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Head and Neck / CF > Ectropion/Entropion > Flashcards

Ectropion/Entropion Flashcards

1
Q

What forms supratarsal fold?

A

Attachments of levator aponeurosis to skin. 8-11mm in caucasians, in Asians, weaker attachment, less distinct fold

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2
Q

What forms infratarsal fold?

A

Attachment of CPF to skin

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3
Q

What is importance of Zeiss glands?

A

sebaceous glands of eyelids, drain into lash shaft and obstruction causes stye

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4
Q

What is the impotantce of meibomian glands

A

Intratarsal, drain to grey line. Obstruction causes chalazion

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5
Q

Describe Asian eyelid anatomy differences (2)

A

1- More ROOF/SOOF 2- Levator aponuerosis attachement to dermis is inferior - causing supratarsal fold to be 0-6mm from lash line

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6
Q

WHat is the main function of each section of the o/oculi? -pretarsal -preseptal -preorbital

A

Pretarsal - presses lid to globe Preseptal - lacrimal drainage Preorbital - tight closure

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7
Q

What is the orgin adn insertion of levator?

A

Oirgin - lesser wing of spehnoid Insertion - anterior tarsal plate, dermis, O.O

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8
Q

What is the function of CPF?

A

Analogou to levator - transmits the function of the voluntary muscle (IR), inserts on the edge of the tarsal plate and dermis- linked to downward gaze CN3

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9
Q

What is the function of inferior tarsal muscle?

A

Analogous to mullers - poor fx definition - sympathetic innervation

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10
Q

What is lockwood ligameent?

A

supports globe invests the IR and IO

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11
Q

Describe the innervation of the eyelids (sensory and motor)

A

Sensory V1 - frontal (supraorbital,supratrochlear), lacrimal, nasociliary (infratrochlear) V2 - ZT, ZF, infraorbital Motor CN3, CN 7, SNS

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12
Q

Define symblepharon

A

cicatrix between eyelid and globe conjunctiva

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13
Q

Define blepharochalasia

A

laxity of skin and lower lid retractors due to allergy recurrence and edema

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14
Q

Define blepharophimosis

A

congenital SHORTENING of eyelid structures

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15
Q

Define blepharophimosis syndrome

A

congenital AD, blepharophimosis, ptosis, telecanthus and epicanthus inversus

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16
Q

Dermatochalasia

A

Upper lid skin only redundancy

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17
Q

Describe the snap test

A

to test for laxity Pull lower lid vertically down and release- lid should return to appose globe. if not suggests laxity

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18
Q

Describe the distraction test

A

to test for laxity If can be distracted anterior to the globe >10mm, suggests laxity

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19
Q

Describe physical exam for entropion

A

Comprehensive ophtho exam including VA, globe position Cicatricial? exmaine lids and conjunctiva Involutional? snap and distraction test, check LCT Spastic? hypertrophy of orbicularis pretarsal muscle Congenital? look for epiblepharon

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20
Q

How do you classify entropion

A

Congenital vs acquired CONGENITAL - epiblepharon - corrected by traction - true congenital - dettached lower lid retractors from skin along entire margin - not corrected by traction ACQUIRED - Cicatricial (deficiency of tissue) - Involutional (corrected with traction) - Spastic

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21
Q

What causes involutional entropion?

A

1- LAXITY in horizontal or vertical dimensions - of Horizontal support (MCT,LCT) - of lower lid retractors (tarsus falls into globe) 2- ENOPHTHALMUS

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22
Q

What causes cicatricial entropion?

A

Vertical deficiency of posterior lamella 2’ - infection - trauma -inflammation - iatrogenic (TC approach)

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23
Q

What causes spastic entropion?

A

o.oculi spasm 2’ corneal irritation - keratitis/FB

24
Q

How do you manage involutional entropion?

A

VERTICAL LAXITY (retractors) - Lid everting sutures (Quickert) - everting skin/wedge excision - CPF plication - excision/reattachment of CPF to skin HORIZONTAL LAXITY (MCT/LCT/lockwood) - canthopexy - Tarsal strip procedure - horizontal excision and lid everting sutures

25
Q

Describe a lateral tarsal strip procedure

A

Lateral end of tarsus is secured to orbital rim as new canthal limb of tendon. Combined with everting sutures 1- subciliary incision w lateral extension 2- dis-insert LCT near tarsal plate 3- mobilize tarsus in submuscular plane 4- attach lateral tarsal strip to inner superiolateral periosteum w 5-0 ticron 5- trim oo and skin excess

26
Q

Describe Lid everting suture (Quickert-rathburn)

A

Chromic 4-0 suture, full thickness suture from below lash line to inferior fornix.

27
Q

How do you manage cicatricial entropion?

A

-wait for scar to mature (tape,lubricate in the interim) - release and reconstruct with interpositional graft (paalte mucoperiosteum, nasal chondromucosa, FT buccal membrane, ear cartilage)

28
Q

How do you manage epiblepharon?

