Eyelid Flashcards
A 10-month-old boy is brought to the office because of the ocular defect shown in the photograph. Which of the following is the correct term for this anomaly? ( notch on medial upper lid) A) Anophthalmia B) Coloboma C) Congenital cataract D) Palpebral fissure E) Tessier No. 6 cleft
B) Coloboma
Coloboma
Coloboma is a congenital ocular defect of the eyelid, iris, retina, choroid, or optic disk. The defects can range in size from a small notch to a large structural cleft.
Origin of colobomas
Palpebral colobomas are thought to arise from a localized growth disturbance, while colobomas of the iris, retina, and optic disk arise from defective closure of the optic fissure.
Vision obstruction and colhbomas
Upper eyelid coloboma rarely affects vision; large defects of the lower eyelid can lead to corneal ulceration.
Anopthalmia
Total absence of the eye
Congenital cataract
A congenital cataract is a lens opacity that is present in 1:4000 to 1:10,000 newborns.
Palpebral fissure
The palpebral fissure is the natural opening between the upper and lower eyelids.
Tessier No. 6 cleft
A Tessier No. 6 cleft involves the inferolateral aspect of the lower eyelid, inferior orbital rim, and the zygoma. This cleft often has an associated lower eyelid coloboma and is related to Treacher Collins syndrome.
A 30-year-old man comes to the office because of excessive tearing of the left eye 3 months after repair of a deep laceration of the left medial canthus. Physical examination confirms epiphora of the left eye. A missed injury to the lacrimal drainage system is suspected. Which of the following is most appropriate to evaluate the suspected injury? A) CT scan B) Jones test C) MRI D) Nasal endoscopy E) Schirmer test
B) Jones test
Jones Test
The Jones test evaluates the drainage component of the lacrimal system. There are two steps in this test. The first step involves instilling two drops of a 2% fluorescein solution into the conjunctiva and observing the appearance or absence of this dye in the ipsilateral middle turbinate by means of a curved, cotton-tipped applicator. When dye is noted on the applicator within 3 minutes, the drainage system is intact. Therefore, if no obstruction is noted, the epiphora is caused by hypersecretion. If no dye passes through the nasolacrimal duct, then a secondary dye test is performed by force-injecting 1 mL of saline through the punctum. If this is done and the dye appears in the nose, then a functional or incomplete block of the nasolacrimal duct is present; if no dye appears, then a complete block is diagnosed.
Differentiating a canalicular block from a nasolacrimal duct block
Differentiating a canalicular block from a nasolacrimal duct block is done by cannulating and injecting 1 mL of saline through a canaliculus and observing the passage of clear fluid out the other canaliculus. A No. 00 Bowman probe can also be passed through the canaliculus, and the distance to the obstruction can be measured.
A No. 00 Bowman probe can be passed through the canaliculus to measure the distance to a canalicular obstruction. Typical distances:
A No. 00 Bowman probe can be passed through the canaliculus to measure the distance to an obstruction: Typical distances are 8 mm to common canaliculus, 10 to 12 mm to the tear sac, and 16 mm to the upper end of the nasolacrimal duct.
Nasal endoscopy role in evaluating a canalicular obstruction
Nasal endoscopy can only examine the nasal cavity for an abnormal location of the meatus under the middle turbinate. It can also determine if there is a physical obstruction of the lower end of the nasolacrimal duct at that location because of polyps or granulation tissue. This test could be indicated if the Jones test were to show partial obstruction.
Schirmer test
The Schirmer test is most useful in diagnosing lacrimal hyposecretion.
Epiphora
Overflow of tears on the face
An 18-year-old man comes to the emergency department 2 hours after beingpunched in the right eye during a fistfight. Physical examination shows swelling, diplopia, and a significant limitation of downward gaze in the affected eye. He is able to rotate the eye in all other directions. This finding is most consistent with dysfunction of which of the following extra ocular muscles? A) Inferior oblique B) Inferior rectus C) Superior oblique D) Superior rectus
B) Inferior rectus
The inferior rectus is innervated by:
CN III
The inferior oblique is innervated by:
CN III
responsible for upward and outward rotation of the eye.
