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OHADM1 > Eyelid > Flashcards

Eyelid Flashcards

1
Q

name the developmental malfunctions and abnormalities of the eyelid

A
  • epicanthic folds
  • epiblepharon
  • congential entropion
  • Colomba
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2
Q

What are the two types of ectropion and one type of entropion

A
  • involutional ectropion
  • paralytic ectropion
  • involutional entropion
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3
Q

name the two types of ptosis

A
  • Simple congential ptosis
    -Involutional ptosis
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4
Q

What is a miscellanous acquired disorder

A

Dermatochalasis

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5
Q

What is epicanthic folds

A

Bilateral folds of skin that extend from upper and lower lids towards the medial canthi

may give rise to psuedo-esotropia

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6
Q

What is the management for epicanthic folds

A

usually not required, as it will become less distinct with age

Refer for surgical treatment- cosmetic reasons

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7
Q

what are the two types of epicanthic folds and decribe each type

A

Palpebralis
- folds symmetrically distributed betweem upper and lower lids
- more common in caucasians

Tarsalis (kinda look like double eyelid)
- folds orginate in medial aspects of upper lids and extend medially before disspiating
- more common in orientals

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8
Q

What is a similar diagnosis for epiblepharon

A

Constantly confused with congenital entropion

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9
Q

What are the signs of epiblepharon

A
  • Extra horizontal fold of skin stretches across anterior lid margin
  • Lash are directed vertically espcially at medial lid
  • Lashes turn out when fold of skin is pulled down revealing normal location of lid
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10
Q

What are the treatment for epiblepharon

A

not required in majority of cases due to spontaneous resolution with age

refer for surgery for persistent cases

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11
Q

What are the causes of the two types of congenital entropion

A

Upper lid entropion
- usually secondary to mircropthalmos (abnormally small eye) causing ypper lid inversion

Lower lid entropion
- caused by improper development of inferior retractor muscles

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12
Q

what is the treatment of congential entropion

A

surgery to realign eyelid

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13
Q

What is coloboma

A

occurs when foetal eyelid development is incomplete

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14
Q

what is the treatment for coloboma

A

Surgery

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15
Q

What is involutional entropion

A

age related in turning of the eyelid (mainly lower)

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16
Q

What is the signs of involutional entropion and what are its complication

A

Pseudotrichiasis
- constant rubbing of lash on the cornea in longstanding entropion. This causes irriation and corneal punctate erosions. Ulceration and pannus formation (servere)

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17
Q

What is the management for involutional entropion

A
  • lubricant with soft tapping at night
  • soft bandage contact lens
  • refer for surgical management
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18
Q

What is involutional ectropion

A

Age related eversion of lower lid in elderly patients

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19
Q

What does involutional ectropion result in

A
  • epiphora (excess tears / watery eye)
  • long standing cases: conjunctiva becomes chronically inflamed, thickened and keratinised
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20
Q

What is the management of involutional ectropion

A

Refer for surgical treatment

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21
Q

What is the cause of paralytic ectropion

A

Eversion of lower lid caused by ipsilateral facial nerve palsy
- associated w retratiction of upper n lower lids + brown ptosis

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22
Q

What is the complications of paralytic ectropion

A

Epiphora, exposure keratopathy

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23
Q

What is mangament for paralytic ectropion

A
  • Lubrication during day, ointment at night and taping lid shut
  • refer for surgical treatment
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24
Q

What is simple congenital ptosis

A

Droopy eyelids
- caused by failure of migration of nerves to final position
- musuclar developmental failure
- hereditary (minor cases)

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25
Q

What are the signs of simple congenital ptosis

A
  • Uni/bilateral ptosis of variable severity
  • Absent upper lid crease and poor levator function
  • Ptosis lid higher than normal in down gaze (poor relaxation of levator muscle)
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26
Q

What is the management for simple congenital ptosis

A

Refer for surgery, esp w amblyopia(one eye better than other) risk

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27
Q

What is involtuional ptosis

A

Dropping of eyelid due to age

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28
Q

What is the signs of involutional ptosis

A
  • Variable sually bilteral, ptosis with high upper lid crease
  • levator fucntion usually reasonably good
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29
Q

What is the treatment of involutional ptosis

A

refer for surgery (functional/ cosmetic problem)

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30
Q

An elderly patient has baggy lids and pseudo-ptosis as well as redundent upper lid skin. Name the condition and the management for it

A

Dermatochalasis. Refer severe cases for excision of redundent skin

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31
Q

Name a benign nodule and describe it

A

Chalazion, a chronic, sterile, granulous inflamm. lesion

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32
Q

What is the cause if chalazion

A

by sebaceous secretion retained in lid stroma that has leaked from adjacent meibomian glands or other sebaceous glands

