Ectropian, Entropian, Lagopthalmos, Ptosis Flashcards
Describe entropian (Involutional, Cictricial, Spastic)
*Be sure to know involutional
- Lower lid turned inward
- Involutional: most common age related loss of horizontal lid tone and weakness of lid retractors
- Cictricial: seconday to conjunctival scarring
- Spastic: - irritation of lid of severe corneal disease causes spasm.
- All entropian leads to corneal scarring and pannus
- Tx Spastic: surgery, epilation, glue
You have a patient that presents with irritation and spasm of lid caused by severe spasm from an inward lid turn. Upon SLE you see corneal scarring and pannus. What is the diagnosis?
A. Spastic Entropian B. Cicatricial Ectropian C. Paralytic Lagothalmos D. Blepharophimosis E. Involutional Entropian
A. Spastic Entropian
Describe ectropian (Involutional, Cictricial/Mechanical, Paralytic, Congenital)
-Outward rolling of lid where lid everts and exposes cornea and conjunctiva
- Involutional - related to age
- Cicatrical/Mechanical - Scarring, burns, dermatoses, tumor, trauma.
Tx: steriods, surgery
- Paralytics - Bells - paralysis of orbicularis
exposure secondary to lagopthalmos leads to epiphoria. Induced with botox
- Congetinal - Tx: tapering, lubrication surgery
You have a patient that presents with burns, dermatose, tumor, trauma from inward eye turn. What is the diagnosis?
A. Spastic Entropian
B. Cicatricial Ectropian
C. Paralytic Lagothalmos
D. Blepharophimosis
B. Cicatricial Ectropian
Describe lagopthalmos (Noctural, Orbital, Mechanical, Paralytic)
-incomplete lid closure
Noctural - Dx by history. idiopathic,
Orbital - Proptosis (i.e. Graves)
Mechanical - scarring
Paralytic - Bell’s unilateral CN VII paralysis
frequently viral, flaccid facies with smooth frontalis appearance, orbicularis can not close
Rule out stroke: Forehead and face are flaccid in Bells, stroke is not.
Tx: Supportive: lubrication, taping, tarsorrharphy if severe
You have a patient that presents with flaccid facies with smooth frontalis appearance that affects the orbicularis. What is the diagnosis?
A. Spastic Entropian
B. Cicatricial Ectropian
C. Paralytic Lagothalmos
D. Blepharophimosis
C. Paralytic Lagothalmos
What is the treatment for Spastic Entropian?
A. Surgery, epilation, glue
B. Tapering, lubrication, surgery
C. Lubrication, taping, tarsorrharphy if severe
A. Surgery, epilation, glue
What is the treatment for Cicatricial Ectropian?
A. Surgery, epilation, glue
B. Tapering, lubrication, surgery
C. Lubrication, taping, tarsorrharphy if severe
B. Tapering, lubrication, surgery
What is the treatment for Paralytic Lagothalmos?
A. Surgery, epilation, glue
B. Tapering, lubrication, surgery
C. Lubrication, taping, tarsorrharphy if severe
C. Lubrication, taping, tarsorrharphy if severe
Describe Ptosis (Congentical, Belpharophimosis, Congenital Hormer’s, Acquired Horners)
Congenital - improper development of levator palpebral superioris. Ptotic lid is higher in downward gaze. Heterochromia
- Blepharophimosis, bilateral ptosis, telecanthus, epicanthus inversus, lateral extropian, hypoplastic superior orbital rim and bridge
- Horner’s: ptosis, miosis, anhydrosis
- Congenital Horners: heterochromia
- Acquired Horners: no heterochromia, loss of Sympathetic innervation. (Central, Preganglionic, Postganglionic)
What are the differences between pre-ganglionic and post-ganglionic acquired Horner’s?
- Pre-ganglionic: associated with chest trauma and tumors (metastasis)
- Post-ganglionic: benign, no loss of sweating
How do you diagnose Horners? (Cocaine 10%, Hydroxyampethamine, Phenylephrine)
- Cocaine 10%, dilates normal eye but not Horner’s. Tests for oculosympathetic paresis
- Hydroxyampethamine - will not dilate post-ganglionic because not enough NE
- Phenylephrine - elevates affected side due to hypersensitivity of Meuller’s. Rules out malignancy in central and pre-ganglionic.
You administer 10% cocaine onto an eye with ptosis. What would you expect to see?
A. Madriasis B. Impaired Dilation if central lesion C. No dilation if pre-ganglionic lesion D. No dilation if post-ganglionic lesion E. All of the above
E. All of the above
You administer Hydroamphetamine onto an eye with ptosis. What would you expect to see?
A. Madriasis B. Normal Dilation if central lesion C. Normal dilation if pre-ganglionic lesion D. No dilation if post-ganglionic lesion E. All of the above
E. All of the above
You have an elderly patient that presents with loss of horizontal lid tone and weakness of lid retractors causing an inward lid turn. Upon SLE you see corneal scarring and pannus. What is the diagnosis?
A. Spastic Entropian B. Cicatricial Ectropian C. Paralytic Lagothalmos D. Blepharophimosis E. Involutional Entropian
E. Involutional Entropian
