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OP3104- AOC- YR 3 > Eyelids > Flashcards

Eyelids Flashcards

1
Q

What is caruncle?

A

Part of the conjunctiva, takes fluid in the years from the punctum into the lacrimal sac and to the nose through nasal- lacrimal duct.

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1
Q

Role of orbicularis oculi?
How do they present?

A

Close the eye
Horizontal lines

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2
Q

Levator palpebrae role?

A

Open the eye
horizontal muscles

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3
Q

Meibomian glands are found in?

A

Tarsal plates

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4
Q

Tarsal plates are bigger in the lower or upper lids?

A

Upper

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5
Q

Function of eyelids?

A
  1. Sweep through the tear film to prevent drying.
  2. Protection from trauma.
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6
Q

Why do patients with extropian get watering?

A

Medial and lateral ectropian= no drainage, hence tears do not stay on the surface.

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7
Q

Why is there redness with ectropion?

A

Because the area is exposed.

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8
Q

Why do we get age related ectropion?

A

Tissue is lost with age, or excess tissue.

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9
Q

How to know if ectropion is caused by cicatrical vs age related?

A

More skin when you pull on lids= age related change. If cicatrical = eyelid skin doesnt move back to normal position when pulled on.

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10
Q

4 causes of ECtropion?

A
  1. Age related
  2. Cicatrical
  3. Paralytic (facial nerve palsy)
  4. Mechanical
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11
Q

Management of ECtropion?

A

Temporary- micropore tape horizontally along lower lid to provide lift. Definitative= surgery

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12
Q

ECtropion meaning?
Which lids are affected?

A

Eyelids turn out
Lower lids affected

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13
Q

What does ECtropian cause?

A

Tear outflow, red appearance of exposed conjunctiva.

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14
Q

What is ENtropion?

A

Age related change that affects the lower lids- inward turn. Constant rubbing of lashes on the cornea in long standing cases.

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15
Q

ENtropion signs?

A

The feeling that something is in your eye.
Eye redness.
Eye irritation or pain.
Sensitivity to light and wind.
Watery eyes (excessive tearing)
Mucous discharge and eyelid crusting.

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16
Q

Differential diagnosis to ENtropion?

A

Palpebral conjunctiva- The conjunctiva lining the inner eyelid of the lower lid may be inspected by gently pulling down the lid with a finger.

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17
Q

What happens in downgaze for ENtropion?

A

Movement of lower lid is reduced

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18
Q

What causes conjunctival scarring?

A

tarcoloma conjunctivitis

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19
Q

3 classifications of ENtropion?

A
  1. Age related
  2. Cicatrical
  3. Congenital - rare
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20
Q

Long & short term management of ENtropion?

A

Short term: Lubricants, bandage CLs for protection. Lid tapping as per ectropion. Botox used temporarily.
Definitive: Surgery

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21
Q

What are lower lid retractors?

A

They have a role in moving eyelids back to their normal position, if they do not work it causes entropion.

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22
Q

What is 7th nerve palsy?

A

The affected side becomes flat and expressionless, ability to winkle forehead and blink is limited and absent.

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23
Q

What are pxs with 7th nerve palsy going to report?

A

Sudden onset of facial droop, ocular discomfort, blurred vision.

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24
Q

How is Lagopthalmos measured?

A

Ask px to close eyes, sclera should not be visible when eyes are closed.

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25
Q

CN 7 supplies which gland?

A

lacrimal gland

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26
Q

What is checked for px’s with a 7th nerve palsy?

A

Corneal sensation, bell’s phenomenon, corneal staining, lagopthalmous

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27
Q

7th nerve palsy must be differentiated to?

A

Bells palsy
Hunts syndrome, lyme disease, ramsay, trauma.

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28
Q

What is Bell’s phenomenon and how is it checked?

A

Ask px to close squeeze lids tight, when they open them- cornea not vissible, only sclera.
Bell’s phenomenon describes the reflex upward movement of the front of the eyeball when the eyelids close (or blink).

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29
Q

Complications of 7th nerve palsy?

A

Exposure keratopathy and corneal perforation.

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30
Q

Treatment options for 7th nerve palsy?

A

Temp: lubrication (Day), ointment (night).
Tape at night.
Botox into upper lid including ptosis.
Lower lid tightening, upper lid lowering.

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31
Q

What is ptosis and what causes it?

A

Droppy lids, caused by overaction of frontalis muscle

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32
Q

Causes of ptosis?

A
  1. Involuntary
  2. Neurogenic- Horner’s 3rd nerve palsy
  3. Myasthenia gravis
  4. Mechanical
  5. Congenital
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33
Q

How is ptosis managed?

A

Depends on cause
1. Abnormal eye movement (consistent with 3rd nerve palsy) = refer to ophthalmology.
2. Tumour= emergence refferal
3. Myasthenia gravis = emergence referal

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34
Q

Ptosis needs to be differenitated from?

A

pseudoptosis

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35
Q

How is levator function tested?

A

Open eyelids on the top using the thumb (blocking action of frontalis muscle), ask px to look all the way down vs up, and measure how much lid moves.

