EYELIDS Flashcards
What are the 6 layers of the eyelid
skin, subcutaneous layer, muscles, submuscular areolar layer, fibrous layer, palpebral conjunctiva
Skin is ______ and _______ and ______
thick; elastic; fat free
T/F the eyelid has fat
F; the eyelid is fat free
Blepharochalasis is what?
orbital fat herniation or edema
________ cell carcinoma is related to ______ exposure
Basal; ultraviolet radiation
T/F malignant growths are evenly distributed b/w upper and lower lids
F benign growths are evenly distributed and malignant tumors are 4 times more common in the lower then upper lid
Why are malignant tumors 4 times more common in the lower lid then the upper
Because the eyebrow protects the upper eyelid from the sun
Which muscle elevate the upper lids and which one closes it
the levator palpebral superioris; orbicularis oculi
Which muscle fibers modulate position of the open eye
Mueller muscle fibers (Tarsal plates)
A fold of skin separating the palpebral from the orbital portion of the lid marks insertion of the ______
levator palpebral superioris
When is the absence of the palpebral sulcus seen?
ptosis
What is the difference between congenital and acquired ptosis?
congenital - born with it; acquired - developed later in life
T/F Obicularis oculi is a striated and voluntary muscle
T
What does the orbicularis oculi do
helps hold the lid tightly against the eye, assistance spreading tears and flushing away waste products
Obicularis oculi is innervated by what cranial nerves?
CN 7
What can paralysis of the orbicularis oculi lead to?
dry eye and lagophthalomos
Levator is innervated by what cranial nerve
CN 3
Tarsal muscles superior and inferior are innervated sympathetically or parasympathetically
sympathetically
T/F Tarsal muscles keep the eye lid up
T
Which muscle gives a wide eye expression of fear
Tarsal muscles (Mueller)
Damage to the _______ innervation causes a _______ lid
sympathetic; droopy
_______ _______ tissues is loose connective tissues between muscle and tarsal plate
submuscular areolar layer
T/F submuscular areolar tissue is full of fat
false; it is fat free
The ______ layer is dense fibrous tissue that gives firmness and shape to eyelid
fibrous layer
T/F collagen is more develop in the upper lid than the lower lid which allows upper lid to be everted
T
What could be the causes of a floppy eyelid syndrom
decrease tarsal elastin and genetic abnormalities of collagen or elastin
What is floppy eyelid syndrome and why would you wake up in the morning with red eye
Upper eyelids are flaccid and easily everted; when you sleep you could be pulling the eyelid away and exposing your conjunctiva to the mattress therefore causing soreness or red eye dryness
Floppy eye syndrome can also be a ______ glad dysfunction
meibomian gland
T/F floppy eye syndrome can also cause an inadequate spreading of tear film
T; poor apposition of eyelid to globe
Floppy eyelid syndrom can often be associated with ____ ____
sleep apnea
What syndrome should not be confused with floppy eyelid syndrome
floppy iris syndrome
the life span of cillia is \_\_\_\_\_\_ to \_\_\_\_\_\_ months A) 6-7 B)5-7 C) 3-5 D) 1-3
3; 5
When cillia are forcibly removed from their follicles approximately how long does it take for new growth A) 1 month B) 3 months C) 2 months D) Never grows back
2 months
What is the chief eyelid secretion
sebum
What gland secretes sebum
meibomian
Sebum forms ____layer over the _____ tear film which _____ evaporation of the aqueous component
superficial; precorneal; slows
There are approximately _______ meibomian gland in each tarsus
30
A _____ barrier is formed preventing tear spillage
hydrophobic
T/F meibomian glands are modified sebaceous glands
T
Little _____ leading to a ____ canal opens at the lid margin of meibomian glands
saccules; central
How many transverse arcades are there per eyelid
2
T/F arteries do not anastomose in the lid
F; they do anastomose in the lid
The facial system has arterial supply from the _____ carotid artery
external
The orbital system has arterial supply from the _____ carotid artery
internal
What two systems are there for the venous drainage
superficial (pre tarsal) system, deep (post tarsal) system
_____ and ______ are provided with lymphatics
lid and conjunctiva
What are the 2 lymphatics systems of the eyelid
superficial or pretarsal plexus; deep or post tarsal plexus
Paralysis of the cranial nerve ______ causes a brow to be lower on the affected side
7
What is the difference between ptosis and paralysis of CN 3
