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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
Impetigo
Superficial skin infection caused by S.aureus or S.pyogenes Painful infection of the face Children Topical and oral antibx (Erythromycin)
26
Molluscum contagiosum
DS-DNA poxvirus 2-4 yo children Multiple lesions in immunocompromised pts Single or multiple pale, waxy, umbilicated nodules
27
How does secondary ipsilateral chronic follicular conjunctivitis occur?
Lesions from Molluscum.contagiosum shed the virus into the tear film
28
Prodrome for H.zoster ophthalmicus and H.simplex
H.zoster: HA, tiredness | H.simplex: facial and lid tingling
29
H.zoster and H.simplex are usually unilateral. True or false?
True
30
Signs for H.simples
Eyelid and periorbital vesicles, corneal ulcers, watery/red eye
31
Blepharitis is a unilateral disorder. True or false?
False
32
Blepharitis has a poor correlation between s/s. True or false?
True
33
Anterior blepharitis
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
Treatment for blepharitis
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
Cause of posterior blepharitis
MGD
36
Signs of posterior blepharitis
Capped meib glands Redness, telengiectasia of lid margin Frothy/foamy/oily tear film Punctate staining of cornea
37
Steroid eye drops for posterior blepharitis
Lotemax, FML (mild steroid; ok for kids)
38
Steroid-antibx combo for posterior blepharitis
``` Tobradex ung or gtts Maxitrol ung (Neomycin+PolyB/Dexamethasone) ```
39
Oral antibx for posterior blepharitis
Tetracycline (contraindications) Erythromycin 250mg bid - if tetracycline contraindicated Doxy 100mg (low dose) bid x2weeks, then qday for 3 mo
40
Associated condition w/ posterior blepharitis
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
In office procedures to enhance lid hygiene
Manually: Lid-margin debridement - spatial or golf spud Electronic: BlephEx - faster than golf spud Lid-margin deep cleaning: Zocular - more gentle *must anesthetize
42
Phthiriasis palpebrarum (blepharitis)
Phthirus pubis | Chronic irritation and itching, dry eye
43
Angular blepharitis
Infection caused by Moraxella Lacunata or S.aureus Unilateral; red/fissured skin around medial and lateral canthus Topical antibx ung
44
Marginal keratitis
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
Causes of ptosis
Neurogenic (CN III) Myogenic Aponeurotic Mechanical
46
Pseudoptosis
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
Ptosis measurements
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
Ptosis associated signs
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
Simple congenital ptosis
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
How to tell the difference btw congenital/acquired ptosis?
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
Marcus Gunn jaw-winking syndrome
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
CN3 misdirection
Congenital or acquired Can occur following CN3 palsies Bizarre movement of UL along w/ various eye movements
53
Involutional ptosis
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
Mechanical ptosis
Dermatochalasis, large tumors (neurofibromas), heavy scar tissue, severe edema, ant orbital lesions
55
Ectropion - involutional ptosis
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
Ectropion - cicatricial ptosis
Scarring or contracture Can be bilateral Defect may be local (trauma) or general (burns, dermatitis, ichthyosis)
57
Ectropion - paralytic
Ipsilateral facial nerve palsy Retraction of upper and lower lids, brow ptosis Exposure keratopathy, epiphora Tx: lubrication, Botox, temporary tarsorraphy
58
Ectropion - mechanical tx
Removal of tumor or correction of horizontal lid laxity
59
Entropion - involutional
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
Entropion - cicatricial
Cicatrizing conjunctivitis, trachoma (roughening of lids, corneal irritation), trauma, chemical injuries Protect the cornea!
61
Floppy eyelid syndrome
Unilateral or bilateral Often misdiagnosed Easy to evert and see lacrimal gland prolapse Keratoconus, obstructive sleep apnea, diabetes
62
Causes of lid retraction
Thyroid eye dx, neurogenic, mechanical, congenital
63
Congenital malformations - test Q!
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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