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Ant Seg I > Eyelid Dx > Flashcards

Eyelid Dx Flashcards

1
Q

Ddx for recurrent chalazion that occurs in the same spot

A

Sebaceous gland carcinoma

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2
Q

Warm compresses can make chalazions go always . True or false

A

False

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3
Q

Steroids used to treat chalazions

A

0.2ml of 5mg/ml triamcinolone acetate (Kenalog)

Systemic tetracycline - prophylaxis in pts w/ rosacea (contraindications)

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4
Q

Actinic keratosis signs

A

Hyperkaratotic plaque w/ distinct borders and sadly surface that may become fissures

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5
Q

Actinic keratosis has a high potential for transformation into SCC. True or false?

A

False

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6
Q

Xanthelasma is usually a unilateral condition. True or false?

A

False

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7
Q

Benign tumor that affects upper lid in kids and causes S-shaped deformities

A

NF-1

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8
Q

BCC is slow-growing, locally invasive but non-metastasizing; can invade orbit and sinuses. True or false?

A

Trueing

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9
Q

SCC can metastasize to regional lymph nodes and spread intracranially via the orbit. True or false?

A

True

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10
Q

SGC

A

Affects elderly, females&raquo_space; males
Arises from meibomian glands (rarely other sebaceous glands like recurrent chalazion)
Affects UL more (LL - BCC and SCC)
*Look for yellowish material in tumor

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11
Q

SGC Ddx

A

Chalazion and blepharitis - Look for yellowish material in tumor!

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12
Q

Ddx for Kaposi sarcoma

A

Hematoma/nevus

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13
Q

Trichiasis

A

Acquired
Can occur in isolation or from scarring of lid margin (blepharitis/H.zoster ophthamicus)
Punctate corneal lesions (worse w/ blinking), corneal ulceration, pannus

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14
Q

Pseudotrichiasis secondary to _____

A

Entropion

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15
Q

Congenital distichiasis

A

Autosomal dominant

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16
Q

Acquired distichiasis

A

Worse than congenital; usually asso w/ scarring dx
Metaplastic lashes
Originates from meib orifices
Stunted and non-pigmented

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17
Q

Most important cause of acquired distichiasis

A

Late stage cicatrizing conjunctivitis — chemical injury, SJS, ocular cicatricial pemphigoid

*SJS — d/t allergy to sulfa drugs; type III autoimmune dx

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18
Q

Trichomegaly

A

Excessive growth of eyelashes
Congenital or acquired — acquired: drug-induced (cyclosporin/PG analogs - Latisse/Latanoprost), AIDS, malnutrition, hypothyroidism

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19
Q

Causes of madarosis

A

Local causes, skin disorders, systemic dx, following removal (iatrogenic or trichotillomania)

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20
Q

Poliosis

A

Premature whitening of lashes/brows

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21
Q

Causes of poliosis

A

Ocular: chronic ant blepharitis, sympathetic ophthalmitis
Systemic: vitiligo, VKH, Marfan’s

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22
Q

Type 1 allergic diseases of the eyelids

A

Angioedema - well circumscribed, sudden, swelling; mast cell histamine; ice packs, antihistamine
Urticaria (hives) - wheal, histamine; not necessarily allergic
Insect bites - acute allergic lid edema, sudden onset bilateral pitting periorbital edema; WATCH for breathing probs, circ system collapse, GI probs

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23
Q

Contact dermatitis

A

Delayed type IV hypersensitivity reaction
Dry, itching, tearing, lid edema, scaling, angular fissuring and tightness, chemosis, Punctate corneal epithelial erosions

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24
Q

Warm compresses are used to treat contact dermatitis. True or false?

A

False

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25
Q

Impetigo

A

Superficial skin infection caused by S.aureus or S.pyogenes
Painful infection of the face
Children
Topical and oral antibx (Erythromycin)

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26
Q

Molluscum contagiosum

A

DS-DNA poxvirus
2-4 yo children
Multiple lesions in immunocompromised pts
Single or multiple pale, waxy, umbilicated nodules

27
Q

How does secondary ipsilateral chronic follicular conjunctivitis occur?

A

Lesions from Molluscum.contagiosum shed the virus into the tear film

28
Q

Prodrome for H.zoster ophthalmicus and H.simplex

A

H.zoster: HA, tiredness

H.simplex: facial and lid tingling

29
Q

H.zoster and H.simplex are usually unilateral. True or false?