The superior oblique is innervated by:
The superior oblique is innervated by the trochlear nerve(cranial nerve IV) and is responsible for downward and outward rotation of the eye.
The superior rectus is innervated by:
CN III
A 23-year-old man comes to the office for evaluation of unilateral blepharoptosis. On examination, the excursion of the eyelid margin is measured from downgaze to upgaze while the eyebrow is manually fixed against the supraorbital rim. Which of the following would best approximate the normal excursion distance of levator function for this patient? A) 2 to 6 mm B) 7 to 11 mm C) 12 to 16 mm D) 17 to 21 mm E) 21 to 25 mm
C) 12 to 16 mm
Normal excursion of elevator function
12 to 16 mm
A 46-year-old woman comes to the office for consultation about improving the appearance of her “saggy” upper eyelids. Physical examination shows moderate skin redundancy in both upper eyelids. The ciliary margin of the upper eyelid is located 1 mm below the superior limbus on the right and 3 mm below the superior limbus on the left. Levator excursion is 14 mm bilaterally. In addition to excision of excess skin bilaterally, which of the following is the most appropriate treatment?
A) Brow lift surgery on the left
B) Frontalis suspension in the left eye
C) Levator aponeurosis plication in the left eye
D) Orbicularis plication in the left eye
C) Levator aponeurosis plication in the left eye
The upper eyelid skin redundancy can be addressed with a standard upper eyelid blepharoplasty with skin excision and, if needed, a slip of orbicularis muscle. The mild ptosis of her left upper eyelid will be accentuated after the blepharoplasty if left untreated. Since her levator function is excellent, her ptosis can be corrected with a simple plication of the distal levator aponeurosis. This can be accomplished through an upper blepharoplasty incision.
Limbus
The corneal limbus is the border of the cornea (the transparent front part of the eye that covers the iris, pupil, and anterior chamber) and the sclera (the white of the eye)
Normal anatomical position of the ciliary margin of the upper eyelid
The normal anatomical position of the ciliary margin of the upper eyelid is 1 mm below the upper corneoscleral junction in straight gaze.
Landmark for ptosis measurement
The upper limbus: the upper corneoscleral junction is the landmark for ptosis measurement
Correction of severe ptosis/poor elevator function
Patients with severe ptosis (3 mm or more) usually have poor levator function, therefore frontalis suspension is required.
Correction of moderate ptosis/moderate elevator function
In patients with moderate function (6 to 10 mm), levator advancement and resection is required.
Correction of mild ptosis / excellent elevator function
For patients with excellentlevator function (10 mm or more) and mild ptosis, aponeurotic surgery (plication) is appropriate.
How much will the eyelid be elevated per amount of elevator advancement?
In levator advancement surgery, the eyelid will be elevated approximately 1 mm for every 3 mm of advancement.
Fasanella-Servat procedure
In a Fasanella-Servat procedure, a portion of the posterior lamella of the eyelid is resected to improve mild eyelid ptosis by shortening the levator muscle. This procedure would not be used in a patient who requires a skin resection since it uses a posterior approach.
A 68-year-old woman is scheduled to undergo a bilateral blepharoplasty with unilateral repair of a levator aponeurosis dehiscence. During the dissection, the distal end of the dehisced levator muscle is reattached to the tarsal plate. Which of the following anatomic structures is most likely to be visualized deep to the repair? A ) Capsulopalpebral fascia B ) Conjunctiva C ) Müller muscle D ) Orbital septum E ) Whitnall ligamen
C ) Müller muscle
The Müller muscle lies below the levator insertion to the superior border of the tarsus and is visualized during the levator muscle repair
.The conjunctiva is located deep to the Müller muscle and should not be visualized during the muscle reinsertion to the tarsus. The orbital septum and retro-orbicularis oculi are anterior and superior to the levator tendon. The Whitnall ligament is also superior to the levator tendon.
