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Ophthalmology > Eyelids > Flashcards

Eyelids Flashcards

1
Q

List the glands of the eyelids

A
  1. Meibomian/tarsal glands
  2. Glands of Zeis
  3. Glands of Moll
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2
Q

Summarise the glands of the eyelids

A
  • Their secretions form a part of the PTF (precorneal tear film)
  • This coats the lid margins, preventing the tear overflow
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3
Q

List the muscles of the eyelid

A
  1. m. orbicularis oculi
  2. m. levator palpebrae
  3. m. malaris

These all connect with the tarsus (CT of the eyelid)

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4
Q

Give the functions of the eyelid

A
  1. Physical protection of the globe
  2. Distribution of the PTF; pumping it into the drainage system
  3. Production of phospholipid-rich secretion
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5
Q

List the notable lesions seen in the eyelid

A
  1. Prominent nasal fold
  2. Disorders of the ciliae
  3. Entropion
  4. Ectropion
  5. Hordeolum
  6. Blepharitis
  7. Trauma
  8. Neoplasia
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6
Q

Notable lesion seen in the eyelid: Prominent nasal fold

  • CSx
  • Tx
A
  • Brachycephalic breeds; permanent irritation to the cornea
  • CSx: Lacrimation; medial pigmentation & corneal vascularisation
  • Tx: Sx removal of the fold; tx of 2° corneal ulcers
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7
Q

Notable lesion seen in the eyelid: List the disorders of the ciliae

A
  1. Districhiasis
  2. Trichiasis
  3. Ectopia ciliae
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8
Q

Disorder of the ciliae: Distichiasis

A

Additional ciliae originating from abnormally located follicles

Follicles are in/near the tarsal gland

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9
Q

Disorder of the ciliae: Trichiasis

A

Ciliae arising from the normally located follicles point in abnormal directions

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10
Q

Disorder of the ciliae: Ectopia ciliae

A

Additional cilia originating from the abnormally located follicle

The follicle may be located anywhere e.g under the palpebral conjunctiva

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11
Q

Disorders of the ciliae: Signs to look for

A
  • Abnormal ciliae rub the corneal surface & conjunctiva
  • Conjunctival hyperaemia
  • Lacrimation
  • Blepharospasm
  • Miosis
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12
Q

Disorders of the ciliae: Treatment

A
  • Trimming of the aberrant ciliae (by owner)
  • Electroepilation & microepilation
  • Surgical excision
  • Treatment of any 2° corneal erosions
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13
Q

Notable lesion seen in the eyelid: Entropion

A

Inward turning of the eyelid margin

  • Developmental or structural
  • Acquired or congenital
  • Spastic

Usually caused by the lower lid

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14
Q

Developmental/structural entropion: Incidence

A
  • Lambs (upper lid)
  • Dogs (lower lid)
    • Usually affecting both eyes & whole lid margin
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15
Q

Developmental/structural entropion: Predisposed dog breeds

A
  • Rottweiler
  • Chow chow
  • St. Bernard
  • Great Dane
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16
Q

Acquired/cicatrical (scar) entropion: Aetiology

A
  • Trauma to the lids → scar formation & skin contraction
  • May be caused by periocular surgery or chronic inflammation
  • Frequent in horses

This is the same aetiology as ectropion

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17
Q

Spastic entropion: Aetiology

A

Ocular pain/discomfort → Blepharospasm → 2° Entropion

  • Common in dog
  • Topical anaesthesia: Helps to make a dx whether the condition is structural or spastic
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18
Q

Entropion: Signs to look for

A
  • Lacrimation, blepharospasm or photophobia
  • Conjunctivitis
  • Rubbing of the eye
  • Corneal oedema, vascularisation, pigmentation
  • Ulceration
  • Turning of the lid margin
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19
Q

Entropion: Treatment

A

Surgery

Developmental entropion: May improve spontaneously in immature dogs

20
Q

Entropion treament: Surgical techniques

A

Prior to anaesthesia, the lid is inverted to estimate how much skin is to be removed

  • Hotz-Celsus technique
  • “Pinch” technique
21
Q

Entropion surgery: Postoperative tx

A
  • ABx; NSAIDS; Elizabethan collar
  • Sutures removal after 10-12 days
  • Spastic entropion: Tx of the underlying condition
22
Q

Notable lesion seen in the eyelid: Ectropion

A

Eversion & turning out of the eyelid; Always the lower eyelid

  • Developmental or structural
  • Acquired or cicatrical
  • Intermittent
23
Q

Developmental/structural ectropion: Aetiology

A

Mainly in dogs

  • Possible genetic basis
  • Some ectropion is considered normal in some breeds of dog
  • CSx may be absent
24
Q