A

True

30
Q

Signs for H.simples

A

Eyelid and periorbital vesicles, corneal ulcers, watery/red eye

31
Q

Blepharitis is a unilateral disorder. True or false?

A

False

32
Q

Blepharitis has a poor correlation between s/s. True or false?

A

True

33
Q

Anterior blepharitis

A

Affects bases of eyelashes

Staphlococcal: reaction to toxins from S.aureus; NOT an infection; red eye/red lids, peripheral corneal infiltrates, dry, hard scales and crusting (collarettes), bulbar injection, scarring and notching (tylosis - thickening of tarsal) of lid margin, madarosis, trichiasis, poliosis, styes, marginal keratitis, phlyctenules (hypersensitivity reaction of cornea and conj to bx antigens - nodules), DRY EYE- erythromycin to decrease bx

Seborrhoeic: hyperopic and greasy ant lid margins, sticky eyelashes, soft scales, DRY EYE

Common symptoms of ant blepharitis: redness, irritation, itching, burning, watering, grittiness, redness of lid margins

34
Q

Treatment for blepharitis

A

Erythromycin/Bacitracin ung pm
Tea tree oil
Azithromycin gtts (Azasite) BID - thick and expensive
Oral Doxy - LT use
Antibx-steroid combo: Tobramycin-dexamethasone ung pm or Loteprednol etbonate (Lotemax) gtts TID-QID

*Lotemax = soft steroid; also used for dry eye

35
Q

Cause of posterior blepharitis

A

MGD

36
Q

Signs of posterior blepharitis

A

Capped meib glands
Redness, telengiectasia of lid margin
Frothy/foamy/oily tear film
Punctate staining of cornea

37
Q

Steroid eye drops for posterior blepharitis

A

Lotemax, FML (mild steroid; ok for kids)

38
Q

Steroid-antibx combo for posterior blepharitis

A 
Tobradex ung or gtts
Maxitrol ung (Neomycin+PolyB/Dexamethasone)
39
Q

Oral antibx for posterior blepharitis

A

Tetracycline (contraindications)
Erythromycin 250mg bid - if tetracycline contraindicated
Doxy 100mg (low dose) bid x2weeks, then qday for 3 mo

40
Q

Associated condition w/ posterior blepharitis

A

CL intolerance
Dry eye
Chalazion formation (styes for Staphylococcal ant blepharitis)
Worsening of corneal epithelial basement membrane dystrophy
Acne rosacea; seborrheic dermatitis
Bacterial keratitis

41
Q

In office procedures to enhance lid hygiene

A

Manually: Lid-margin debridement - spatial or golf spud
Electronic: BlephEx - faster than golf spud

Lid-margin deep cleaning: Zocular - more gentle

*must anesthetize

42
Q

Phthiriasis palpebrarum (blepharitis)

A

Phthirus pubis

Chronic irritation and itching, dry eye

43
Q

Angular blepharitis

A

Infection caused by Moraxella Lacunata or S.aureus
Unilateral; red/fissured skin around medial and lateral canthus
Topical antibx ung

44
Q

Marginal keratitis

A

Inflammation of outer edge of cornea d/t staphyloccus
Inflamed lids, corneal infiltrates, ulcers, epithelial atrophy, watery discharge, transient hemorrhages

Tx: antibx and steroid — ONLY TIME steroids allowed to be used on open wounds

45
Q

Causes of ptosis

A

Neurogenic (CN III)
Myogenic
Aponeurotic
Mechanical

46
Q

Pseudoptosis

A

Lack of support: phthisis bulbi, microphthalmos,enophthalmos
Contralateral lid retraction
Ipsilateral hypotropia
Brow ptosis: excess skin on brows, 7th nerve palsy
Dermatochalasis: excess skin on ULs - can cause mechanical ptosis

47
Q

Ptosis measurements

A

Margin-reflex distance
Palpebral fissure height: shorter in males; unilateral ptosis can be quantified by comparison w/ contralateral side; smaller than diameter of cornea
Levator function/upper lid excursion
Upper lid crease: absence in congenital ptosis (poor levator fxn); high crease (aponeurotic defect); initial incision
Pretarsal show

48
Q

Ptosis associated signs

A

Increased innervation may flow to levator of unilateral ptosis - contralateral lid retraction; WARN pts if contralateral lid droops when you manually elevate the ptotic lid that surgical correction may induce a drop in the opposite lid

Fatigability - progressive drooping = myasthenia
Cogan twitch sign on downgaze to primary position; “hop” on sidegaze

Ocular motility defects w/ congenital ptosis - correction of ipsilateral hypotropia can improve ptosis

Jaw-winking phenomenon

Bell phenomenon - weak Bell phen = risk of post op exposure keratopathy

49
Q

Simple congenital ptosis

A

Unilateral or bilateral
Absent lid crease = poor levator function
SR weakness d/t asso w/ LPS
Compensatory chin elevation in bilateral cases
RE - can cause amblyopia
Ptosis can cause amblyopia! - early sx tx to prevent

50
Q

How to tell the difference btw congenital/acquired ptosis?