During a dissection, the distal end of the dehisced levator muscle is reattached to the tarsal plate. What should be visualized deep to the repair?
the Muller muscle
What are the layers of the eyelid?
The layers of the eyelid are the conjunctiva, Müller muscle, levator muscle, orbital fat, orbital septum, retro-orbicularis oculi fat, orbicularis oculi muscle, and skin.
Where is the Muller muscle vs the levator muscle?
deep
Where is the conjunctiva vs the levator muscle?
The conjunctiva is deep to the Muller muscle, which is deep to the levator
Where is the Whitnall ligament vs the levator muscle?
superior
Capsulopalpebral fascia
The capsulopalpebral fascia is the extension of the lower eyelid retractors and fuses at the inferior aspect of the lower eyelid tarsus
A 40-year-old woman is scheduled to undergo surgical correction ofbilateral upper eyelid dermatochalasis and mild blepharoptosis. A Fasanella-Servat procedure is planned. Which of the following is the most likely disadvantage of performing this procedure instead of a levator aponeurosis reinsertion?
A ) Dry eyes
B ) Eyelid asymmetry
C ) Incomplete correction of eyelid ptosis
D ) No removal of excess eyelid fold skin
E ) Overcorrection of eyelid position
D ) No removal of excess eyelid fold skin
One of the major disadvantages of the Fasanella-Servat procedure is that it does not address excess skin of the eyelid fold. Dry eyes, incompletecorrection, overcorrection, and eyelid asymmetry are possible complications of both procedures.
What is the major disadvantage of the Fasanella-Servat procedure vs a elevator aponeurosis reinsertion?
The Fasanella-Servat does not address excess skin of the eyelid fold.
A 64-year-old man is evaluated for reconstruction of a defect of the lower eyelid following resection of a 1.4-cm nodular basal cell carcinoma. Examination shows an 80% full-thickness defect of the lateral lower eyelid. Which of the following is the most appropriate method of reconstruction?
A ) Cantholysis, lateral canthotomy, and primary closure
B ) Cheek advancement flap with composite graft for lining
C ) Composite graft from the ear
D ) Forehead flap with septal cartilage grafting
E ) Hughes tarsoconjunctival flap with skin grafting
B ) Cheek advancement flap with composite graft for lining
The most appropriate method of reconstruction is the cheek advancement flap with a nasal septal cartilage and lining graft for internal lining.
Reconstruction of major (>75%) defect of the lower eyelid
The most appropriate method of reconstruction is the cheek advancement flap with a nasal septal cartilage and lining graft for internal lining. The cheek advancement flap can be elevated widely and rotated without tension to provide anterior coverage of the defect, while the composite graft is used for lining and support of the lower eyelid.
Reconstruction of lower lid defects <50%
Cantholysis, lateral canthotomy, and primary closure are most useful for defects that are less than 50%. Similarly, theHughes tarsoconjunctival flap is best used in defects that are less than 50%, as larger flaps would result in significant deformity of the upper eyelid.
Composite grafts from the ear and lower eyelid reconstruction
Composite grafts from the ear are rarely used for lower eyelid reconstruction because the tissues are usually thicker than the lower eyelid and may be associated with partial or complete graft loss.
A 69-year-old woman comes to theoffice because she has had dryness, tearing, and irritation in both eyes for the past two years. Physical examination shows outward turning of the lower eyelid margin. Anterior eyelid distraction is 7 mm from the globe. Snap-back test is greater than one second. Muscle tone is normal bilaterally. Which of the following is the most likely cause of lower eyelid ectropion in this patient?
