Diseases of Lid Placement Flashcards
Congenital Entropion
- lower lid turned inward
- rare
- often confused with epiblepharon: extra horizontal skin fold, self resolves; common in orientals
- true congenital occurs form improper aponeurosis insertion of the retractor muscle
Involutional Entropion
- lower lid turned inward
- most common form and is age related
- due to decreased horizontal lid tone, weakness of lid retractor muscle, and orbital tissue atrophy
Cicatricial Entropion
- lower lid turned inward
- occurs secondary to conjunctival scarring
Spastic Entropion
-lower lid turned inward
-due to severe irritation of the anterior segment (lid) causes spasms
-associated with generalized blepharospasm
-starts as trichiasis, progresses to corneal scarring and pannus
Tx: surgery, epilation of offending lashes, glue
Involutional Ectropion
- an outward rolling of the lid, in which lid everts; exposes cornea and conjuntiva
- related to age and due to increased lid laxity
Cicatricial or Mechanical Ectropion
- an outward rolling of the lid, in which lid everts; exposes cornea and conjuntiva
- occurs secondary to scarring, as with burns, dermatoses, tumor, trauma
- Tx: surgery or steroids
Paralytic Ectropion
- an outward rolling of the lid, in which lid everts; exposes cornea and conjuntiva
- Bell’s palsy: leads to paralysis of obicularis muscle
- when occuring with lagophthalmos, can lead to exposure and epiphora
- medically induced with BOTOX
Congenital Ectropion
-an outward rolling of the lid, in which lid everts; exposes cornea and conjuntiva
-associated with other lid problems
Tx: taping and lubrication used in mild and young patients
-surgical repair will be needed in older, progressed patients
Nocturnal Lagophthalmos
- incomplete lid closure
- idiopathic condition
- spouse/family members typically diagnose
- Patient may present with inferior morning SPK with no other lid margin diseases
- adults most commonly present due to decreased tear production
- Dx: instill NaFl and recline patient, close their eyes. use Burton lamp to see if NaFl visible between incomplete closed lids
Orbital Lagophthalmos
- incomplete lid closure
- orbital lagophthalmos occurs with Pt proptosis
- Grave’s ophthalmopathy, orbital pseudotumor or mucocele, cavernous sinus fistula
Mechanical Lagophthalmos
- incomplete lid closure
- results due to ocular or facial scarring
Paralytic Lagophthalmos
-Bell’s palsy on CNVII (unilateral paralysis); impacts orbicularis so lids cannot close completely
-often viral etiology with self-limiting inflammation
-face and forehead are flaccid (in stroke face uneven)
Bell’s resolves within three months, but can recur with residual damage
-Tx: supportive, involving lubricants, taping, tarsorrhaphy (sew eye lids closer together to narrow fissure)
Congenital Ptosis
- drooping upper lid
- autosomal dominant, improper development of levator palpebrae superioris
- in down gaze the congenital ptotic lid appears HIGHER than the normal lid
Blepharophimosis Ptosis
- drooping upper lid, autosomal dominant trait
- moderate to severe BILATERAL ptosis
- other ocular signs: telecanthus, epicanthus inversus, lateral ectropioc, hypoplastic superior orbital rim and bridge
Horner’s Ptosis
- occurs with the triad: ptosis, miosis, anhydrosis
- Congenital: associated with a heterochromia
- Acquired: loss of sympathetic innervation along three step path (central, pre-ganglionic @ chest/breast/lungs area, post-ganglionic-benign, no loss of sweating); no heterochromia
- Dx:
1. cocaine testing will dilate normal eye but not Horner eye and tests for oculosympathetic paresis
2. hydroxyamphetamine will not dipate post-ganglionic as there will be no NE release
3. Phenylephrine elevates the affected side because Mueller’s will be hypersensitive (rules out malignancy in central/post-ganglionic) *does this go here, or it’s just important to rule it out?