A

Congenital - Ptotic lid higher than normal d/t poor levator relaxation in downgaze; lid lag in downgaze may worse s/p surgical correction

Acquired - ptotic lid level w/ or lower than normal lid in downgaze

51
Q

Marcus Gunn jaw-winking syndrome

A

5% of congenital ptosis
Unilateral mostly
V3 misdirected to LPS - almost no ptosis w/ mouth open; retraction of ptotic lid in conjunction of ipsi pterygoid muscles or contralateral jaw movement
Does not improve w/ age

52
Q

CN3 misdirection

A

Congenital or acquired
Can occur following CN3 palsies
Bizarre movement of UL along w/ various eye movements

53
Q

Involutional ptosis

A

Dehiscence, disinsertion, stretching of levator apo restricting transmission of force from normal levator to upper lid
Fatigue of Muller muscle; worsens toward end of the day
Ddx: M.gravis

Bilateral ptosis
High UL crease; good levator fxn
VF loss - dangerous for driving - sx

54
Q

Mechanical ptosis

A

Dermatochalasis, large tumors (neurofibromas), heavy scar tissue, severe edema, ant orbital lesions

55
Q

Ectropion - involutional ptosis

A

Epiphora, inflamed tarsal conj (can become thickened and keratinized)

Horiz lid laxity - won’t snap back
Medial canthal tendon laxity - punctum should not move more the 1-2mm when LL pulled laterally
Lateral canthal tendon laxity - rounded lateral canthus, can pull LL medially more than 2 mm, disinsertion of LL retractors

56
Q

Ectropion - cicatricial ptosis

A

Scarring or contracture
Can be bilateral
Defect may be local (trauma) or general (burns, dermatitis, ichthyosis)

57
Q

Ectropion - paralytic

A

Ipsilateral facial nerve palsy
Retraction of upper and lower lids, brow ptosis
Exposure keratopathy, epiphora

Tx: lubrication, Botox, temporary tarsorraphy

58
Q

Ectropion - mechanical tx

A

Removal of tumor or correction of horizontal lid laxity

59
Q

Entropion - involutional

A

LL - upper lid more stable
Pseudotrichiasis - irritation, punctate corneal lesions/erosions , ulceration if no tx
Bandage CL, taping, Botox, lubricants
Age-related degeneration
- horizontal lid laxity - stretching of canthal tendons and tarsal plate
- vertical lid instability - attenuation, dehiscence, or disinsertion of LL retractors
- overriding of pretarsal by preseptal obicularis during lid closure
- orbital septum laxity w/ prolapse of orbital fat in LL

60
Q

Entropion - cicatricial

A

Cicatrizing conjunctivitis, trachoma (roughening of lids, corneal irritation), trauma, chemical injuries

Protect the cornea!

61
Q

Floppy eyelid syndrome

A

Unilateral or bilateral
Often misdiagnosed
Easy to evert and see lacrimal gland prolapse
Keratoconus, obstructive sleep apnea, diabetes

62
Q

Causes of lid retraction

A

Thyroid eye dx, neurogenic, mechanical, congenital

63
Q

Congenital malformations - test Q!

A

Epicanthal folds - bilateral; can cause pseudo eso TROPIA
Telecanthus
Blepharophimosis - ptosis, telecanthus, epicanthus inversus, poorly developed nasal bridge
Congenital entropion - upper lid d/t microphthalmos, lower lid d/t abnormal dev of inferior retractor
Coloboma - unilateral or bilateral eyelid defect; LL = systemic
Cryptophthamos
- complete: lids replaced by layer of skin fused w/ microphthalmic eye
- incomplete: microphthalmos, rudimentary lids and small conjunctival sac
Ankyloblepharon - UL/LL joined by skin rages

Ant Seg I (3 decks)

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