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Exam One Material Flashcards

1
Q

what happens with the eyes on primary telecanthus

A

the inner canthi are farther apart, and the outer canthi are normal

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2
Q

this is neoplasm involving the Meibomian glands ; rare but highly malignant

A

sebaceous gland carcinoma

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3
Q

this is an infectious disease of the skin caused by a large DNA pox virus ; transmission by direct person to person contact

A

molluscum contagiosum

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4
Q

what are the stages of blepharochalasis

A
  1. edema stage - transient painless lid swelling with mild redness 2. atonic ptosis stage- skin assumes a reddish brown color, becoming telangiectatici and loose \3. ptosis adipose stage- involves dehiscence of the orbital septum with herniation of orbital fit into the eyelid ( steatoblepharon) ( slide 16)
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5
Q

this results from any process in the eyelid or orbit that restricts eyelid elevation

A

mechanical blepharoptosis- most COMMON ptosis seen in children and adolescents

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6
Q

this is a neoplasm arising from epidermal melanocytes

A

malignant melanoma - mgt same as SCC and BCC

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7
Q

what is the most common cause of eyelid laceration

A

domestic violence

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8
Q

how do we manage lid laceration

A

clean with betadine scrub and irrigate ; if partial thickness with no levator involvement apply Ab ointment and sterile dressing; if full thickness cover and refer to oculoplastics ; cases involving levator need surgery

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9
Q

this is characterized by horizontal enlargement of the palpebral fissure and the eyelid is shortened vertically ; assoc with lateral ectropion

A

euryblepharon - slide 39

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10
Q

this is an autosomal dominant dystrophy presenting in the 3rd-4th decade of life ; progressive atrophy and weakness of the hypopharyngeal and ocular muscles

A

oculopharnygeal dystrophy slide 23

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11
Q

this is defined as the inability to completely close the eyelids, resulting in ocular exposure ; caused by cicatricial ( injury), iatrogenic , and neurological

A

lagoopthalmos

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12
Q

this is a rare multisystem disorder characterized by fluid accumulation in the legs and distichiasis; occurs around puberty ; caused by mutations of the FOXC2 gene and inherited as an autosomal dominant trait

A

lymphedema distichiasis syndrome

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13
Q

Is molluscum contagiosum a reactivation infection ( ie lies dormant)

A

Nope

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14
Q

this is a change in the type of adult cells in a tissue to a form that is abnormal for that tissue

A

metaplasia ( shift rom benign to malignant)

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15
Q

how do we manage blepharochalasis

A

therapy during acute stages is controversial; Sx necessary for cosmesis

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16
Q

how does seborrheic blepharitis present

A

assoc with seborrheic dermatitis, bilateral, symptoms like itching, burning, grittiness,

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17
Q

this is a deep , dermal, nodular lesion arising from the matrix of the hair follicle ; uncommon tumor, BENIGN BUT PROGRESSIVE

A

pilomatricoma

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18
Q

this infection of the lid can spread to adjacent glands, lid tissue ( Preseptal cellulitis) or the orbit ( orbital cellulitis); rare association with necrotizing fasciitis

A

hordeolum

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19
Q

this is a condition where the eyelids cant be fully retracted; sometimes referred to as BPEI or BPES; key features of this disorder - blepharophimosis, ptosis, and epicanthus inversus

A

Blepharophimosis

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20
Q

how do we manage demidicosis

A

lid scrubs and Ab/steroids are inadequate ; requires removal with chemical assault ; some tx options: baby shampoo, topical metronidazole gel, mercury oxude, pilocarpine gel ( interferes with their respoiration and motility via toxic muscarinic effects) , and TTO therapy ( best therapy )_

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21
Q

management for blepharospasm

A

supportive- eye protection , lid hygiene medical - botox ( temporary relief) surgical- myectomy

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22
Q

management of syringoma

A

asymptomatic cases require no tx; medical therapy limited to case reports and anecdotal series; surgical care ( ie electrodessication)

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23
Q

how can we manage entropions

A

conservative: lube, taping the lid medical: botox for spams sx: sutures, vertical shortening procedures

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24
Q

this type of blepharoptosis reps a muscular etiology, typically where there is loss of muscle tone affecting the levator

A

myogenic blepharoptosis

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25
Q

which glands are involved with internal hordeolums

A

Meibomian

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26
Q

T or F: Melanoma is the most aggressive type of eyelid cancer

A

T

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27
Q

how is the meibomiam gland expression graded

A

grade 0- clear meibum easily expressed grade 1- cloudy meibum expressed with pressure grade 2- cloudy meibum expressed with more than moderate pressure grade 3- mebium cannot be expressed even with pressure

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28
Q

this is a sudoriferous cyst that is caused by abnormal proliferation of these modified apocrine secretory glands ;

A

Cysts of moll - these glands lie posterior to the lashes and beneath the gray line

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29
Q

what is the management option for molluscum contagiosum

A

self limiting, no antivirals efficacious, keratolytic agents ( KOH, and salicylic acid or cantaharidin), imiquimod cream; surgical therapy is useful for solitary uncomplicated lesions ( ie Electrodessication with the Ellman unit)

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30
Q

this is aka atopic eczema ; type I, IGE mediated hypersentivity reaction l focal manifestation of a systemic condition

A

atopic dermatitis

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31
Q

this condition represents proliferations of melanocytes in contact with each other, forming nests ; formed during childhood ; these are benign neoplasms