Acquired/cicatrical ectropion: Aetiology

A
  • Trauma to the lids → scar formation & skin contraction
  • May be caused by periocular surgery or chronic inflammation
  • Frequent in horses

This is the same aetiology as entropion

25
Q

Intermittent ectropion: Summary

A
  • Seen in larger hunting breed of dogs (setters & retrievers)
  • Eyelids are normal in the morning; Ectropion seen at night
  • Unknown mechanism
  • Surgery is contraindicated
26
Q

Ectropion: Signs to look for

A
  • Lacrimation & conjunctivitis
  • Corneal vascularisation in advanced cases
  • Eversion of the lower lid
27
Q

Ectropion: Treatment

A

Many animals tolerate slight ectropion

Indications for surgery:

  • Presence of secondary signs
  • If it is desired by the owner
28
Q

Ectropion: Surgical technique

A

Modified Kuhnt-Szymanowski method

29
Q

Ectropion surgery: Postoperative tx

A
  • ABx; NSAIDS; Elizabethan collar
  • Suture removal after 10-12 days
30
Q

Notable lesion seen in the eyelid: Hordeolum

A

Hordeolum externum or Hordeolum internum

  • Externum: Purulent inflam. of a lash follicle & gland of Zeis
  • Internum: Purulent inflam. of a tarsal gland

Caused by S. aureus

31
Q

Hordeolum: Signs to look for

A
  • Focal & painful microabscesses on the lid margin
  • Yellowish; up to 10mm in diameter
32
Q

Hordeolum: Treatment

A

Medical management / Surgery

33
Q

Notable lesion seen in the eyelid: Blepharitis

A

Inflammation of the eyelid

Classified by:

  • Aetiology: Bacterial; mycotic; parasitic; allergic
  • Location: Unilateral; bilateral; upper; lower; both
  • Expansion: Focal; diffuse
34
Q

Blepharitis: Signs to look for (Acute)

A
  • Pain; blepharospasm; pruritis; alopecia
  • Swelling; hyperaemia; sero-purulent discharge
35
Q

Blepharitis: Signs to look for (Chronic)

A
  • Ulceration & fibrosis
  • May have associated conjunctivitis/keratoconjunctivitis
36
Q

Blepharitis: Laboratory testing available

A
  • Cotton swab sample: Bacteriology
  • Scraping: Parasites
  • Skin biopsy: Fungi
37
Q

Blepharitis: Treatment

A

Dependent on the cause; Elizabethan collar needed

  • Bacterial
  • Fungal
  • Parasitic
  • Allergic
38
Q

Causes of blepharitis: Bacterial infection

A

Staphylococcus & Streptococcus spp.

  • Acute Tx: Hot compress & washing; topical & systemic ABx
  • Chronic Tx: Topical & systemic ABx & steroids
39
Q

Causes of blepharitis: Fungal infection

A
  • Microsporum* & Trichophyton spp.
  • Tx: Topical & systemic fungicides
  • Avoid contact between the drug and the cornea*
40
Q

Causes of blepharitis: Parasitic infection

A
  • Demodex* & Sarcoptes spp.
  • Tx: Topical & systemic parasiticides
  • Avoid contact between the drug and the cornea*
41
Q

Causes of blepharitis: Allergies

A

Tx:

  • Elimination of the allergen
  • Topical & systemic steroids
42
Q

Traumatic injuries to the eyelid: Signs to look for

A
  • May be just in the skin or full thickness of the lid
  • Varying size of laceration
  • Fresh injuries: Intensive bleeding

It’s important to evaluate the globe & lacrimal punctas’ condition

43
Q

Traumatic injury to the eyelid: Treatment

A

Wound management

  • Repair to restore anatomic & functional integrity ASAP after injury
  • Untreated injury → Cicatricial entropion/ectropion
44
Q

Notable lesion seen in the eyelid: Tumour

A
  • Equally common amongst all species
  • Malignant or benign; metastasis is rare
45
Q

Tumour of the eyelid: Signs to look for

A
  • Malignant tumours: Locally invasive → Loss of function & deformity
  • Pain; discharge; ulcer; haemorrhage; lacrimation; dry eye surface
46
Q

Tumour of the eyelid: Treatment

A

Surgery

​Radiotherapy; chemotherapy

Ophthalmology (9 decks)

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