Eyelid Malpositions Flashcards
Dermatochalasis
- What is it
- Cause
Lax and redundant upper eyelid skin
Degeneration of connective tissue most commonly the result of aging.
Dermatochalasis
Demographics
Laterality
Elderly
Bilateral
Dermatochalasis
Symptoms
Signs
Asymptomatic, droopy eyelid, obstruction of superior visual field.
Upper eyelid skin laxity and redundancy
Decreased MRD 1 (Marginal reflex distance. Between K reflex and UL margin. 4-4.5 is normal)
Dermatochalasis
Management
None if asymptomatic.
If symptoms, refer out for blepharoplasty. Prior, perform a VF with lids taped vs untaped.
Ptosis
- What is it
- Cause
Droopy upper eyelid
Most commonly aponeurotic (levator stretching or dehiscence due to aging/repetitive eye rubbing)
Less commonly
Mechanical (eyelid tumor)
Myogenic (muscular dystrophy)
Neurologic (Horner, myasthenia gravis, MS)
Ptosis
- Demographics
- laterality
Depends on cause
Unilateral more common
Ptosis
Symptoms
Signs
No symptoms, droopy eyelid, obstruction of superior VF.
Signs- UL most commonly affected. Decreased MRD1 and maybe 2. Signs of underlying cause could be chalazion, EOM restriction, anisocoria, diplopia, high/absent eyelid create if aponeurotic.
Ptosis
Management
Determine and treat the underlying condition.
If no resolution, refer out for surgery
Pseudoptosis
Dermatochalasis, brow ptosis, enopthalmos, micropthalmia, corneal protective mechanisms, contralateral eyelid retraction.
Entropion
- What is it
- cause
Eyelid turns in towards globe
Most commonly age related
Less commonly: Cicatricial (Conj scarring in trauma, burn injury, trachoma), spastic, congenial
Entropion
Demographics
Laterality
Most commonly presents in the elderly
Unilateral or bilateral
Entropion
symptoms
Signs
Symptoms- Asymptomatic, ocular redness, ocular irritation, tearing.
sings- inversion of eyelid. May have underlying cause- conj scarring, spastic contraction of OO muscle.
Entropion
Complications
Trichiasis –> Ocular surface damage.
Conj injection, SPK, pannus, K ulcer
Entropion
Management
Determine and treat underlying condition. If no resolution, refer out for surgery.
Supportive management for trichiasis- lash epilation, aggressive topical lubrication, bandage CL.
Ectropion
- What is it
- Cause
Eyelid turns out away from globe
Most commonly age related due to horizontal eyelid laxity.
Less commonly due to mechanical (eyelid tumor), cicatricial, neurologic, congenital.
Ectropion
Demographics
Laterality
Most commonly presents in the elderly
Unilateral or bilateral
Ectropion
Symptoms
Signs
Asymptomatic, ocular redness, ocular irritation, tearing.
Signs- Eversion of the eyelid. LL is most commonly affected. Might have underlying cause such as eyelid tumor, eyelid scarring, paralysis of facial muscles.
Ectropion complications
Lagophthalmos causing exposure keratopathy.
Ectropion management
Determine and treat the underlying condition. If no resolution, surgery.
Supportive management for exposure keratopathy.
Eyelid Retraction
- What is it
- Cause
Excessive elevation of the eyelid.
Most commonly due to thyroid eye disease. Increased sympathetic tone acting on miller’s muscle, contraction of levator, proptosis and or scarring between the lacrimal gland and levator.
Less commonly mechanical, cicatricial, neurological, pharmacological, congenital.
Eyelid Retraction
Demographics
Laterality
Women > men
Unilateral or bilateral
Eyelid Retraction
- Symptoms
- Signs
Asymptomatic, ocular redness, irritation.
Excessive elevation of the eyelid. UL most commonly affected. Increased MRD1 and or 2. Signs of underlying cause such as proptosis, deficiency in upward gaze, UL retraction and pupillary constriction on downsize and adduction, dilated pupil.
Eyelid Retraction complications
Lagophthalmos –> Exposure keratopathy. Supportive management
Floppy eyelid Syndrome
- What is it
- Cause
Flaccid upper eyelids due to a lax tarsal plate
Cause is unknown. May be due to sleep apnea.
Floppy eyelid Syndrome
Demographics and laterality
Typically presents between ages of 45-65.
Men > women
Bilateral
Floppy eyelid Syndrome
Symptoms
Signs
Symptoms- Asymptomatic, ocular redness, irritation, mild mucous discharge, symptoms can be unilateral based on the side they sleep on.
Signs- Upper eyelids that are easily everted, rubbery tarsal plate, Eyelid imbrication (UL overrides the LL on closure), conj injection, palpebral papillae superior, SPK, mild mucous discharge, ptosis.
Floppy eyelid Syndrome
Complications
Lagophthalmos due to eyelid imbrication –> exposure keratopathy.
Bacterial conjunctivitis due to eyelid eversion during sleep
Floppy eyelid Syndrome Management
Supportive management
Topical lubricant, eyelid taping or patch qhs, don’t sleep face down.
Refer out for surgery for definitive treatment.
If not previously diagnosed, refer to PCP for sleep apnea.
Lagophthalmos
- What is it
- Cause
Incomplete closure of the eyelids
Could be mechanical, cicatricial, neurologic, congenital.
Lagophthalmos
- Demographics
- Laterality
Depends on cause
Unilateral or bilateral
Lagophthalmos
Symptoms
Signs
Asymptomatic, ocular redness, irritation, tearing.
Signs- inadequate blinking or closure of the eyelids. Signs of underlying cause such as eyelid tumor, proptosis, chemises, eyelid scarring, restriction in upgrade.
Lagophthalmos
Complications
Management
Complications- Exposure keratopathy.
Management- Determine and treat the underlying condition.
If no resolution, refer out for treatment. Supportive management for exposure keratopathy.