A

acquired melanocytic nevus

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32
Q

what are some special considerations with blink lagoophtlamos

A

incomplete blink mainly with prolonged visual tasking

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33
Q

these represent localized, bacterial infections of the eyelid sebaceous glands with abscess formation: most commonly caused by Staph Aureus and epidermis

A

hordeolum

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34
Q

this is upper lid retraction with downgaze or adduction ; pupillary constriction with downgaze or adduction; and limitation of vertical gaze

A

aberrant 3rd nerve regeneration

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35
Q

this type of trauma results from blunt force; non penetrating injury ; reps rupture of capillaries,

A

eyelid contusion

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36
Q

this represents a true sebaceous cyst; caused by acquired obstruction of the sebaceous gland duct, with subsequent accumulation of glandular sebum and intradermal expansion , the Zeis glands lie distal and anterior to the lashes

A

cysts of Zeis

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37
Q

this is a vertical skin fold of redundant tissue at the medial and ( sometimes lateral ) canthus ; found in pts with down syndrome, FAS; bilateral; can create appearance of esotropia

A

Epicanthal folds

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38
Q

these represent multiple tiny epidermoid cysts ; caused by occlusion of pilosebaceous units resulting in retention of keratin ; pearly white domed lesions ; common in infants , benign

A

milia

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39
Q

how do keratoacathoma present

A

fair skinned male, > 60 YO, solitary , firm , round or oval lesion with central ulceration or keratin plug ; symptoms = PAIN ( slide 34, dysplastic disorders)

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40
Q

this means hidden eye

A

cryptophthalmos - complete : eyelids do not form ; incomplete : facial skin fuses to the medial aspect of the globe ; abortive : upper eyelid is adherene to the superior aspect of the globe and fuses with the upper cornea

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41
Q

T or F: MGD is the primary cause of evaporative dry eye

A

T

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42
Q

when do the eyelids during embryogenesus

A

at week 8- they separate again at 25 weeks

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43
Q

T or F: HZO is unilateral and HSV is bilateral

A

T

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44
Q

this is the formation of presence of a new, abnormal growth of tissue

A

neoplasia

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45
Q

this type of blepharoptosis is dehiscence or disinsertion of the levator aponeurosis from the superior tarsal plate; bilateral and no pupillary involvement

A

aponeurotic blepharoptosis - Most COMMON and least difficult to treat - slide 14 disorders eyelid

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46
Q

how does HZO present

A

more common over 70 YO; symptoms- facial pain, fever and malaise, redness and welling, tearing of affected eye, variable visual impairment; dermatomal skin rash that doesn’t cross midline ; swelling ptosis of eyelid ( slide 51, infect. disorders)

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47
Q

this is complete absence of ocular tissue within the orbit ; can be unilateral or bilateral ; simple type : assoc absence of EOM and microblepharon with cyst: globe is replaced by a cyst

A

anopthalmos

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48
Q

this condition is more commonly in children; symptoms include pain and tenderness on palpation and tearing; rash around eye and eyelid ; ulcers and erosions of the lid margin; eyelid edema and redness ; swollen PA nodes

A

herpes simplex blepharitis

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49
Q

this condition is characterized by diminished meibum flow that results in increased tear evaporation and hyperosmolarity ; its exacerbated by resident bacteria mainly Staph Epidermis and P. Acnes ; assoc with rosacea and diet and nutrition

A

MGD

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50
Q

how do we manage seborrheic keratosis

A

medical therapy : dichloroacetic acid, cryotherapy ; surgical removeal is the TREATMENT OF CHOICE for cosmesis or biopsy

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51
Q

this refers to a loss of lashes ; a cause could be trichotillomania

A

madarosis - slide 11

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52
Q

how does verruca present

A

pt tend to be younger ( 5-20 YO) ; pts usually have cosmetic concerns, lesions arise from the skin of the eyelid or adnexa , possible secondary infection from “ pickers”; may be flat or stalked, solitary or multiple, uniform pigmentation of diff colors ( Y, Pink, Br, Blk); tiny red or black dots near the surface

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53
Q

how do we manage aponeurotic blepharoptosis

A

Sx repair - 3 main techniques 1. Mullers muscle resection 2. levator advancement 3. frontalis sling

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54
Q

how can we manage Preseptal cellulitis

A

hot compresses tid- qid, Ab therapy mainly orals ( cephalexin250-500 mg bid-qid) oral analgesics for pain

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55
Q

this type of blepharitis deals with disorders of the Meibomian glands; non inflammatory obstructive disorder

A

posterior blepharitis

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56
Q

if nevus cells are derived from epidermial melanocytes what are they termed

A

junctional, compound, or intradermal

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57
Q

what are the two presentations of herpes simplex blepharitis

A

classic vesicular or pustular form and the erosive/ ulcerative form

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58
Q

this is when the Epicanthal folds originate in the lower lid and extend upwards; see in blepharophimosis

A

epicanthus inversus

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59
Q

how do we manage hidrocystoma

A

no tx necessary unless pt is symptomatic ; supportive: avoid warm environments : medical : anticholinegic topical Ung or creams; drainage via stab incisions

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60
Q

this is a subtype of seborrheic keratosis ; presents as solitary nodule on the face ; asymptomatic and firm and white to pink in coloration

