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Diseases Of EyeLid Flashcards

1
Q

Trichiasis

A

Posterior misdirection of eye lashes from their normal sites of origin -> rubbing against conjunctive/cornea

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2
Q

Metaplastic lashes (Distichiasis)

A

Partial/complete second row of lashes arises from or behind the meibomian gland orifices

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3
Q

Madorosis

A

Decrease in number or complete loss of lashes

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4
Q

Poliosis

A

Premature whitening of lashes sometimes may involve eyebrows

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5
Q

Blepharitis

A

Bilateral symmetrical condition
Chronic inflammation of eyelid margins
Lid margin becomes thickened & red

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6
Q

Anterior Blepharitis

A

Due to staphylococcal infection in seborrhoeic patients

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7
Q

Posterior Blepharitis

A

Associated with meibomian gland dysfunction (ocular rosasea)
- toothpaste like plaques

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8
Q

Entropion

A

Inversion of lid margin with the lashes
Maybe be congenital or acquired (senile)

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9
Q

What is the pathogenesis of senile entropion?

A
  1. horizontal lid laxity along with medial and lateral tendon laxity
  2. overriding of preseptal orbicularis over pretarsal orbicularis
  3. lower lid retractor weakness - decreased excursion of lower lid in downgaze
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10
Q

What are the causes of Senile/Acquired Entropion?

A

Aging changes
Trachoma
Acid and alkali burns
Chronic conjunctival inflammations (ocular pemphigoid)

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11
Q

Ectropion

A

Eversion of lid margin
Can be congenital/acquired

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12
Q

What are the causes of Ectropion?

A

Ageing
Mechanical (tumors)
Scarring of anterior lamella (circatricial)
Weakness of orbicularis muscle (paralytic)

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13
Q

Ptosis

A

Abnormally low position (drooping) of the upper eye lid

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14
Q

Neurogenic conditions where ptosis is seen

A

3rd nerve palsy
Horner syndrome
Marcus Gun jaw-winking syndrome
3rd nerve misdirection

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15
Q

Myogenic condition where ptosis is seen?

A

Myasthenia gravis
Myotonic dystrophy
Ocular myopathy
Simple congenital
Blepharophimosis syndrome

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16
Q

What are the features of Blepharophimosis Syndrome?

A

Telecanthus - increased distance between medial canthi
Epicanthus inversus
Bilateral ptosis

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17
Q

Simple Congenital Ptosis

A
  • Caused by developmental dystrophy of levator muscles
  • Bilateral/unilateral
  • Poor relaxation leading to ptotic eye lid being slightly higher than normal in downgaze
  • Weakness of superior rectus muscle (sometime)
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18
Q

Marcus Gunn Jaw-winking

A

Retraction of ptotic lid in conjunction with stimulation of ipsilateral pterygoid muscle

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19
Q

3rd nerve misdirection

A

Bizarre movements of upper lid which accompany various eye movements

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20
Q

How to evaluate patient with ptosis?

A

Margin reflex distance
Vertical fissure height
Levator function (Upper lid excursion)

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21
Q

Margin reflex distance

A

Distance between upper lid margin and light reflex in pupil is normally 4-4.5 mm

If distance decreases -> ptosis present

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22
Q

Vertical fissure height

A
  • Distance between upper and lower eye lids margins
  • Upper eye lid margin rest 2mm below upper limbus
  • Lower eye lid margin rests 1mm above lower limbus
  • VFH is 9mm (males) and 11mm (females)
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23
Q

Upper Lid Excursion (Levator Function)

A
  • Measured after eliminating frontalis muscle function by pressing above the eyebrow and ask patient to look down
  • Amount of excursion is measured
  • 15mm or more - normal
  • 12mm - good
  • 5-11mm - fair
  • 4mm or less - poor
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24
Q

What is the treatment for congenital ptosis?