(A)Dehiscence of lower eyelid retractors
(B)Horizontal laxity of the lower eyelid
(C)Loss of lower eyelid tone secondary to paralysis of orbicularis oculi muscle
(D)Neoplasia within the lower eyelid causing the eyelid to be pulled away from the globe
(E)Vertical shortening of the anterior lamella of the eyelid
(B)Horizontal laxity of the lower eyelid
Physical findings suggesting abnormal horizontal lid laxity
Physical examination findings of abnormal snap-back test and distraction test in the patient described suggest abnormal horizontal lid laxity
Causal factors leading to ectropion
Causal factors leading to ectropion include horizontal laxity of the eyelid (involutional), vertical shortening of the anterior lamella of the eyelid (congenital or cicatricial), paralysis of the orbicularis oculi muscle (secondary to paralytic entropion) causing loss of eyelid muscular tone, and neoplasia within the lower eyelid pulling or forcing the eyelid away from the globe.
An 82-year-old woman comes to the office because she has had excessive tearing and irritation of both eyes for the past three months. Physical examination shows severe lower eyelid laxity, scleral show, downward drift of the lateral canthus, and a shortened intercanthal distance bilaterally. Entropion is suspected. Which of the following is most likely to confirm the suspected diagnosis?
(A)Animation test of the orbicularis oculi muscle
(B)Hertel exophthalmometry
(C)Jones dye test
(D)Lower eyelid snap-back test
(E)Schirmer test
(A)Animation test of the orbicularis oculi muscle
Involutional entropion can be confused with involutional ectropion because:
They are completely distinguishable when:
Involutional entropion can be confused with involutional ectropion in the static state because of the associated lower eyelid laxity in both instances.
The two conditions are completely distinguishable on animation of the orbicularis oculi muscle.
What happens on attempted eyelid closure in cases of involutional entropion?
Inversion of the lower eyelid occurs on attempted eyelid closure in cases of involutional entropion.
Causes of involutional entropion
Causal factors include orbicularis dysfunction with the preseptal portion overriding the pretarsal portion, upper eyelid “closure kick,” disinsertion of lower eyelid retractors, loss of horizontal and vertical eyelid support, and loss of orbital fat volume
A 32-year-old woman comes to the office for follow-up examination six months after she underwent repair of a fracture of the left orbit. A preoperative photograph is shown. Physical examination shows cicatricial ectropion of the lower eyelid. Which of the following is the most appropriate management? (lower lid lacks height)
(A)Complete tarsorrhaphy
(B)Pentagonal wedge resection of the lower eyelid
(C)Placement of a graft to the lower eyelid
(D)Punctal occlusion ofthe lower eyelid
(E)Resuspension of the lower eyelid retractors
(C)Placement of a graft to the lower eyelid
Protection of the ocular surfaces is the primary goal in managing the cicatricial ectropion of the lower eyelid in the patient described.The patient’s lower eyelid lacks height. Scarring between the capsulopalpebral fascia (lower eyelid retractors) and the orbital septum because of trauma or following aggressive lower eyelid blepharoplasty can cause vertical contracture of the lower eyelid, resulting in corneal exposure. Lower eyelid position can only be restored by placement of an autogenous or alloplastic spacer graft (hard palate, donor sclera, auricular cartilage, tarsus, and others), as in the postoperative image shown. In conjunction,eyelid-tightening procedures such as lateral canthopexy and canthoplasty address horizontal skin laxity
Primary goal in managing cicatricial ectropion w/ lower lid which lacks height
Protection of the ocular surfaces is the primary goal in managing the cicatricial ectropion of the lower eyelid in the patient described.
What can cause vertical contracture of the lower eyelid?
Scarring between the capsulopalpebral fascia (lower eyelid retractors) and the orbital septum because of trauma or following aggressive lower eyelid blepharoplasty can cause vertical contracture of the lower eyelid, resulting in corneal exposure.