A

inverted follicular keratosis

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61
Q

whats management options for staph blepharitis

A

hyperthermia, lid margin cleansing, topical Ab and corticosteroids, oral Ab for secondary lid infections

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62
Q

this is characterized by loose, flaccid, easily everted upper eyelids ; association with obstructive sleep apnea

A

floppy eyelid syndrome

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63
Q

how does sebaceous gland carcinoma present

A

upper eyelid margin is common, redness and thickening and necrosis of the lid ( slide 75, dysplastic disorders) - management the same as for SCC and BCC

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64
Q

how do chalazia affect vision

A

can cause WTR astigmatism and deprivation amblyopia

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65
Q

how does atopic dermatitis present

A

hx of allergy, signs: scaling mainly slide 7 allergic disorders

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66
Q

mgt of milia

A

asymptomatic cases require no tx; no topical or systemic meds are effective for primary or secondary milia ; surgical care ie electrodessication

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67
Q

which glands are involved with external hordeolums

A

Zeiss

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68
Q

what happens with the eyes on true ocular hypertelorism

A

both the inner and outer canthi are abnormally far apart

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69
Q

what are some red flags for orbital cellulitis

A

high fever, recent hx of sinusitis or dental issues , proptosis / displaced eye , EOM restriction, chemosis of the globe, reduced vision, APD, increased WBC/ ESR

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70
Q

this is more commonly known as freckles ; NO malignant potential

A

ephelis

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71
Q

whats the main disorder Hypertelorism is assoc with

A

median cleft face syndrome ( frontonasal dysplasia) - slide 18, congenital )

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72
Q

how do we manage floppy eyelid syndrome

A

lubrication and protection from nocturnal damage,eyelid weights, sx for recalcitrant cases , refer for physical and sleep studies due to obstructive sleep apnea

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73
Q

how does seborrheic keratitis present

A

most common benign non infectious tumor of the elderly ; called “barnacles of aging” well circumscribed , rough surface round or oval lesions with uneven pigmentation ( slide 16 - dysplastic disorders)

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74
Q

what do you do in cases of Preseptal cellulitis that do not respond to oral Ab

A

consider alternate dx ( infectious disease) or consider surgical intervention ( oculoplastics)

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75
Q

this syndrome is characterized by genetic mutations in EDN3, EDNRB, MITF, PAX3, SNAI2,and SOX 10; have telecanthus and white forelock, variable hearing difficulties, light blue irides and/or heterchromia

A

Waardenburg Syndrome ( slide 18, congenital)

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76
Q

this is a soft tissue vascular sarcoma caused by human herpes virus 8

A

karposi sarcoma

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77
Q

this is the most common related sun growth ; reps dysplasis and architectural disorder of the epidermis ; risk factor is cumulative UV EXPOSURE ; precursor to SQUAMOUS CELL CARCINOMA

A

actinic keratosis

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78
Q

this type of anterior blepharitis results from dysfunction of the pilosebaceous glands ( too much sebum produced); related to fungal infection by Malassezia furfur

A

seborrheic blepharitis

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79
Q

relatively common low grade skin tumor; originates in the pilosebaceous glands ; resembles squamous cell carcinoma ; rapid growth followed by SPONTANEOUS REGRESSION; primary risk factor is UV EXPOSURE

A

keratoacanthoma

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80
Q

democidosis is really common in elderly, T or F

A

T

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81
Q

this is a hereditary degeneration of muscle fibers with variable age of onset ; characteristic muscle contraction w/o ability to relax “ myotonia”

A

myotonic dystrophy

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82
Q

this is the distance between the upper and lower eyelid : normal 7-10 mm in males and 8-12 mm in females

A

palpebral fissure

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83
Q

this type of nevus is the most common; occurs in older age ; papillomatous with little to no pigmentation l cells confined to dermis

A

intradermal

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84
Q

this is rare; when the Epicanthal folds arise above the brow and extend downward

A

epicanthus superciliaris

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85
Q

this is a rare condition where there is overriding of upper eyelids on lower eyelids ; congenital entropion of both lower eyelids ;

A

congenital eyelid imbrication syndrome

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86
Q

how is angular blepharitis managed

A

Dx made by classic appearance; lid hygiene ;broad spectrum Ab ( ie. FQL) - usually a self limiting disorder

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87
Q

how do cysts of moll present

A

translucent pink in color , situated at the lid margin ; painless

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88
Q

this is the enlargement of an organ or tissue by the proliferation of cells of an abnormal type , as a developmental disorder or an early stage in the development of cancer

A

dysplasia

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89
Q

this represents chronic obstruction of the glands

A

MGD

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90
Q

this type of nevus occurs in younger people l cells at epidermial/dermal junction

A

junctional nevus

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91
Q

this disorder involves synkinesis of CN V3 -> CN III

A

Marcus Gun Jaw Winking SYndrome

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92
Q

this looks like a stroke but reps a peripheral lesion; sudden onset; more common in older pts; presents with relative ptosis, ectropion and facial paralysis ; ALWAYS unileratal ; self limiting

A

bells palsy

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93
Q

this is defined as a hereditary predisposition to allergy or hypersensitivity

A

atopy

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94
Q

this is a unique automated device that performs lid/gland hyperthermia in conjunction with focused gland expression

A

lipiflow:

