Eyelid Flashcards
1
Q
name the developmental malfunctions and abnormalities of the eyelid
A
- epicanthic folds
- epiblepharon
- congential entropion
- Colomba
2
Q
What are the two types of ectropion and one type of entropion
A
- involutional ectropion
- paralytic ectropion
- involutional entropion
3
Q
name the two types of ptosis
A
- Simple congential ptosis
-Involutional ptosis
4
Q
What is a miscellanous acquired disorder
A
Dermatochalasis
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
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
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
8
Q
What is a similar diagnosis for epiblepharon
A
Constantly confused with congenital entropion
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
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
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
12
Q
what is the treatment of congential entropion
A
surgery to realign eyelid
13
Q
What is coloboma
A
occurs when foetal eyelid development is incomplete
14
Q
what is the treatment for coloboma
A
Surgery
15
Q
What is involutional entropion
A
age related in turning of the eyelid (mainly lower)
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)
17
Q
What is the management for involutional entropion
A
- lubricant with soft tapping at night
- soft bandage contact lens
- refer for surgical management
18
Q
What is involutional ectropion
A
Age related eversion of lower lid in elderly patients
19
Q
What does involutional ectropion result in
A
- epiphora (excess tears / watery eye)
- long standing cases: conjunctiva becomes chronically inflamed, thickened and keratinised
20
Q
What is the management of involutional ectropion
A
Refer for surgical treatment
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
22
Q
What is the complications of paralytic ectropion
A
Epiphora, exposure keratopathy
23
Q
What is mangament for paralytic ectropion
A
- Lubrication during day, ointment at night and taping lid shut
- refer for surgical treatment
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)
25
What are the signs of simple congenital ptosis
- 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)
26
What is the management for simple congenital ptosis
Refer for surgery, esp w amblyopia(one eye better than other) risk
27
What is involtuional ptosis
Dropping of eyelid due to age
28
What is the signs of involutional ptosis
- Variable sually bilteral, ptosis with high upper lid crease
- levator fucntion usually reasonably good
29
What is the treatment of involutional ptosis
refer for surgery (functional/ cosmetic problem)
30
An elderly patient has baggy lids and pseudo-ptosis as well as redundent upper lid skin. Name the condition and the management for it
Dermatochalasis. Refer severe cases for excision of redundent skin
31
Name a benign nodule and describe it
Chalazion, a chronic, sterile, granulous inflamm. lesion
32
What is the cause if chalazion
by sebaceous secretion retained in lid stroma that has leaked from adjacent meibomian glands or other sebaceous glands
33
What happens if the chalazion gets secondarily infected
Internal hordeolum
34
What is the sign of chalazion
Non-tender roundish nodule within tarsal plate
35
What is the treatment for chalazion
- may not be required, 1/3 cases resolves spontaneously + internal hordeolum may discharge n disappear
- Remove for surgical removal for persistent lesions
36
name the benign tumours
Sqaumous cell papilloma, basal cell papilloma (terrifying), xanthelasma
37
What is the defining trait of squamous cell papilloma
Variable clinical appearance but common histological features
38
What is the mangament of squamous cell papilloma
refer for simple exicision
39
What is the signs of basal cell papilloma
Discrete, greasy, brown plaque with a friable surface and a stuck on appearance
40
what is the managment of basal cell papilloma
Refer for surgical excision of lesions
41
What is the most common group of people with xanthelasma
Found in middle aged/ elderly, esp in young males
42
What is xanthelasma associated with
increased level of serum cholesterol and LDL cholestrol
43
How to tell if a tumour is benign
- Lack of induration and ulceration
- uniform colour
- Lack of/ v slow growth
- Regular outline
- Preservation of normal lid margin structures
44
Name the two malignant tumours
basal cell carcinoma(90% of all cases) and squamous cell carcinoma
45
Name the risk factors of basal cell carcinoma
fair skin, inability to tan and chronic exposure to sunlight
46
name the general features of squamous cell carcinoma
