Eyelid Abnormalities Flashcards
name 2 subjective reasons for a ptosis
cosmesis and visual field loss (superiorly)
what are some objective findings for a ptosis?
head posture, pupils, VA, ocular motility, palpebral fissure, marginal reflex distance (MRD1) and VF
what is a normal palpebral fissure opening?
9-10mm
what is MRD1 and what is a normal finding?
pupillary light reflex to upper eyelid margin
normal = 4-5mm
what is a normal levator function finding?
downgaze to upgaze = 13-17mm
what causes a congenital ptosis?
superior tarsal fold is usually absent or poorly developed - dystrophic levator muscle
what causes an acquired ptosis?
myogenic, neurogenic, mechanical, age-related, or traumatic - stress/fatigue may make it worse
what is an age related ptosis called?
dermatochalasis
what is a neurogenic ptosis?
CN3 palsy from meningioma
what is the treatment for ptosis?
depends on the cause - may refer to oculoplastics
what is lagophthalmos?
inability to close upper eyelid(s)
what are some subjective findings for lagophthalmos?
irritated eye (exposure related symptoms), cosmesis, poor sleep
what are some objective findings for lagophthalmos?
VA, pupils, EOMs, palpebral fissure, MRD1, bells response, SLEx cornea
what is a congenital cause of lagophthalmos?
lack of orbicularis oculi tone
what is an acquired cause of lagophthalmos?
CN7 palsy, s/p cosmetic or reconstructive surgery
what is the treatment for lagophthalmos?
determine cause - artificial tears/ointment, tarsorrhaphy or gold eyelid weight
what are some signs and symptoms of floppy eyelid?
chronically red, irritated eye, mild mucous discharge/tearing
floppy eyelid syndrome is typically seen in which type of patients?
patients that are obese with short, thick necks and sleep apnea syndrome
what are some treatments for floppy eyelid syndrome?
ocular lubrications, consultation with PCP, topical antibiotic ointment, eyelid taping/shield, oculoplastics
what is eyelid myokymia?
involuntary, repetitive spasms of eyelid muscles, typically continue on and off for a few days
what are some objective items for myokymia?
history, external exam, and possible MRI
what are some causes of myokymia?
fatigue, stress, caffeine/alcohol intake
what is the treatment for myokymia?
reduce precipitating factors, consider Botox injections
what is a blepharospasm?
uncontrolled blinking, twitching, closure of eyelids - always bilateral (disappears during sleep) no pain
what are some objective items for blepharospasms?
history, SLEx, neuro-ophthalmic exam, MRI with attention to posterior fossa
what are 2 causes of blapharospasms?
abnormal basal ganglia or secondary to systemic disease, drug induced
what are some treatments for blepharospams?
tinted sunglasses with UV protection and refer to oculoplastics (Botox)