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95
Q

how do we manage MGD

A

lid hyperthermia and gland expression, lid cleansing, and surface lubrication . Topicals : Ab ( azithromycin, erythromycin , cyclosporine) orals : tetracyclines ; surgical : Meibomian gland probing and lipiflow

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96
Q

neuro disorder; in upgaze the lids retract but motility restricted and a normal downgaze; light near dissociated pupils ( does not react to light but does to accommodation)

A

colliers sign in dorsal midbrain syndrome slide 34

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97
Q

this is muscular dystrophy with several variants ; pts in their 30s ; symmetrical bilateral, progressive ptosis followed by ophthalmoparesis in month to years

A

chronic progressive external ophthalmoplegia slide 22

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98
Q

this is a specific type of inflammation in which the antigen is some external ( rather than internal ) force

A

trauma

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99
Q

this is an abnormality of eyelid position b which the upper eyelid overrides the lower eyelid on closure, leading to chronic ocular irritation

A

eyelid imbrication; assoc with floppy eyelid syndrome

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100
Q

this is a condition where the eyelashes grow inwardly toward the globe ; can be associated with trauma ( cicatricial)

A

trichiasis ( slide 3, multifactorial ltrue )

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101
Q

how do we manage a nevus

A

BENIGN NEGLECT and surgery

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102
Q

how do we manage basal cell carcinoma

A

biopsy is critical, SX RESECTION : MOHS MICROGRAPHIC SX

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103
Q

how does blepharochalasis present

A

typically adolescents and younger adults; unilateral or bilateral on upper lids , hx of recurrent painless eyelid edema

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104
Q

how does karposi sarcoma present

A

as firm, palpable nodules or blotches that are red, purple, bronwn or black ( slide 92, dysplasia)

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105
Q

how does Phthiariasis Pubis present

A

with reddish black deposits, can be seen with lid eversion , blepharitis, PA lymphadenopathy, follicular conj, will have chronic redness and itching and irritation ( slide 84, infec disorders)

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106
Q

how does Preseptal cellulitis present

A

unilateral usually, pts usually AFEBRILE, no predilections ( see slide 23 , infect lids lecture )

107
Q

how do we manage Phthiriasis Pubis

A

manual removal with forceps and topical therapy ( bland ointment to smother ) and pesticides applied to lid margin ; wash all clothes on high heat

108
Q

how do cysts of Zeis present

A

opaque to transilllumination ( non translucent) ; painless ( slide 35, obstruct )

109
Q

this results from direct skin exposure to allergens or other irritants ; type IV delayed hypersensitiviey reaction

A

contact dermatitis

110
Q

how do we manage xanthelasma

A

dx by clinical appearance intervention is for cosmesis only , managed with chemocautery or sx if pt desires

111
Q

this is the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells

A

hyperplasia

112
Q

T or F: There is no proven therapeutic value for topical or oral antivirals in the acute phase of HSV blepharitis

A

T ( topical Antivirals are indicated if there is corneal involvement ) oral antivirals are helpful in reducing the frequency of recurrences ( acyclovir )

113
Q

this represents a neurological condition characterized by forcible closure of the eyelids; etiology is multifactorial : females more than males; seen in older adults

A

blepharospasm

114
Q

this was the first company to identify the potential for a prostaglanding analogue as a cosmetic eyelash enhancement

A

allergan

115
Q

this is when the Epicanthal folds are symmetrically dist. between upper and lower lid ie. caucasians

A

epicanthus palpebralis ( slide 11 , congenital )

116
Q

T or F; All prostaglandin analogues can cause hypertrichosis

A

T ( ie Latanoprost “ Xalatan” and Travaprost “Travatan” ) -

117
Q

how does blepharospasm present

A

increased blinking frequency, forceful eyelid closure; dystonic movements of other facial muscles, interference with “ Activities of Daily Living” slide 39

118
Q

how does demiodicosis present

A

more common in anyone > 50 YO ; red inflamed lid margins, crusty debris, burning/irritation. secondary dry eye ; key feature is cylindrical dandruff ( slide 95, infec, disorders)

119
Q

this is single or multiple bands of tissue joining the upper and lower eyelids ; can be unilateral or bilateral ; congenital defect assoc. with iridogoniodysgenesis and juvenile glaucoma

A

ankyloblepharon ( slide 35)

120
Q

how do the squamous papilloma present

A

more common in obese and old people ; assoc with diabetes and pregnancy; asymptomatic; painful if inflamed ; pedunculated ( slide 7 , dysplastic disorders), benign and non infectious

121
Q

how do we manage squamous papilloma

A

lesions are treated if they display bleeding or irritation and for cosmesis ; tx includes cryotherapy, chemical cautery, surgical removal

122
Q

how does actinic keratosis present

A

usally older, noted in fair skinned ppl, more in men , SCALY REDDISH BROWN LESIONS ( slide 41, dysplastic disorders); considered a pre malignancy

123
Q

this is a hypersensitivity reaction to an allergen

A

Type I- driven by mast cells

124
Q

this is the distance bw the pupillary light reflex and the lower eyelid margin with eye in primary gaze

A

marginal reflex distance 2 : normal > 5 mm

125
Q

which vaccine is indicated for the prevention of shingles for anyone 50 and older who have had chickenpox but not yet shingles

A

Zostavax

126
Q

how can we manage trichiasis

A

lubricants, bandage CL, epilation , follicle destruction

127
Q

this is a dysfunction affecting innervation to the muscles of the eyelid : Horners syndrome “ ptosis , miosis , anhydrosis”