- Potentially more aggersive than BCC. Spreads to lymph node and surrounding area
- More likely at lower eyelid and lid margin
47
mangament of malignant tumours
- 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
Name the bacterial infection of the eyelid
External hordeolum
49
What is the cause of external hordeolum (stye)
Actue staphylococcal abscess of a lash follicle and its associated gland of Zeis
50
What is the signs of external hordeolum
Tender swelling in the lid margin, sometimes with a lash at the apex
51
What is the treatment of external hordeolum
- Hot compresses, epilation of assoicated lash to hasten resolution
- refer to GP for topical antibiotics
52
name the viral infections that take place in the eyelids
Molluscom Contagiosum
Herpes Simplex
Herpes zoster
53
What is molluscom contagiosum caused by
poxvirus (affects healthy children)
54
What are the signs of molluscom contagiosum
- 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
What is the treatment of molluscom contagiosum
- Not necessary unless lesion is close to lid margin
- Refer for cauterisation, cryotherapy or laser
56
What is the cause of herpes zoster ophthalmicus
- common unilateral condition that affects elderly, caused by varicella-zoster virus (VZV)
57
What is the sign of herpes zoster opthalmicus
- Maculopapular rash on forehead with vesicles and crusting
- ocular complications
58
What is the treatment of herpes zoster opthalmicus
Refer for systemic/ topical antiviral
59
What is the causes of herpes simplex
primary infection or reactiation of herpes simplex cirus taht was previously dormant in trigeminal ganglion
60
What is the diagnosis of herpes simplex
- early facial and lid tingling lasting around 24h
- eyelid and periorbital vesicles on lid margin that breakdown over 48 hours
- ocular complications
61
What is the treatment for herpes simplex
refer for topical antiviral
62
name the allergic disorders that occur at the eyelids
Acute allergic oedema
Contact dermatitis
Atopic dermatitis
63
What is the cause of acute allergic oedema
insect bites, angioedema, urticaria, occcasionally drugs
64
What is the signs of acute allergic oedema
Sudden onset, bilateral periorbital oedema
65
What is the mangament of acute allergic oedema
Refer to GP for systemic antihistamines
66
What is the cause of contact dermatitis
Inflmmatory response that usually follows exposure to medication, preservative, ceosmetic, metals
67
What are the signs of contact dermatitis
- Lid oedema, scaling and angular fissuring and tightness
- Chemosis, redness, papillary conjunctivitis
- Punctate corneal erosions
68
What is the management for contact dermatitis
- 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
What is the cause of atopic dermatitis
Asthma and hay fever
70
What are the signs of atopic dermatitis
- Thickening, crusing and vertical fissuring of the lids associated with staphyloccocal blepharitis and madarosis
71
What are the managment for atopic dermatitis
- Moisturiser to hydrate skin
- mild topical steroids
- treat associated infection with antibiotics if necessary
72
What are the symptoms of chronic anterior blepharitis
- 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
What is the cause of staphylococcal chronic anterior blepharitis
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
What is the signs of staphylococcal chronic anterior blepharitis
- 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
What is the cause of seborrhoeic chronic anterior blepharitis
often associated with generalized seborrheic dermatitis taht may involve scalp, nasolabial folds, behind the ears and the sternum
76
What are the signs of seborrhoeic chronic anterior blepharitis
- hyperaemic and greasy anterior lid margins with lashes sticking together
- scales are soft and located anywhere on lid margin and lashes
77
What is the treatment for chronic anterior blepharitis
- 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
What is the cause of chronic posterior blepharitis
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
What are the signs of chronic posterior blepharitis (symptoms similar as anterior blepharitis)
- 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
What is the mangament for chronic posterior blepharitis
- 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
What are the disorder of lashes and describe them (5)
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
What are the signs of trichiasis
- 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
what is the treatment for trichiasis
- 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