A

When levator function is poor,
1. Levator resection (most chosen)
2. Frontalis brow suspension

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25
What is the treatment for involuntional and aponeurotic ptosis?
- levator function is mostly good - pathology - detachment of levator muscle from upper border of tarsus - Rx - attach levator back to upper tarsal border
26
Dermatochalasis
- Common in elderly - Eyelids - baggy appearance with indistinct lid creases - Rx - blepharoplasty
27
Lid Retraction
- upper lid margin is above superior limbus - commonly seen in thyroid eye disease
28
Epicanthal folds
Bilateral vertical skin folds that overhangs from upper/lower lid towards the medial canthus
29
Telecanthus
Increased distance between the medial canthi as a result of abnormally long medial tendons
30
Coloboma
Congenital partial/full thickness eye lid defect Upper lid - not associated with any systemic anomalies Lower lid - associated with Treacher Collins syndrome
31
Strawberry Naevus (Capillary Hemangioma)
- Unilateral, red raised lesion - common during 1st year of life - resolves spontaneously by age 4-7 - steroid injection given if it threatens vision
32
Pyogenic Granuloma
Fast growing granulomatous hemangioma usually after surgery/trauma
33
Keratoacanthoma
Uncommon benign but rapidly growing tumors Most common in immunosuppressive patients
34
Solar (Actinic) Kertosis
Most common premalignant skin lesion
35
Basal cell carcinoma
90% on head & neck 10% eyelid Slow growing, locally invasive but non metastasizing
36
Squamous cell carcinoma
- 5-10% eyelid malignancies - more aggressive than BCC - 3 types - plaque like, modular, ulcerating
37
What are the layers of eyelid?
1. Skin + SC tissue 2. Muscular layer - Orbicularis oculi (horizontal concentric fibres) supplied by facial nerve - Levator palpebrae superioris (eyelid elevation) sympathetic Innervation 3. Fibrous layer (Tarsal Plate) - contains meibomian glands 4. Mucous layers - formed by palpebral conjunctiva
38
What are glands of the eyelids?
1. Meibomian glands - modified sebaceous glands, secrete oily secretion 2. Glands of Zies - sebaceous glands developed as outgrowth of hair follicles of eye lashes 3. Glands of moll - modified sweat glands
39
What are situated on the lid margins?
1. Eye lashes 2. Opening of ducts of meibomian glands posteriorly 3. Glands of zies and moll
40
Causes of inflammatory edema of lids
1. Inflammation of lids - allergic dermatitis 2. Acute conjunctivitis 3. Acute dacryocystitis 4. Acute iridocyclitis 5. Panophthalmaitis 6. Orbital cellulites
41
Causes of passive edema of lids
Due to circulatory obstruction - nephrotic syndrome - cardiac failure - cavernous sinus thrombosis
42
Squamous Blepharitis
Encrustration of lid margin by white scales 2 types - Oleosa/seborrheic = seborrheic dermatitis of scalp, dandruff - Sicca = chemical irritants, cosmetics -> acne rosacea, uncorrected refractive error (astigmatism)
43
Ulcerative Blepharitis
Encrustation of lid margin by yellow scales with underlying ulceration. Ulcers bleed on removing the scales Caused by staphylococci
44
Angular Blepharitis
Inflammation of lid margin is associated conjunctivitis (foamy discharge) - caused by morax-axenfeld bacillus
45
Symptoms of Blepharitis
Itching Soreness Lacrimation Photophobia
46
Complications that occurs (especially in ulcerative Blepharitis)
- chronic conjunctivitis - marginal corneal ulcer - stye (acne on the edge of eyelid) - madarosis (loss of lashes) - tylosis (hypertrophy of lid border) - trichiasis - entropion, ectropion
47
Treatment for Blepharitis
Antibiotics - chlormycetin, erythromycin, oxytetracycline ointment
48
External hordeolum/stye
Acute inflammation at the edge of the lid caused by staphylococcal infection of glands of zies usually ending in suppuration
49
Symptoms of external hordeolum/stye
- red swelling in lash line of margin of lid - pain - tenderness - edema of lids - if has yellowish summit -> indicates suppuration
50
What is the treatment for external hordeolum/stye?
1. Hot fomentation - hastens suppuration - pus evacuated by horizontal incision 2. Antibiotics
51