A

neurogenic blepharoptosis

128
Q

how do acquired melanocytic nevi present

A

as a flat or slightly raise papule - evenly pigmented - usually soliary - commonly seen on eyelid margin

129
Q

this is diffuse , subcutaneous inflammation of ocular tissue secondary to infection anterior to the orbital septum

A

Preseptal cellulitis

130
Q

this type of anterior blepharitis is not infectious - results from bacterial overgrowth ( staph, epidermis and staph aureus )

A

staph blepharitis

131
Q

this is an extremely rare inherited disorder; physical abnormalities affecting the craniofacial region, skin , fingers, and genitalia- “fish like mouth” and low set ears

A

ableparon- macrostomia syndrome ( slide 32)

132
Q

how do we manage comedones

A

open comedones are removed via minor sx ; closed comedones are more difficult to tx surgically bc of their deep nature

133
Q

these represent multiple, tiny hidrocystomas; caused by proliferation of intraductal epithelium in eccrine and /or apocrine glands ; appear as small, skin colored or yellowish dermal papules; common on cheeks and lower lids , appear at puberty; associated with down syndrome and diabetes

A

syringoma ( slide 49, obstruct)

134
Q

how does molluscum contagiosum present

A

in children

135
Q

how do we manage ectropion

A

conservative:

136
Q

this occurs when the lashes of the upper lid begin pointing in a more more horizontal to inferior orientation ; can be congenital or acquired;

A

eyelash ptosis

137
Q

this is a rare and highly aggressive tumor ; caused by a virus ) merkel cell polyomavirus) ; color varies from flesh colored , red, violet or blue

A

merkel cell carcinoma ( slide 88, dysplastic disorders)

138
Q

what are some associations to eyelid coloboma

A

Goldenhar syndrome, Treacher Collins Syndrome

139
Q

this is cutaneous deposit of fatty material ; assoc with elevated serum cholesterol

A

xanthelasma

140
Q

how do we manage epidermoid cyst

A

asymptomatic cysts don’t require tx; intralesional triamcinolone injection may hasten resolution ; surgical removal of the cyst and wall

141
Q

this is an inward turning of the eyelid ; reps an abnormal inversion of the lid margin toward the globe ; involves mainly the lower lid

A

entropion

142
Q

this is an alternative tx for demodex and is an antihelminthic agent - two 200 mcg doses given 7 days apart

A

oral ivermectin

143
Q

what are the stages of the varicella zoster infection

A
  1. varicella infection 2. latency period 3. VZV Reactivation in trigeminal ganglion 4. chronic pain phase
144
Q

what is the diff between classic vesicular herpes simplex and erosive /ulcerative simplex

A

classic- vesicles form, ulcerate , or harden , assoc redness and swelling , resolve without scar erosive - involves larger but fewer focal lesions, erosions at the gray line and/or ulcers along lid margin; assoc redness and swelling ( pics slide 38, infec disease)

145
Q

how can Preseptal cellulitis happen

A

puncture wound, insect bite, secondary to acute infection, surgical complication

146
Q

how do we manage eyelid contusions

A

cold initially , heat thereafter, avoid/limit blood thinning agents , rule out orbital fracture with X ray and CT scan

147
Q

how will contact dermatitis present

A

photo contact dermatitis “ photoallergic or phototoxic

148
Q

this is a closed sac that contains liquid or semisolid material

A

cyst

149
Q

management options for chalazion

A

conservative: hyperthermia with gentle digital massage tid- qid ; anti inflammatory therapy ( topicals ineffective ) use Kenalog steroid injection; you can do an incision and cut it out as well

150
Q

this is a sweat filled cyst

A

hidrocystoma aka eccrine hidrocystoma, apocrine hidrocystoma

151
Q

what is nocturnal lagopthalmos

A

lagopthalmos mainly upon wakening ; may be related to CPAP / BiPAP for sleep apnea

152
Q

which type of herpes infection is mainly corneal

A

secondary

153
Q

how can we manage nocturnal lagopthalmos

A

gels or ung for overnight therapy, lid taping, protective eyewear

154
Q

this is a related condition to squamous papilloms which is seen in African american pts but is benign

A

dermatosis papulose nigrans

155
Q

how do we manage herpes simplex blepharitis

A

self limiting condition, supportive therapy ( warm saline compresses, drying agents )

156
Q

how do we manage cysts of moll

A

treated same as hidrocystoma; refer to oculoplastics for marsupialization or excision of the lesion

157
Q

this is a focal acute infection of the canthal region caused by mainly Moraxella Lacunata

A

Angular Blepharitis

158
Q

this is removal of the eye from the orbit while preserving all other orbital structures ( lids , EOMS, fat are all left in place) ; indicated for malignant intraocular tumors, in congenital anophthalmia or severe microophthalmia

A

enucleation

159
Q

this results from proliferation of epidermal cells within a circumscribed space In the dermis

A

epidermoid cyst

160
Q

this refers to a los of pigment in the lashes “ whitening” ;

A

poliosis ( slide 12)

161
Q

these are eyes that are far apart; increased distance between the medial canthi ; occurs in Waardenburg syndrome and FAS

A

telecanthus ie. Oprah haha

162
Q

what are the 5 categories of blepharoptosis

A

aponeurotic, mechanical, myogenic, neuromuscular junction disorder, neurogenic

163
Q

what is the management for squamous cell carcinoma; same as BCC

A

biopsy critical, surgical resection is treatment of choice : Mohs micrographic sx