Most likely diagnosis: A 66-year-old man with visual obstruction of the left eye and elevation of the supratarsal crease
Senile ptosis
Most likely diagnosis: A 60-year-old woman with general muscle fatigue and bilateral upper visual field obstruction that worsens at the end of the day
Myasthenia gravis
A 26-year-old woman comes to the office after being referred by an ophthalmologist because of scleral show of the left lower eyelid. Three weeks ago, she sustained a laceration of the lower eyelid, which was sutured in the emergency department. Which of the following is the most appropriate next step in management?
(A)Tear supplementation and massage of the scar
(B)Injection of a corticosteroid into the scar and silicone sheeting
(C)Lysis of scar adhesions and septal cartilage interposition grafting
(D)Excision of the scar and full-thickness skin grafting
(E)Lateral canthopexy and cheek advancement flap
(A)Tear supplementation and massage of the scar
At three weeks into the postoperative period, the wounds are still in the active phase of healing. Over the next six to nine months, as the collagen with the scar remodels, the lid may return to a more normal position. Therefore, during this time frame, the ectropion should be managed with scar tissue massage and a regimento prevent complications related to dry eyes, such as tear supplementation and eye patching. Surgical intervention is warranted if there is no improvement after this time frame or if conservative therapy is ineffective and there is a risk of visual compromise.
Injection of a corticosteroid can reduce inflammation and soften the scar, allowing the eyelid to return to a better position. However, use of corticosteroids in the lower eyelid is not advocated because of the risks of tissue atrophy and skin discoloration
Ectropion is classified as:
In general, ectropion is classified as involutional, cicatricial, or neurogenic.
Assessing for midlamellar scar
Placing upward traction on the eyelid can identify scar contracture in this location. If adequate skin is present, the lower eyelid should reach at least the level of the midpupil. If this movement is restricted, midlamellar scarring is likely.
Treatment of midlamellar scar
Lysis of scar adhesions and the placement of an interpositional graft are indicated for cases of midlamellar scar.
A 24-year-old man who works as a chef comes to the office because he has ectropion of the left lower eyelid and ulceration of the cornea five months after he sustained an oil burn to the left side of the face. On physical examination, the burn scars are hypertrophic and immature, extending from the infraorbital rim to the mandibular border. Which of the following is the most effective management of the ectropion?
(A) Full-thickness skin grafting
(B) Massage of the eyelid and injection of a corticosteroid
(C) Palatal mucosal grafting
(D) Tarsoconjunctival flap
(E) Tissue expansion
(A) Full-thickness skin grafting
Cicatricial ectropion and burns
Cicatricial ectropion can be prevented by early surgical intervention with burn excision and grafting, thereby avoiding the need for late reconstructive procedures.
Cicatricial ectropion treatment
Cicatricial ectropion is best treated by full-thickness skin grafting to replace the skin deficit. A tarsal support procedure, such as a lateral canthoplasty, may be needed to fully restore the tone and position of the eyelid. Depending on their thickness and distribution, scars may be released by incision or excision.
When should burn reconstruction be performed?
Most burn reconstruction should be delayed until scars have matured sufficiently, usually by one year after injury. Earlier intervention is needed when a vital skin function is impaired, such as corneal protection.
Scarred skin and tissue expansion
Scarred tissue does not expand effectively, limiting the role of tissue expansion in burned/scarred patients
Which of the following best differentiates the Asian upper eyelid from the Occidental upper eyelid?
(A) Absence of epicanthal folds
(B) Decreased amount of suborbicularis oculi fat
(C) More superior fusion of the orbital septum and levator aponeurosis
(D) Relative lack of insertions from the levator aponeurosis into the dermis
(E) Well-defined supratarsal lid fold with a larger pretarsal segment
(D) Relative lack of insertions from the levator aponeurosis into the dermis
Cause of lack of supra tarsal fold in Asians
In as much as 50% of the Asian population, there is a general lack of insertion of the levator aponeurosis into the dermis, causing a lack of a supratarsal fold.
Fusion of orbital septum to the elevator aponeurosis in asians
The fusion of the orbital septum to the levator aponeurosis is typically more caudad and decreases the width of the pretarsal segment of the supratarsal lid fold when it is present.