Hordeolum internum
Acute suppurative inflammation of meibomian gland due to staphylococcus
52
Symptoms of hordeolum internum
- more violent - immediately there is pus points on palpebral conjunctiva
53
What is the treatment for hordeolum internum?
1. Hot fomentation (but pus evacuated by vertical incision) 2. Antibiotic
54
Chalazion
Achronic granulomatous enlargement of one of the meibomian glands
55
What is the pathogenesis of chalazion?
1. Proliferation of meibomian duct epithelium 2. Meibomian duct becomes obstructed 3. Gland enlarges 4. Fatty secretion escapes into surrounding tissues 5. Exites a foreign body reaction
56
Symptoms of Chalazion
1. Cosmetic disfigurement (circumscribed hard lid swelling) 2. Conjunctival irritation
57
Treatment of Chalazion
1. Antibiotic (erythromycin) 2. Surgery for cosmetic purpose
58
Blepharospasm
Condition in which there are involuntary and forcible eye lid closure
59
Causes of blepharospasm
1. **Reflex sensory stimulation through branches of 5th cranial nerve** (commonest) - phlyctenular keratoconjunctivitis, foreign body on cornea, membranous conjunctivitis, acute iridocyclitis 2. **Excessive stimulation of retina** - bright light on sensitive eye, dilated pupil, albinism 3. Essential (hysteria)
60
Etiology of trichiasis
Secondary to chronic blepharitis
61
Signs & symptoms of trichiasis
misdirection of lashes causes - mechanical irritation/injury to cornea - ulceration - pain - lacrimation - photophobia - blepharospasm - vascularisation - opacities of cornea
62
Treatment for trichiasis
1. Epilation 2. Electrolysis To remove eyelashes that are causing issue
63
Causes of Madarosis
1. Chronic anterior lid margin diseases 2. Infiltrating tumors 3. Burns 4. Radiotherapy/cryotherapy of lid tumors
64
Causes of circatricial entropion
- old case of trachoma - Blepharitis - burns - operation upon lids
65
Causes of spastic entropion
Spasm of palpebral portion of orbicularis muscle - atrophy/absence of eye ball - old age - after surgical operation - blepharospasm
66
Signs and symptoms of entropion
misdirection of lashes causes - mechanical irritation/injury to cornea - ulceration - pain - lacrimation - photophobia - blepharospasm - vascularisation - opacities of cornea
67
Etiology of ectropion
1. Cicatrical 2. Senile 3. Paralytic - result of weakness of orbicularis muscle due to facial nerve paralysis
68
Symptoms of ectropion
Epiphora due to eversion of lacrimal puncta
69
Complications of Ectropion
1. Xerosis of conjunctiva 2. Chronic conjunctiva & exposure keratitis
70
Causes of ectropion
1. Burns from lime, acid, molten metal 2. Operations 3. Trachoma
71
Symplepharon
Cicatrical attachment btwn the conjunctiva of lid & eye ball - affects both lids - usually lower, sometimes includes part of cornea
72
Types of symblepharon
**Anterior** = extending bridge like from lid to globe, leaving a free portion of conjunctiva **Posterior** = involves only the fornix **Total** = when lids are adherent to globe throughout
73
Etiology of Symblepharon
- injuries (burns from lime, acid, molten metal) - operation - trachoma
74
Lagophthalmos
Incomplete closure of palpebral aperture when an attempt is made to shut eyes
75
Causes of Lagophthalmos
1. Exophthalmos (grave disease) 2. Proptosis (orbital tumor) 3. Facial nerve paralysis 4. Cicatrical ectropion of upper lid 5. Symblepharon
76
Complications of Lagophthalmos
- xerosis of conjunctiva - chronic conjunctiva & exposure keratitis
77
What are the congenital abnormalities of the lids?
1. Distichiasis 2. Coloboma of eyelid 3. Ptosis
78
Congenital ptosis seen in?
- whith normal superior rectus formation - whith superior rectus weakness - Marcus Gunn or jaw winking ptosis
79
Acquired ptosis seen in?
- neurogenic due to lesion of 3rd nerve nucleus - myogenic = myasthenia gravis - mechanical = increase with of lid tumor - traumatic
80
What the **benign** tumors of eyelids?
- Papilloma - Molluscum contagiosum - Naevus - Xanthelasma - Hemangioma
81
What are the **malignant** tumors of eyelids?
- rodent ulcer/BCC - SCC - meibomian gland carcinoma

Ophthal (18 decks)

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