164
Q

how do we distinguish hordeola and chalazia

A

discomfort: hordeola are painful and chalazia are painless timing: hordeola are acute and chalazia are chronic

165
Q

this drug treats hypotrichosis of the eyelashes; made with bimatoprost “ Latisse”

A

Latisse

166
Q

this is a dysfunction of message signaling between motor neurons and muscle fibers : “ myasthenia gravis” and Lambert Eaton myasthenic syndrome

A

neuromuscular junction disorders

167
Q

how can we manage blink lagopthalmos

A

ocular lubricants and blink training

168
Q

how is actinic keratosis managed

A

pt education about sun exposure, FLOUROURACIL ( medical therapy ) , chemical peels or dermabrasion

169
Q

how does lagophthalmos presnet

A

variable, unilateral and bilateral, concurrent lid retraction, incomplete blink on slit lamp exam ; assoc with exposure keratoconjunctivitis slide 39

170
Q

what are the palpebral fissure mesaurements in blepharoptosis

A

mild - up to 2 mm, moderate - 3 mm severe- 4 mm or greater

171
Q

this the most common virus found in humans; systemic transmission via secreted fluid in close contact with mucosal tissues

A

herpes simplex virus

172
Q

how does floppy eyelid syndrome present

A

typical pt : Male, middle aged and obsese can be unilateral or bilateral ; will have ocular irritation, itching, and stringy mucuous discharge ( slide 59)

173
Q

how do we manage bells palsy

A

supportive mgmt. like oral acyclovir

174
Q

how does a Hordeolum present

A

as one or more focal, firm, painful nodules in the eyelid ; More common in younger pts ; concurrent findings -> anterior/posterior blepharitis, bleparoconjunctivitis, general hygiene issues ( see slide 14, inf lid disorders)

175
Q

how do we manage trichomegaly/ hypertrichosis

A

not overtly symptomatic , mainly cosmesis; can use eflornithine cream ( slide 10)

176
Q

multiple dysplastic nevi may be a sign of _________

A

FAMMM ( familial atypical multiple mole and melanoma syndrome)

177
Q

how does dermatochalasis present

A

sagging of upper and lower lids ; bilateral ; symptomatic pts are > 50 YO ; no gender biased ; “hooding effect” slide 68; visual field may be impacted in severe cases

178
Q

when do the lids begin to differentiate during embryogenesis

A

at week 6

179
Q

how does angular blepharitis present

A

unilateral, focal redness and excoriation at the inner and outer canthus ; symptoms: itching, dryness, irritation, tenderness, crusting, sticking of the lids “ frothy “ presentation ; No predilections ( slide 6, infec.t disorders lecture for pic)

180
Q

this is the distance the lid travels from downgaze to upgaze while the frontalis muscle is held inactive at the brow

A

levator function normal > 15 mm good 12-4 fair 5-11 poor

181
Q

how does myogenic blepharoptosis present

A

slow onset, progressive, bilateral ; assoc with diplopia; poor levator function

182
Q

this is the distance between the pupillary light reflex and the upper eyelid margin with eye in primary gaze

A

marginal reflex distance 1: normal is 4-4.5 mm

183
Q

this is small and malformed globe and eyelids ; may be unilateral or bilateral ; assoc with colobomas

A

micropthalmos ( slide 48)

184
Q

this is aka skin polyp; benign HYPERPLASIA of normal epithelium with variable keratinization and pigmentation; arise as part of the aging process or due to skin fold

A

squamous papilloma

185
Q

this is the most common inflammatory lesion of the eyelid ; lipogranulomatous inflammation of the Meibomian gland ; this is painless

A

chalazion

186
Q

how does basal cell carcinoma present

A

translucent raised nodule with PEARLY MARGINS , INVOLUTION AND ULCERATION at the center ( slide 50 dysplastic )

187
Q

how do comedones present

A

rasied thickened nodule with central pore, multiple in appearance seen mainly in teens and young adults ; ( slide 40, obstruct)

188
Q

this is a def. or absence of eyelids assoc with congenital anomlaies

A

ablepharon ( slide 31)

189
Q

how do we manage HZO

A

Oral Antivirals ( Acyclovir, Valacyclovir, Famciclovir ) must be initiated within 72 hours to minimize risk of postherpetic neuralgia; oral corticosteroids for edema ( prednisone), pain management ( cool compresses, CIMETIDINE); topical Ab for lesiosn

190
Q

how do we manage cysts of Zeis

A

asymptomatic- no tx required; warm compresses and massage ; surgical intervention for larger or symptomatic lesion

191
Q

what are some systemic associations with Epicanthal folds

A

Cri du Chat Syndrome , Klinefelter Syndrome, Turner Syndrome, and Ehlers Danlos Syndrome

192
Q

what are the two phases of initial insult of the herpes virus

A

initial infection ( mild) and reactivation ( more symptomatic)

193
Q

how does xanthelasma ppresent

A

pts > 40 YO, women more than men; cosmetic concerns ; typically non painful; characterstic yellow plaques

194
Q

this denotes manifestations primarily affecting the lashes and their assoc pilosebaceous glands : types are staph blepharitis and seborrheic blepharitis