ptosis is a weakness of the upper eyelid; paralysis is a complete closure of the upper eyelid
Which EOMs are supplied with CN 3
MR, IR, SR, IO
Why wouldn’t a patient with 3rd nerve palsy have diplopia
They would have diplopia but the patient
If there is complete paralysis from third nerve palsy would the patient complain of diplopia
no; because it is complete paralysis and the eyelid is completely closed
If you were to manually open the upper eyelid of a third nerve palsy patient would they complain of diplopia
yes; because the EOMs are not working well
______ paralysis causes minor ptosis in mueller’s muscles and is one of the components of _____ syndrome
sympathetic; Horner’s syndrome
Weak solutions of ____ causes reversal of ptosis _____ to sympathetic paralysis
epinephrine; secondary
T/F will epinephrine topical can work on a normal person
F; it can only work on a sympathetic paralysis which causes ptosis
What three symptoms goes with Horner’s syndrome
Ptosis (droopy eyelids), miosis (state of pupillary constriction), anhydrosis (reduced facial sweating)
Usually Horner’s happens on one side of the face
What does the corrugator supercilli do
pulls eyebrow together frown
The _____ muscle raises brow in expression of surprise and is oriented _____ over the forehead
frontalis; radially
______ muscles of the eyebrow has a ____ action and closes the eyelid
obicularis oculi and sphincter
In Bell’s phenomenon the globe turns _____ as the eyelids are ____
upward; closed
T/F bell’s phenomenon is found during reflex blinking
F
If a patient does not have good bell’s phenomenon what can that cause
they will have exposure to the cornea and could cause drying of the cornea
Reflex blinking is activated by what 4 things
touch, strong lights, approaching objects and loud noise, corneal, conjunctival or cilliary touch
Which type of sensations activate reflex blinking
tactile, optic and auditory
________ reflex and _______ reflex are common optically initiated blink reflexes
dazzle; menace
_______ and ______ reflexes are tactile in origin
corneal and cilliary
Dazzle and menace reflex are initiated by the perception of what?
sudden motion in depth towards the eye
What quantifies the corneal reflex
aesthesiometer
T/F In CL wearers the tactile corneal reflex is not diminished slightly
F; it is diminished slightly
Common clinical practice is to use a ______ filaments to touch the cornea without any associated optic stimulus
twisted wisp of sterile cotton (q-tip)
What is reflex blinking versus blepharospasm
Reflex blinking - high speed response to tactile or propprioceptive (detects motion) stimuli;
Blepharospasm - slow sustained closure to nociceptive (pain) stimuli
T/F Spontaneous blinking occurs on a regular basis with external stimulus
F; occurs on a regular basis without external stimulus
What three things can spontaneous blinking change
level of visual acuity, emotional states and environmental conditions
From a clinical point what can cause spontaneous blinking
computer users and any activity that involves increased attention (you have to remind yourself to blink)
Spontaneous blinking is _____ or _______ in infants
extremely low; absent
T/F spontaneous blinking is not present with blindness and is dependent on optic stimulation
F; spontaneous blinking is present despite blindness and does not depend on optic stimulation
T/F During spontaneous blinking the lower lid moves
False; lower lid remains almost stationary most of movement by upper lid
The palpebral fissure narrows in a _____ like motion ______ to _______
zipper; laterally; medially
The tear strip moves towards what?
puncta
Spontaneous blink rate is \_\_\_\_\_\_\_ per min a) 15X b)16X C)17X D)18X
15 x
Duration of a blink is \_\_\_\_ to \_\_\_\_\_\_ msec a) 300-600 b)400-600 C)300-400 D)100-400
300; 400
Average time between blinks is \_\_\_\_\_ a) 3.0 b)2.8 C)2.6 D)2.5
2.8 sec
Obscuring visual input up to \_\_\_\_\_ msec is barely detectable a) 3.0 b)5 C)4 D)10
3; barely
Obscuring visual input for greater than \_\_\_\_\_\_ msec is \_\_\_\_\_\_ detectable a)10 b)20 C)15 D)30
30; easily
Voluntary winking is _____ initiated closure of _____ eye
consciously; one
Most people can wink freely with the _____ eye but not with the ______ eye.
What is that related to?
left; right
It is related to predominance of right handedness
Blepharospasm is a _____ disorder of ______ control (obicularis muscle)
idiopathic; neuromuscular
Blepharospasm results in
symmetrical, progressive, involuntary closure of both eyes
Blepharospasm is dangerous during _____ procedure in which the globe is open.
