eye lid, lacrimal and orbit disease Flashcards
where is the lacrimal gland located
just below the orbital rim
3 functions of the eyelid
- maintain lubrication
- protection from infection
- prevent drying
4 types of tear film disorder + causes
- low tear quantity (age, damage to gland, etc.)
- poor quality tears (belpharitis)
- disturbance of blink reflex (e.g. post surgery)
- increased evaporation through exposure (CN VII palsy, surgery, thyroid eye disease, poor orbicularis tone etc.)
what can exposure of the ocular surface lead to (2)
- drying
- microbial ketatitis -> loss of vision
4 symptoms of dry eyes
- irritation
- stinging
- burning
- red sticky eye in the morning
what is lagophthalmos
incomplete eyelid closure (leads to exposure of ocular surface)
what is blepharitis
inflammation of the eyelids - occurs when tiny oil glands near the base of the eyelashes become clogged, causing irritation and redness
blepharitis in young pts vs old
young - usually anterior lid margin
old - posterior lid margin
what is chalazia and what condition is it associated with
a small swelling or lump on your eyelid because of a blocked gland; often associated with blepharitis
treatment for chalazia (4)
- sponteneous resolve (usually)
- hot lid massage
- incision and cutturage
- lid hygeine (underlying blepharitis)
what is entropion
when the eyelid is rolled inward against the eyeball
5 causes of entropion
- lid laxity
- aging
- congenital
- spastic (muscle spazams)
- cicatricial (chronic inflammation leading to fibrosis, scarring and shortening of the posterior lamella)
how can entropion be unmasked
asking pts to close their eyes forcibly
6 symptoms of entropion
- irritation (e.g. due to eyelashes rolling in and touching occular surface)
- watering
- grittiness
- stickiness
- recurrent infections
- intermittent presentation
what is the definative treatment for entropion + 3 other treatments
definitive - surgery (everting sutures, lid tightening)
others - lubricants, taping, botox (short term, useful if surgery waiting list is long)
which type of surgery is most definitive for entropion
lateral canthal sling
what is ectropion
when the eyelid is turned outwards away from the eyeball
3 causes of ectropion
- lid laxity/aging
- paralytic (CN VII palsy)
- cicatrical (shortening of ant. lamella)
6 symptoms of ectropion
- asymptomatic
- watering
- red appearance
- discharge
- blurred vision
- stinging/pain (if exposed)
ectropion treatment (2)
lubrication, surgery
what needs to be excluded in a ptosis presentation
acute neurology
what is ptosis
drooping of upper eyelid
what needs to be checked on examination with ptosis (6)
- lid heights and variability as the eye moves
- lid movements
- ocular surface dryness
- pupil reactions
- obicularis tone and function
- visual function
what might acute onset ptosis indicate (3)
serious underlying pathology
1. horner’s syndrome (look for pupil asymmetry)
2. CN III palsy
3. myasthenia gravis
etc.
6 causes of ptosis
- congenital (dystropic muscle that hasnt developed properly)
- aponeurotic/senile
- traumatic
- neurogenic
- myogenic
- mechanical
what might ptosis increase the risk of developing in children and why
amblyopia - occurs when the eyelid is encroaching on the pupilary axis and therefore leads to impaired vision in that eye -> brain begins to supress input from that eye etc.
4 characteristics of benign lid lesions
- long history
- gradual change
- asymptomatic often
- possibly tender e.g. acute stye
4 characteristics of malignant lid lesions
- recent onset
- rapid growth
- bleeding
- pigmented (rare, red flag if seen)
4 characteristics of benign lid lesions on examination
- distinct edges
- cystic
- no loss of lashes
- no destruction of lid architecture
7 characteristics of malignant lid lesions on examination
- ill defined borders
- loss of lashes
- destruction of the lid architecture
- bleeding
- ulceration
- diplopia
- extension into orbit
5 examples of benign lid lesions
- chalazion (cystic appearance)
- cyst of moll (fluid filled lesion arising from the gland of moll
- papilloma
- cyst of zeiss (blockage of acessory glands)
- xanthelasma
3 examples of pre-malignant lid lesions
- ketatocanthoma
- lentigo maligna
- solar keratosis
4 examples of malignant lid lesions
- BCC (nodular)
- BCC (inflitrative)
- SCC
- Merkel cell cancer
how can merkel cell cancer be treated and what is the side effect of this
Radiotherapy (very sensitive to RT)
can damage lacrimal system leading to increased risk of dryness
3 treatment options for periocular BCCsa
- excision (conventionsl)
- excision (Mohs - refer to derm, usually if lesion is close to important structures or borders are ill defined)
- reconstruction (post surgery)
what is the risk from neglecting a BCC
extension into the orbit
3 examples of lacrimal system disorders
- dacryocystisis
- dacryodenitis
- nasolacrimal duct obstruction (leads to watery eyes)
what is dacryocystitis
the inflammation and infection of your tear sac
what is dacryoadenitis
inflammation in one or both of your lacrimal glands
characteristic eye lid shape seen in dacryoadenitis
S shaped lip contour
dacryoadenitis treatment
typically conservative- may require antibiotics but typically resolves without complications
what is IgG4 disease
a chronic, immune-mediated disorder that often manifests with multiorgan involvement and tumor-like masses most often affecting the pancreas, bile ducts, lacrimal glands etc.
what can be done if lacrimal gland swelling doesnt resolve spontaneously
lacrimal gland debulking surgery; CT head to look for nefarious causes
management for dacryocystitis
- oral Abx
- drain
- dacryocystorhinostomy (a connection between the lacrimal sac and nasal mucosa is made to allow tears to drain here
why does dacryocystitis arise
usually due to fibrosis of the lacrimal tracts, often hx of recurrent rhinitis as a cause of this
6 general symptoms of orbital disease
- diplopia
- swelling around the eye
- bluging prominent eye
- awareness of a lump
- ache behind the eye
- pain on eye movements
7 general signs of orbital disease
- restriced eye movements
- swelling around the eye
- proptosis (abnormal protrusion or displacement of an eye)
- lid retraction
- reduced vision
- reduced colour vision (early sign!!)
- pupil abnormalities
what is orbital cellulitis and how is it managed
an infection that involves the eye and the eye structures within the bony cavity of the face
medical emergency - admission and IV abx, abcess drained endoscopically
what is proptosis
abnormal protrusion or displacement of an eye - eye may appear bigger as it is being pushed forwards
why is the eye pushed forwards in proptosis
the eye is surrounded by the bony orbital cavity on all other sides -> the only direction it can expand in
what underlying condition is the most common cause for ptoptosis
thyroid eye disease (TED)
other causes for proptosis (not TED - 2)
- primary orbital tumours (lymphoma, glioma)
- metastasis (breast, prostate, lung)
what is thyroid eye disease
an autoimmune disease in which the eye muscles and fatty tissue behind the eye become inflamed
red flags for urgent ophthal referal (7)
- exposure of the eye
- double vision and ptosis
- reduced vision
- rapidly growing suspicious eye lid lesion
- proptosis
- swelling in lacrimal gland or sac area
- entropion (eyelid is rolled inward against the eyeball)
4 red flags for routine referral to ophthal
- long standing lid lesion with no suspiciuos features
- gradual onset adult ptosis
- non painful ectropion
- watery eye alone
how is ocular perfusion pressure calculated
2/3 mean arterial pressure - IOP