A

anterior blepharitis

195
Q

how does mechanical blepharoptosis present

A

variable acuity, no pupil involvement

196
Q

how do epidermoid cysts present

A

can occur at any time in life; males more than females; foul smelling “ cheese like” material ( slide 26, obstructive )

197
Q

in blunt ocular trauma what is the “ tip of the iceberg”

A

the lids

198
Q

how does the eyelid contusion present

A

with pain and tenderness

199
Q

how does pilomatricoma present

A

small, hard lump under the skin on palpation ; asymptomatic, occurs in head and neck, more common in Caucasian females , solitary ( slide 29, dysplastic disorders)

200
Q

these are obstructive lesions of the hair follicle with a potential for inflammation/infection ; retention of sebum and keratin; involves skin of faced, back and chest, class feature of acne vulgaris ; open “ blackheads” and closed ( white heads)

A

comedones

201
Q

this is the distance from upper lid margin to the eyelid crease

A

margin crease distance ( 7-8 mmm in males and 9-10 mm in females)

202
Q

what is hutchinsons sign

A

during HZO , when nasociliary nerve involvement induces inflammation involving the anterior segment

203
Q

this is the prolapse of extraconal orbital fat into the upper and lower eyelids due to a lax orbital septum

A

steatoblepharon- slide 17

204
Q

how does blepharophimosis present

A

abnormal narrowing of the palpebral fissures, absence of levator fold, lateral ectropion, hypoplasia of superior orbital rims, low nasal bridge, amblyopia ( slide 21)

205
Q

how does hidrocystoma present

A

prevalent in 30-70 YO; asymptomatic, signs : Translucent ; lesions grow slowly and persist indefinitely ; exacerbated in warmer climates

206
Q

what are the ABCs of suspicious dermatologic lesions

A

asymmetry, borders, bleeding, color , circulation, diameter, and elevation

207
Q

this is a type of basal cell carcinoma that account for

A

sclerosing or morpheaform BCC

208
Q

how is the herpes virus mainly contracted

A

via orofacial contact ie kissing

209
Q

how do we manage distichiasis

A

lubricants, bandage Cl, epilation, follicle destruction

210
Q

this is an abnormally increased distance between two organs

A

Hypertelorism ( ie in the eyes)

211
Q

how does basal cell carcinoma present

A

usually older and seen more in men than women

212
Q

T or F: recurrent or atypical chalazia warranty BIOPSY

A

T

213
Q

this is an infestation by demodex; most common age dependent ectoparasite ; cant see with naked eye ; they inhabit hair follicles and are not parasitic by nature ( feed on sebaceous oils and dead skin cells ) their overpopulation causes inflammation

A

demodicosis

214
Q

eyelashes of increased length, thicknes and pigmentation ; can be congenital or acquired ( ie prostaglandin analogues)

A

trichomegaly or hypertrichosis

215
Q

this is when the Epicanthal folds originate in the lateral aspect of the upper lid and dissipate medially ie Asians

A

epicanthus tarsalis

216
Q

how does eyelid retraction present

A

uncommon; can affect pts of any age ; seen mostly in adults ; bilateral or unilateral slide 31

217
Q

T or F: recurrent hordeolas are not as ominous as recurrent chalazia but still warrant concern

A

T : there could be possible assoc with selective IgM def. or Hyperglobulinemia E, possible malignancy

218
Q

T or F: immunocompromised pts present with larger, more numerous , multicentric molluscum as compared to immunocompetent pts

A

T

219
Q

how do we manage hordeola

A

they are usually self limiting; hot compresses tid-qid with gentle massage, antibiotic therapy ( cephalexin, amoxicillin, tetracyclines) ; surgical therapy for EXTERNAL hordeola , surgery not recommended for INTERNAL

220
Q

this is removal of the contents of the globe while leaving the sclera and EOM intact; indicated for endophthalmitis

A

evisceration

221
Q

what are the most common organisms to cause Preseptal cellulitis

A

staphylococcus and streptococcus, H. Influenzae, and klebsiella pneumonia

222
Q

how does staph blepharitis present

A

bilateral, itching, burning, grittiness, Foreign body sensation, heaviness, and tearing ; crustiness around base of lashes, collartes conj injection,

223
Q

what are some commercially available TTO tx for demodex

A

CLIRADEX, blephadex, and oust demodex

224
Q

mgt of karposi sarcoma

A

best managed by infectious disease specialist

225
Q

this condition is not well understood for etiology ; mainly caused by CHRONIC UV EXPOSURE; MOST COMMON NON MELANOMA SKIN CANCER IN THE US

A

basal cell carcinoma

226
Q

this is drooping or slack eyelids; rare condition that involves recurrent episodes of eyelid edema ; subsequent damage to levator aponeurosis resulting in ptosis ; considered idiopathic

A

blepharochalasis

227
Q

how do we manage contact dermatitis

A

remove the offending agent , topical steroids , supportvie therapy

228
Q

this is an outward turning of the eyelid; reps an abnormal eversion of the lid margin away from the globe ; involves lower lid mainly ; uncommon ; no predilections but mainly in older people ; unilateral or bilateral

A

ectropion- slide 25

229
Q

what is Iliff’s sign

A

when you evert the eyelid and ask the pt to look up- failure of the eyelid to return to its normal position when the pt looks up indicates poor levator function