Periorbital fat in asians
There are generally increased amounts of retro-orbicularis oculi fat and suborbicularis oculi fat. T
Differences between Asian and Occidental eyelids
The Asian eyelid has specific anatomic variations compared with the Occidental eyelid. First, in as much as 50% of the Asian population, there is a general lack of insertion of the levator aponeurosis into the dermis, causing a lack of a supratarsal fold. The fusion of the orbital septum to the levator aponeurosis is typically more caudad and decreases the width of the pretarsal segment of the supratarsal lid fold when it is present. There are generally increased amounts of retro-orbicularis oculi fat and suborbicularis oculi fat. The Asian eyelid is likely to have more epicanthal folds than is the Occidental eyelid.
A 65-year-old man has a 3-cm-diameter open wound of the medial cheek inferior to the lower eyelid after undergoing Mohs’ micrographic surgery for excision of nodular basal cell carcinoma. Snap-back test of the lower eyelid shows poor tone. Reconstruction of the defect is performed with a cervicofacial flap. Which of the following is the most appropriate next step in management to avoid a deformity of the lower eyelid?
(A) Application of adhesive bandages to the lower eyelid and daily massage
(B) Placementof a temporary tarsorrhaphy (Frost) suture
(C) Reconstruction with a tarsoconjunctival flap
(D) Horizontal shortening of the lower eyelid and lateral canthopexy
(E) Full-thickness skin grafting of the lower eyelid
(D) Horizontal shortening of the lower eyelid and lateral canthopexy
The snapback test assesses:
The snap-back test can be used to assess horizontal laxity of the eyelid.
Cicatricial changes
Due to loss of skin
Use of tarsorrhaphy to protect the cornea
The use of tarsorrhaphy is a temporary means to protect the cornea from exposure. The suture itself will not prevent lower eyelid malposition.
A 3-year-old boy is brought to the office by his parents because of new onset of bilateral epiphora. The boy’s parents say that similar symptoms occurred in one of their older children but resolved without treatment. On physical examination, the lashes of both lower eyelids rub against the inferior cornea. Which of the following is the pathophysiologic mechanism underlying this patient’s condition?
(A) Abnormal attachment of the canthal tendons
(B) Abnormal attachment of the orbital septum
(C) Enophthalmos
(D) Laxity of the tarsal plate
(E) Redundancy of skin and orbicularis muscle
(E) Redundancy of skin and orbicularis muscle
A 13-month-old girl has had tearing and discharge from the right eye since birth. Which of the following is the most appropriate management?
(A) Observation
(B) Instruction of the parents in massage with antibiotic ointment
(C) Silastic intubation
(D) Probing of the nasolacrimal duct
(E) Dacryocystorhinostomy
(D) Probing of the nasolacrimal duct
Congenital tearing problem is most likely due to..
A child with congenital tearing is likely to have a nasolacrimal duct problem. Punctual agenesis, lacrimal sac fistula, and other rare abnormalities should be ruled out with dye disappearance testing, which usually is markedly asymmetric in a nasolacrimal duct problem.
Management of congenital nasolacrimal duct problems
Generally, a nasolacrimal duct problem should be treated with massage and antibiotic drops until the child is age 12 to 13 months. For about 70% of children with tearing at age 6 months, this conservative treatment leads to resolution by age 12 months. If tearing persists, probing of the nasolacrimal duct should be performed. The longer probing is delayed beyond age 13 months, the greater the number and complexity of the procedures needed to successfully treat congenital dacryostenosis.
When should congenital nasolacrimal duct problems be probed?
If tearing persists beyond 12 months, probing of the nasolacrimal duct should be performed. The longer probing is delayed beyond age 13 months, the greater the number and complexity of the procedures needed to successfully treat congenital dacryostenosis. Therefore, initial probing and irrigation should be performed before age 13 months.