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33
Q

What happens if the chalazion gets secondarily infected

A

Internal hordeolum

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34
Q

What is the sign of chalazion

A

Non-tender roundish nodule within tarsal plate

35
Q

What is the treatment for chalazion

A
  • may not be required, 1/3 cases resolves spontaneously + internal hordeolum may discharge n disappear
  • Remove for surgical removal for persistent lesions
36
Q

name the benign tumours

A

Sqaumous cell papilloma, basal cell papilloma (terrifying), xanthelasma

37
Q

What is the defining trait of squamous cell papilloma

A

Variable clinical appearance but common histological features

38
Q

What is the mangament of squamous cell papilloma

A

refer for simple exicision

39
Q

What is the signs of basal cell papilloma

A

Discrete, greasy, brown plaque with a friable surface and a stuck on appearance

40
Q

what is the managment of basal cell papilloma

A

Refer for surgical excision of lesions

41
Q

What is the most common group of people with xanthelasma

A

Found in middle aged/ elderly, esp in young males

42
Q

What is xanthelasma associated with

A

increased level of serum cholesterol and LDL cholestrol

43
Q

How to tell if a tumour is benign

A
  • Lack of induration and ulceration
  • uniform colour
  • Lack of/ v slow growth
  • Regular outline
  • Preservation of normal lid margin structures
44
Q

Name the two malignant tumours

A

basal cell carcinoma(90% of all cases) and squamous cell carcinoma

45
Q

Name the risk factors of basal cell carcinoma

A

fair skin, inability to tan and chronic exposure to sunlight

46
Q

name the general features of squamous cell carcinoma

A
  • Potentially more aggersive than BCC. Spreads to lymph node and surrounding area
  • More likely at lower eyelid and lid margin
47
Q

mangament of malignant tumours

A
  • Biopsy (remove partial/ entire lesion to determine presence or extent of disease)
  • Surgical excision (entire tumour should be removed with presercation of as much normal tissues as possible)
  • Reconstruction
  • Radiotherphy
  • Cryotheraphy
48
Q

Name the bacterial infection of the eyelid

A

External hordeolum

49
Q

What is the cause of external hordeolum (stye)

A

Actue staphylococcal abscess of a lash follicle and its associated gland of Zeis

50
Q

What is the signs of external hordeolum

A

Tender swelling in the lid margin, sometimes with a lash at the apex

51
Q

What is the treatment of external hordeolum

A
  • Hot compresses, epilation of assoicated lash to hasten resolution
  • refer to GP for topical antibiotics
52
Q

name the viral infections that take place in the eyelids

A

Molluscom Contagiosum
Herpes Simplex
Herpes zoster

53
Q

What is molluscom contagiosum caused by

A

poxvirus (affects healthy children)

54
Q

What are the signs of molluscom contagiosum

A
  • Single or multiple, pale, waxy nodule
  • Lesion in lid can shed virus to tears resulting in conjunctivitis
  • White cheesy material consiting of infected degenerated cells can be expressed from lesion
55
Q

What is the treatment of molluscom contagiosum

A
  • Not necessary unless lesion is close to lid margin
  • Refer for cauterisation, cryotherapy or laser
56
Q

What is the cause of herpes zoster ophthalmicus

A
  • common unilateral condition that affects elderly, caused by varicella-zoster virus (VZV)
57
Q

What is the sign of herpes zoster opthalmicus

A
  • Maculopapular rash on forehead with vesicles and crusting
  • ocular complications
58
Q

What is the treatment of herpes zoster opthalmicus

A

Refer for systemic/ topical antiviral

59
Q

What is the causes of herpes simplex

A

primary infection or reactiation of herpes simplex cirus taht was previously dormant in trigeminal ganglion

60
Q

What is the diagnosis of herpes simplex

A
  • early facial and lid tingling lasting around 24h
  • eyelid and periorbital vesicles on lid margin that breakdown over 48 hours
  • ocular complications
61
Q

What is the treatment for herpes simplex

A

refer for topical antiviral

62
Q

name the allergic disorders that occur at the eyelids

A

Acute allergic oedema
Contact dermatitis
Atopic dermatitis

63
Q

What is the cause of acute allergic oedema

A

insect bites, angioedema, urticaria, occcasionally drugs

64
Q

What is the signs of acute allergic oedema

A

Sudden onset, bilateral periorbital oedema

65
Q

What is the mangament of acute allergic oedema

A

Refer to GP for systemic antihistamines

66
Q

What is the cause of contact dermatitis

A

Inflmmatory response that usually follows exposure to medication, preservative, ceosmetic, metals