230
Q

how does squamous cell carcinoma present

A

usually in older fair skinned peeps, often looks like a scab that wont heal ( slide 69, dysplastic disorders); SCC more aggressive than BCC

231
Q

this is really radical and involves removal of the eye, adnexa, and part of the bony orbit; indicated for invasive lid tumors

A

exenteration

232
Q

rare condition where the lashes grow from the meibomian orifices ; can be congenital or acquired and complete or partial

A

distichiasis

233
Q

what are some risk factors for post herpetic neuralgia

A

older age, severe shingles, severe acute pain, presence of prodrome

234
Q

how do you manage pilomatricoma

A

do not regress spontaneously, requires surgical management if symptomatic or cosmetically undesirable ; POTENTIAL FOR INFLAMMATION

235
Q

how is dermatochalasis managed

A

no tx required for asymptomatic pts ; surgical mgmt. is blepharoplasty

236
Q

how does MGD present

A

bilateral ; any age but most are > 40YO , will complain of itching, burning, stinging sensation

237
Q

can SCC arise from actinic keratosis

A

Yes

238
Q

this is a papillomatous skin response to viral infection by HPV; produces fibrovascular, epithelial projections with vascularized cores , covered by hyperkeratotic epithelium

A

verruca ( slide 72, infect. disorders)

239
Q

how do we manage eyelash ptosis

A

lubricants, bandage CL, epilation ( temporary) and blepharoplasty ( definitive)

240
Q

etiology of this condition not understood may be due to chronic UV exposure; second most common melanoma skin cancer in the US

A

squamous cell carcinoma

241
Q

how do we manage atopic dermatitis

A

stress control, avoidance of allergens and irritants, medial therapy: topical steroids ( Arisocort, Lidex, and Elocon ) and topical immunomodulatory agents for recalcitrant cases ( Elidel and Protopic)

242
Q

this is characterized by a horizontal fold of skin stretching across the border of the eyelid ; normal eyelid margin position ; Entropion posture; common in Asians ; comorbities = keratophy secondary to trichiasis ; may resolve spontaneoulsy

A

epiblepharon ( slide 24)

243
Q

how do we manage Epicanthal folds

A

mgt is surgical if pt symptomatic;

244
Q

how do we manage keratoacanthoma

A

SURGICAL ; for poor surgical candidates we can do methotrexate. 5- FU, Bleomycin, and corticosteroids

245
Q

what are the signs of Preseptal cellulitis

A

mechanical ptosis, red-purple skin coloration, swelling and firmness, involvement of connunctiva, pain on palpation, cant open eye, tearing

246
Q

whats the mgt for ankyloblepharon

A

amblyogenic if untreated ; surgical mgt warranted

247
Q

this type of nevus occurs in middle age- the cells extend from the epidermis into the dermis

A

compound

248
Q

T or F: 90 % of adults harbor the HSV-1 virus

A

T- typically as fever blisters and cold sores

249
Q

this is usually present at birth and is bilateral ; common in African american and down syndrome children ; when the upper eyelid everts

A

congenital upper eyelid eversion “lamellar ichythyosis”

250
Q

condition where the upper and lower eyelid is position significantly more open;

A

eyelid retraction- this is a sign NOT a diagnosis

251
Q

if nevus cells are derived from dermal melanocytes what are they called

A

blue nevi

252
Q

what are some differentials for hordeola

A

cysts of zeis or moll, pyogenic granuloma, Kaposi’s sarcoma, Preseptal cellulitis

253
Q

management for seborrheic blepharitis

A

hyperthermia, lid margin cleasning, topical Ab NOT necessary and topical steroids are CI, orals unnecessary

254
Q

this is a rare congenital anomaly where you have vertical shortening of the eyelids ; managed with ocular lubricants and sx in severe cases

A

microblepharon

255
Q

how do we manage verruca

A

benign neglect; intervention only for cosmesis ( keratolytic agents: KOH, Salicylic acid, cantharidin) imiquimod cream , electrocautery , chemical cautery or cryotherapy

256
Q

this is drooping or slack skin; reps a normal involutional change due to decrease in laxity and gravity ; blinking and photochemical stress contribute

A

dermatochalasis

257
Q

how does entropion present

A

uncommon; mainly in older pts; can be unilateral or bilateral- slide 33

258
Q

this results from a defect in closure of the optic fissure during embryogenesis ; most common position is at junction of the medial and middle third of upper lid

A

eyelid coloboma ( slide 27)

259
Q

this is an infestation by Phthiriasis ( aka crabs) ; organisms infest where adjacent hairs are within grasp such as eyebrows and lashes; transmission by direct contact ; they burrow in at lash base and feed off blood of host ; fecal deposits visible

A

Phthiriasis Pubis

260
Q

how do chalazions present

A

one or more focal and firm and painless!; affects men more may follow an acute infection slide 9 ( inflamm. disorders)

261
Q

this condition involves proliferation of epidermal cells ; assoc with gene mutation coding for FGFR3

A

seborrheic keratitis

262
Q

what are some potential complications of MGD

A

hordeola, chalazia, Preseptal cellulitis, and marginal keratitis ; if untreated can result in Meibomian gland atrophy and dropout

263
Q

this disease involves development of molluscum bodies ( aka Henderon Patteron bodies )- large round or oval cytoplasmic inclusions containing molluscum virions, eosinophils, and basophils; produces an acanthosis; forms a central cavity and will appear umbilicated

A

molluscum contagiosum

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