE
EYELID NEOPLASMS…
commonality?
diffuse vs. focal?
often originates from the ___ ___ & causes SECONDARY ___ from…
MOST of what we see are ____ _____ _____ in DOGS
CATS vs. DOGS?
VERY COMMON
usually FOCAL
often originates from the MEIBOMIAN GLAND & causes SECONDARY CHELAZIAN from SECONDARY SWELLING OF GLAND bc LIPID PRODUCT CANNOT ESCAPE
MOST of what we see are MEIBOMIAN GLAND ADENOMAS in DOGS
DOGS = usually BENIGN
CATS = often AGGRESSIVE
what EYELID NEOPLASMS can we commonly see in CATS? (2)
- SQUAMOUS CELL CARCINOMA
- MAST CELL TUMORS
ID LESION
MEIBOMIAN GLAND ADENOMA
TREATMENT for EYELID NEOPLASM…
depends on… (3)
___ is usually required
depends on…
1. CLINICAL SIGNS –> is it bothering the pet?
2. TUMOR TYPE
3. COST of tx
SURGERY is USUALLY REQUIRED
ID LESION (2 possibilities)
what is the PROGNOSIS for this?
common in WHAT AGE dogs?
HISTIOCYTOMA or PAPILLOMA
prognosis is GOOD, these USUALLY REGRESS
common in YOUNG DOGS
SURGERY for SMALL EYELID TUMOR…
usually perform a ____ ____
4 steps?
what is ONE REQUIREMENT to even do this procedure?
–> what do we need to do?
usually perform a WEDGE RESECTION
steps?
1. make 2 INCISIONS on EITHER SIDE OF MASS at RIGHT ANGLES TO LID MARGIN
2. make a HOUSE-SHAPED INCISION so that LOWER-LID DOES NOT PUCKER
3. close in 2 LAYERS with 4-0 to 6-0 VICRYL (WEDGE and FIGURE OF 8)
4. submit for PATHOLOGY
the MASS must be <1/3 EYELID MARGIN LENGTH or else WILL NOT BE ABLE TO CLOSE EYE UPON REMOVAL
–> we need to MEASURE BEFOREHAND
TREATMENT for LARGE EYELID TUMOR…
= define WHAT a large eyelid tumor is
what DIAGNOSTIC procedure can we perform?
if we need to treat SURGICALLY…
= >1/3 EYELID LENGTH
diagnostic? = FNA if POSSIBLE!
if we need to treat SURGICALLY, might need RECONSTRUCTIVE PROCEDURE/SKIN GRAFT, so REFER OUT!
EYELID AGENESIS…
“aka?”
= definition & etiology
common in WHAT species?
causes what 3 clinical signs?
2 treatment goals?
aka “COLOBOMA”
= INCOMPLETE LATERAL UPPER EYELID MARGIN & CONJUNCTIVA that has CONGENITAL ORIGIN
3 clinical signs..
1. TRICHIASIS
2. TEARING
3. CHRONIC EXPOSURE KERATITIS
2 treatment goals?
1. RESOLVE TRICHIASIS
2. create SMOOTH EYELID MARGIN
ID DZ (2 names)
EYELID AGENESIS / COLOBOMA
what is the SURGICAL TREATMENT for EYELID AGENESIS / COLOBOMA?
what can be CHALLENGING about treating this?
use ROTATIONAL SKIN FLAPS to move SKIN FROM BELOW to TOP TO RECREATE EYELID MARGIN
difficult to RESTORE INTEGRITY OF EYELID MARGIN (close tightly)
DERMOID…
= definition
commonality?
tx?
= HAIR GROWING in ABNORMAL PLACE
UNCOMMON
tx = SURGICAL RESECTION
ID LESION
DERMOID
DISTICHIASIS
= definition
commonality?
unilateral vs. bilateral?
3 clinical signs?
= ABERRANT CILIA that GROW from the MEIBOMIAN GLANDS due to ABNORMAL DEVELOPMENT
COMMON
usually BILATERAL
3 clinical signs?
1. INCREASED BLINKING
2. BLEPHAROSPASM (squinting)
3. TEARING
ID LESION & define
DISTICHIASIS
ABERRANT CILIA grow out of MEIBOMIAN GLANDS
ID LESION
DISTICHIA
ECTOPIC CILIA…
= definition
commonly also have WHAT secondary condition?
2 clinical signs? 1 signalment?
= CILIA that emerge THROUGH PALPEBRAL CONJUNCTIVA to TOUCH CORNEA
commonly also have DISTICHIASIS
2 clinical signs?
1. PAINFUL EYE
2. RECURRENT CORNEAL ULCERS
1 signalment = YOUNG DOGS
TREATMENT for DISTICHIASIS…
most commonly? what is the procedure?
2 benefits?
2 risks? both are +/-
MOST COMMONLY = use CRYOTHERAPY to FREEZE MEIBOMIAN GLAND & DESTROY FOLLICLE
2 benefits?
1. SPARES the NORMAL tissue
2. PRESERVES EYELID MARGIN
2 risk?
+/- DEPIGMENTATION
+/- REGROWTH of hairs, but usually come back SOFTER
TREATMENT for ECTOPIC CILIA? (2)
- EXCISE the ABERRANT HAIRS
- use CRYOTHERAPY to REMOVE
CHALAZION…
= definition
2 common etiologies?
2 treatment options?
= LIPID in the MEIBOMIAN GLAND causing INFLAMMATION
2 common etiologies?
1. ATOPY (allergy)
2. EYELID TUMORS that are BLOCKING EXIT OF LIPID SECRETIONS
treatment?
1. WEDGE RESECTION to remove
2. use BLADE to EXCISE then CRYOTHERAPY
ID LESION
CHALAZION
BLEPHARITIS
= definition
causes WHAT 4 CLINICAL SIGNS?
clinical approach? (overall and 4 subs)
surgery?
= ANY SWELLING of EYELIDS
4 signs?
1. MARKED LID HYPEREMIA & EDEMA
2. PAIN
3. TEARING
4. SELF-TRAUMA (alopecia, erosions)
clinical approach? = DIAGNOSTICS to DETERMINE CAUSE, so CLIP & CLEAN then…
1. SKIN SCRAPE
2. C&S
3. CYTOLOGY
4. TRICHOGRAM
NO SURGERY
ID CLINICAL SIGN
BLEPHARITIS
7 possible ETIOLOGIES for BLEPHARITIS?
- BACTERIAL infection
- SEBACEOUS OVERPRODUCTION
- DEMODEX & SCABIES
- IMMUNE-MEDIATED
- DRUG RXN
- FOOD ALLERGY
- ACTINIC KERATOSIS (sun-related injury)
PUPPY STRANGLES..
aka?
= definition
3 tx?
if this is NOT RESOLVED…
common in WHAT patients? with WHAT?
aka BACTERIAL BLEPHARITIS
= STAPHYLOCOCCAL INFECTION around the EYELID
3 tx?
1. ANTIBIOTICS
2. ORAL PREDNISONE
3. TOPICAL ANTIBIOTICS & ANTI-INFLAMMATORIES via EYE DROPS
if NOT RESOLVED, can cause CICATRICAL ENTROPION from EYELID DISTORTION
common in WHITE FLUFFY DOGS with ATOPY
SURGICAL TREATMENT for ____ BREED with LAGOPHTHALMOS? (3 words, & define what it does)
is this always done?
BRACHYCEPHALIC BREED
= PERMANENT MEDIAL CANTHOPLASTY, helps to MAKE THE MEDIAL EYELID SMALLER
NOT ALWAYS DONE, can try LUBRICATING EYE REGULARLY