A

Excision of infratarsal skin and orbicularis, 1.5mm below lashes at inturned area. Suture skin edges to lower edge of tarsus

29
Q

Describe your exam for ectropion

A

Comprehensive ophtho assessment with VA Bell’s, lagophthalmus, CN7 fx, scleral show, punctum asymmetry, lid laxity (snap/distraction), difference b/w voluntary and spontaneous lid closure

30
Q

How do you classify ectropion

A

CONGENITAL - poor developed structures (CT, tarsus, anterior lamella) ACQUIRED - Cicatricial (inflammaotry, infx, iatrogenic, trauma) - Involutional (H or V laxity) - Mechanical (edema, mass) - Paralytic (bells, myasthenia, botox)

31
Q

How do you manage congenital ectropion

A
  • reposition//tighten
32
Q

How do you manage cicatricial ectropion

A

Release scar and reconstruct Recon options - z plasty/tripier/FTSG - chondral/mucoperiosteal graft

33
Q

How do you manage involutional ectropion

A

HORIZONTAL LAXITY 1- wedge excision + canthopexy 2- Lateral tarsal strip procedure 3- fascial sling VERTICAL LAXITY - add structure with graft (cartilage/mucoperisoteal)

34
Q

How do you manage mechanical ectropion

A

excise lesion or treat cause

35
Q

How do you manage paralytic ectropion

A

Canthopexy, wedge excision, tarsorhaphy, static sling

36
Q

Describe non-operative management of ectropion cases in the interim.

A

taping lubrication temporary tarsorrhaphy scar management

37
Q

What is ptosis

A
  • lid margin falls below normal position (midway between pupil and corneoscleral jx or 2mm below limbus
38
Q

What causes ptosis

A

dysfunction of levator complex (mueller/levator muscle, aponeurosis)

39
Q

What is normal levator excursion?

A

from max upward to max downward gaze is >12mm

40
Q

How do you classify ptosis?

A

CONGENITAL - Isolated - Synkinetic - with SR dysfx - Blepharophimosis syndrome ACQUIRED - Traumatic - Aponeurotic - Myogenic - Neurogenic - Mechanical

41
Q

How do you diagnose congenital isolated ptosis

A

lagophthalmus on downward gaze - indicates stiffness of levator complex

42
Q

What is synkinetic ocngenital ptosis?

A

marcus gunn jaw winking : aberrant synkinesis between V3 and CN3 - ptosis resolves with clenching teeth

43
Q

What is blepharophimosis syndrome

A

telecanthus, ptosis, ectropion, epicanthus inversus AD

44
Q

What are causes of acquired aponeurotic ptosis?

A

involutional - aponeurosis laxity, dehiscence. Increased distance to supratarsal fold, may have normal levator excursion

45
Q

What are causes of acquired neurogenic ptosis?

A

palsy of CN3, associated with ophthalmoplegia or horners

46
Q

What are causes of acquired myogenic ptosis

A

myasthenia gravis, thyroid ophthalmopathy, involutional

47
Q

Describe key questions in your assessment of patient presenting w ptosis

A

Is it true ptosis or pseudoptosis Hx: onset is key - acquired vs congenital Levator function/excursion and dehiscence? * most importnat for treatment decision History of previous eye surgery Protective mechanisms present? bells Is enurologic workup needed?

48
Q

What is a schirmer test

A

testing for basic and reflex secretion - 35x5mmfitler pper adjacent to conjunctiva and leave for 5mins. if less than 10mm wetting, abnormal Can also block reflex secretions with local anesthetic

49
Q

What is your PE for patient presenting with ptosis

A

Comprehensive ophtho asx - EOM, pupils, VA, VF - lid position, brow position, intact bells phenomenon

50
Q

What are common findings of patient with acquired aponeurotic ptosis

A
  • normal levator excursion - absent or elevated supratarsal crease
51
Q

What is bells phenomenon

A

involuntary upward movement of eye with closure of eyelids - indicates normal SR function

52
Q

What are surgicla options for treatment of ptosis

A
  • Fasanella-Servat procedure (tarsal conjunctival mullerectomy - levator plication/resection* - levator advancement/aponeurosis repair/resection* - Frontalis suspension sling * can combine w upper bleph
53
Q

Describe a fasenella servat procedure (tarsomyectomy)

A

Lid eversion En bloc excision of conjunctiva and posterior lamella at superior tarsus margin - attempt to excise muller and conj and induce scarring Indicated if good levator function and mild ptosis

54
Q

Describe levator resection/aponeurosis repair

A

aponeurosis is cut horizontally and reattached to tarsus indicated if good levator function - and aponeurotic involution

55
Q

Describe frontalis suspension

A

tarsus suspended from frontalis w TPF, tensor fascia lata Indicated for svere congenital ptosis w no levator fx

Head and Neck / CF (27 decks)

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