Give two examples
Surgical;
1 .cataract extraction
2. corneal transplantation
What is injected for temporary relief in blepharospasm patient
botox (botuliunum-A toxin) and is injected subcutaneously
Blepharospasm ________ IOP
raises
What is myokymia
fibrillary twitching of the eyelids
Myokymia is aggravated by what 3 things
fatigue, thyrotoxicosis, psychological stress (most common)
T/F Myokymia is not related to the more severe dystonias
T
What is dystonias
invlountary muscle contraction and slow repetitive movement
What is lagophthalmos
incomplete closure of the eye during sleep
Lagophthalmos results in _____ and ______ exposure of the _____ portions of the cornea
desiccation; excessive; lower
What is desiccation
state of extreme dryness
T/F lagophthalmos can happen in a normal person or a common consequence of some diseases
T
What is ectropion
a falling away of the lower lid away from the globe
Ectropion is caused by _______ of the obicularis
weakness
What can result from ectropion
epiphora (overflow of tears) and poor blink closure
Describe senile ectropion
lower lid may sag away from the eye as the inferior portion of the obicularis loose tone
loss of tone and loss of orbital fat deep to the eye due to age can cause what
senile ectropion
What is the difference entropion and ectropion
Entropion is an anatomic defect; turning in of the eyelid
Ectropion is a pathologic condition; turning outward of the eyelid
T/F Snap test can check the muscle tone of the lower lid
T
Ectropion of the lower lid is commonly caused by flaccid paralysis of the ______ muscle in the CN ______ weakness of _______
obicularis; 7; bell’s palsy
What is cicatrical entropion and why does it happen
caused by or related to scar tissue; happens because of trichiasis
What is trichiasis
misdirected upper or lower eyelashes that turn inward towards the eyeball may scratch the cornea
What disease may have entropion as a result of it
trachoma (chlamydia infection) and ocular pemphigoid (chronic blisterring and scarring of eyes)
The palpebral fissure vertically is \_\_\_\_\_\_ to \_\_\_\_\_\_\_ mm and \_\_\_\_\_\_\_ to \_\_\_\_\_\_ horizontally a) 8 -11, 27-30 b)2-9, 27-30 C)8-11, 40-50 D)2-9, 40-50
8- 11; 27-30;
If there is forward displacement of the globe then _______ of palpebral fissure
widening
large eye with shallow orbit is _____ globe with a _____ fissure
prominent; wider
Abnormal recession of the globe into the orbit results in what
narrowing of the palpebral fissure
T/F Any process that results in proptosis or forward movement of the globe within the orbit will produce widening of the palpebral fissure on that side
T
In exophthalmos the palpebral fissure measurements measured from \_\_\_\_ to \_\_\_\_ is obtained in normal subjects with a mean of \_\_\_\_\_\_ mm a) 12-21 , 16 b)12-21, 17 C)9-10, 16 D)9-10, 17 The palpebral fissure measurements in thyroid eye disease have values ranging from \_\_\_\_\_ to \_\_\_\_\_ with a mean of \_\_\_\_\_\_ mm a) 12-24, 18 b)12-24, 19 C)12-21, 16 D)12-21, 17 Measurements of greater then \_\_\_\_\_ was found in only \_\_\_\_\_\_ % of normals while \_\_\_\_\_% of those with thyroid eye disease fell above this level a) 19, 5-32 b)19, 10-15 C) 21, 5-32 D)21, 10-15
A)12; 21; 16
B)12; 24; 19
19; 5; 32
What is the principal component in the apparent exophthalomos of eye disease
the degree lid retraction
In what disease is exophthalmos seen
thyroid
T/F exophthalmometry measurements are not similar to normal patients
F; they are similar to normal patients
What type of fissure measurements are better in exophthalmos patients
vertical
retraction of the ___ eyelid causes a _____ palpebral fissure
upper; widening
What is thyrotoxicosis
means an excess of thyroid hormone in the body
What two clinical signs signal hypothyroidism?
Collier’s sign - retraction of the upper lid
Von Grafe’s sign - delay of movement of the upper lid when shifting gaze from up to down causes a staring expression
- True of False: In Thyrotoxicosis, Collier’s Sign is the delay of movement of the upper lid when shifting gaze from up to down, causing a widening of the palpebral fissure & a staring expression.
F , Von’s grafes sign