67
Q

What are the signs of contact dermatitis

A
  • Lid oedema, scaling and angular fissuring and tightness
  • Chemosis, redness, papillary conjunctivitis
  • Punctate corneal erosions
68
Q

What is the management for contact dermatitis

A
  • stop exposure to allergen, if possible
  • use non-preservd dropsm if sensitivity to preservative suspected
  • cold compress to relief symptoms
  • refer for topical medications or ststemic medications (if severe)
69
Q

What is the cause of atopic dermatitis

A

Asthma and hay fever

70
Q

What are the signs of atopic dermatitis

A
  • Thickening, crusing and vertical fissuring of the lids associated with staphyloccocal blepharitis and madarosis
71
Q

What are the managment for atopic dermatitis

A
  • Moisturiser to hydrate skin
  • mild topical steroids
  • treat associated infection with antibiotics if necessary
72
Q

What are the symptoms of chronic anterior blepharitis

A
  • burning, grittness and mild photophobia
  • usually worse in morning, patients w dry eye says it may increase during the day

Caused by disruption of normal ocular surface function and reduction in tear stability

73
Q

What is the cause of staphylococcal chronic anterior blepharitis

A

abnormal cell mediated response to component of cell wall of S. aureus which may be responsible for red eye reaction and peripheral corneal infiltrates in some patients

74
Q

What is the signs of staphylococcal chronic anterior blepharitis

A
  • hard scales and crusting around bases of lashes
  • mild papillary conjunctivitis and chronic conjunctival hyperaemia
  • tear film instability and dry eyes
  • long standing cases: scarring, notching of lid margin, madarosis, trichaises, poliosis
75
Q

What is the cause of seborrhoeic chronic anterior blepharitis

A

often associated with generalized seborrheic dermatitis taht may involve scalp, nasolabial folds, behind the ears and the sternum

76
Q

What are the signs of seborrhoeic chronic anterior blepharitis

A
  • hyperaemic and greasy anterior lid margins with lashes sticking together
  • scales are soft and located anywhere on lid margin and lashes
77
Q

What is the treatment for chronic anterior blepharitis

A
  • adive patient on chronic nature of condtion
  • lid hygiene (warm compress for several minutes, lid cleaning once or twice daily with cotton bud dipped in dilute baby shampoo or commercial lid scrubs)
  • tear supplements for associated tear film instability and dry eyes
  • refer for steroid and antibiotics treatment in serious cases
78
Q

What is the cause of chronic posterior blepharitis

A

caused by meibomian gland dysfunction and alterations in meibomian gland secreation resulting in
- increased melting pouint of meibum preventing its expression from gland, contributin to surface irritation an possible enabling growth of S.auerus
- unstable tear film

79
Q

What are the signs of chronic posterior blepharitis (symptoms similar as anterior blepharitis)

A
  • excessive and abnormal meibomian gland secretion which may manigest as capping of meibomian gland orifices with oil globules
  • plugging on meibomian gland orifices with hyperaemia and telangiectasis of posterior lid margin
  • tear film is oily and foamy
  • pressure on lid margin results in rexpression of meibomian fluid or paste (expression imposible in severe cases)
80
Q

What is the mangament for chronic posterior blepharitis

A
  • remission mat be achieved, but not fully cured
  • Lid hygeine (warm compress n hygience with emphasis on massaging lid to express accumulated meibum)
  • tear supplements for associated tear film instability and dry eyes
  • refer for systemic antibiotics and topical medications for severe cases
81
Q

What are the disorder of lashes and describe them (5)

A

Eyelash ptosis
- downward sagging of upper eyelid lashes

Trichomegaly
- excessive eyelash growth

madarosis
- decrease in number of lashes

Poliosis
- premature localized whitening of hair which may involve lashes and eyebrows

Trichiasis
- posterior misdirection o lashes arising from normal sites of orgin

82
Q

What are the signs of trichiasis

A
  • Trauma to corneal epithelium may cause epithelial eorision
  • Ocular irritation made worse on blinking
  • Corneal ulceration and punnus formation may occur in severe long-stading cases
83
Q

what is the treatment for trichiasis

A
  • Few misdirected lashes (epilation but reccurence common)
  • diffuse, seerve, recurrent (epilate or refer for defintive theraphy- such as electrolysis, cryotherphy or eyelid surgery)
  • contact lens to prevernt lashes contact with cornea

OHADM1 (5 decks)

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