If probing is not successful for congenital nasolacrimal duct problem…
Probing should be performed between 12 and 13 months (after conservative management w/ antibiotic ointment and massage, and before greater risk of requiring more numerous and complex procedures.)
If probing is unsuccessful, Silastic intubation should be done.
Dacryocystorhinostomy and congenital nasolacrimal duct problem
Probing should be performed between 12 and 13 months (after conservative management w/ antibiotic ointment and massage, and before greater risk of requiring more numerous and complex procedures.)
If probing is unsuccessful, Silastic intubation should be done.
Dacryocystorhinostomy is reserved for those rare cases that do not respond to Silastic intubation.
A 16-year-old girl has persistent ptosis of the eyelid (shown) six months after undergoing reconstruction of the forehead and supraorbital bar for fibrous dysplasia. One month postoperatively, a wound developed from extrusion of hardware through the medial eyelid. Debridement of the wound with excision of the involved inflammatory tissue and reconstruction with a pericranial flap were performed at that time. On current examination, no levator function is noted medially in the eyelid and lateral movement of the eyelid is minimal. Which of the following interventions is the most appropriate next step in management? (the function as shown in the photographs is minimal)
(A) Lysis of adhesions
(B)Kuhnt-Szymanowski procedure
(C) Fasanella-Servat procedure
(D) Suspension to the frontalis muscle with fascia lata grafting
(E) Advancement of the levator muscle
(D) Suspension to the frontalis muscle with fascia lata grafting
This patient has traumatic ptosis as a complication of prior surgical procedures. At the time of debridement, either a portion of the levator muscle was excised or the muscle function is limited by scar tissue. In either case, the function as shown in the photographs is minimal, and the ptosis is best managed by a frontalis suspension procedure.
Choice of sling for frontal suspension procedure for ptosis
fascia lata
The Fasanella-Servat procedure
The Fasanella-Servat procedure involves excision of a portion of the conjunctiva, tarsus, orbital septum, levator aponeurosis, and Müller muscle. It can be used in cases of mild ptosis (1-2 mm). Levator function must be present.
The Kuhnt-Szymanowski procedure
The Kuhnt-Szymanowski procedure is used to correct lower eyelid ectropion. It involves a wedge excision of the lower eyelid.
Hyphema results from traumatic hemorrhage of which of the following ocular structures? (A) Anterior chamber (B) Conjunctiva (C) Lens (D) Posterior chamber (E) Vitreous chamber
(A) Anterior chamber
Hyphema
Hyphema is traumatic hemorrhage of the anterior chamber of the eye, typically resulting from blunt trauma to ocular structures.
In patients with hyphema, vessels are torn in the iris or in the ciliary body, leading to onset of hemorrhage. The blood collects in the most inferior section of the anterior chamber, obscuring the lower portion of the iris
Anterior chamber anatomy
The anterior chamber of the eye is bordered by the cornea anteriorly and the iris and central portion of the lens posteriorly. This structure is filled with aqueous humor originating from the ciliary processes in the posterior chamber and flowing through the pupil into the anterior chamber.
Adverse consequences of hyphema
Significant hyphema may result in increased ocular pressure and/or permanent staining of the cornea. Because of the potential for these complications, screening is recommended in patients with facial trauma, and ophthalmologic referral is indicated in any patient with positive findings.
Treatment of hyphen
Treatment involves administration of acetazolamide and corticosteroid eye drops to decrease ocular tension.
Subconjunctival hemorrhage
Bleeding that occurs in the bulbar or palpebral conjunctiva is referred to as subconjunctival hemorrhage. This condition is seen in patients with facial trauma and results from extravasation of conjunctival capillaries. It also occurs in association with zygomatic fractures that extend through the lateral orbital wall in which there is bleeding along the side of the orbit and into the subconjunctival interstitium. Treatment of the fracture is likely to resolve the hemorrhage.
Treatment of subconjunctival hemorrhage
Due to facial fractures - Treatment of the fracture is likely to resolve the hemorrhage.