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36
Q

What must be checked in ptosis?

A

EOM
Pupils

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37
Q

Risk of using steroids on skin?

A

Pigmentation

38
Q

Chalazion- how does it look?

A

Eyelid bump- same colour as skin.

39
Q

What causes chalazion?

A

Blocked meibomian glands.

40
Q

chalazion px’s may also have?

A

Rosacea and seborrheic dermatitis.

41
Q

Treatment of chalazion?

A

Hot compress and surgery is non-resolving.

42
Q

Cyst of Moll- how does it look?

A

Small, clear fluid filled cysts. Transilluminates when light is shone.
(Clear= due to sweat)

43
Q

Cysts of Moll treatment?

A

Treated surgically if cosmesis is bad and px is uncomfortable.
Sac is removed to prevent it from reforming.

44
Q

Cyst of Zeis - how does it look?

A

White cyst
Contains oily secretion hence not translucent.

45
Q

Cyst of Zeis treatment?

A

Hot compression and expression.
Surgery if non-resolving, irritating and cosmesis is bad.

46
Q

How does pyogenic granuloma look like?

A

Red lump on the lids- can bleed.

47
Q

What causes pyogenic granuloma?

A

After trauma at wound site, occurs due to abnormal wound healing.
Caused by proliferation of immature capillaries.

48
Q

Treatment of pyogenic granuloma?

A

Lubrication, tropical steroids, excise surgically.

49
Q

What is basal cell carcinoma (BCC), and how does it look?

A

Malginant lid lession.
Ulceration, shiny/ pearly appearance, blood vessels run on the surface, gets bigger with time, common with sun exposure.

50
Q

BCC is more common in fair skin individuals- true or false?

51
Q

Common position of BCC?

A

Lower lid and medial canthus

52
Q

Red flags in patients with BCC?

A

Lash follicle destruction, raised pearly edge with telangiectasia, cysts forming, bleeding

53
Q

BCC or SCC- which one is more common?

54
Q

Squamous cell carcinoma (SCC)- how does it look?

A

Scaly, hyperkeratosis, irregular margins, ulceration, crusting.

55
Q

Why is SCC concerning?

A

Risk of metastasis- risk of the cancer spreading to other parts.

56
Q

Risk factors for SCC?

A

age, white skin, X-ray, chemical exposure, immunosuppression, xeroderma pigmentosa.

57
Q

BCC and SCC- Similarity and differences?

A

Both usually occur on sun-exposed areas.
Differences: BCC- Most common skin cancer, shiny pearly nodule, umbricalted centers of telangiectasias, grows slowly.
SCC- Most common in immunosuppressed or transplant px’s, hyperkeratotic lesions with crusting and ulceration, can be more aggressive than BCC.

58
Q

How does malignant melanoma look?

A

Pigmented lessions.

59
Q

malignant melanoma affect lids?

60
Q

What must you consider in any pigmented lesion?

61
Q

What is the ABCD rule followed in malignant melanoma?

A

Asymmetry
Border
Colour heterogeneity
Dunamic (Change in colour, elevation or size)

62
Q

Risk factors of malignant melanoma?

A
  1. Age
  2. Complexation
  3. UV
63
Q

What is the key examinations for lids abnormality?

A
  1. Loss of normal architecture
  2. Lash loss
  3. Ulceration
  4. Irregular border or contour
  5. Telagietasia or pearly appearance
  6. Alternated sensation
64
Q

Drainage system starts from?

A

Canaliculi’s

65
Q

Role of lacrimal gland?

A

Produce tears and aqueous component of tears.

66
Q

Role of lacrimal sac?

A

Drain tears away from ocular surface

67
Q

2 systems of lacrimal?

A
  1. Production system
  2. Drainage system
68
Q

What happens when lacrimal drain is blocked?

69
Q

3 components of lacrimal system?

A

Tear lake
Lacrimal sac
Nasal cavity

70
Q

Important clinical assesments in px’s with watery eyes?

A
  1. VA
  2. Observe for any surgical scars? trauma? related sag? lacrimal swelling?
  3. Lids- MG? Malposition? lid laxity?
  4. Puncta- position? scarring? patency?
  5. Cornea and conjunctiva- signs of irritation? inflammation?
  6. Tear film- meniscus height? TBUT? dry eyes?
  7. Flurosecein dye disappearance test?
71
Q

Lacrimal sac blockage causes high tear film, why?

A

Beacause tears do not drain

72
Q

What causes medial spillage and lateral spillage - what is 1 underlying cause for watery eyes?

A

Medial spillage = due to impaired drainage.
Lateral spillage = due to lower lid laxity

73
Q

State 2 causes of overproduction vs 2 causes of impaired drainage ?

A

Overproduction- FB, Conjunctivitis.
Impaired drainage- Pump failure, laxity

74
Q

How is blockage investigated?

A
  1. Dye recovery- Jones 1 & 2 dye test.
  2. Syrnging- commonly used
  3. Imaging- DCG, CT
75
Q

With a Jones 2 dye test no dye is detected on cotton bud, what does this suggest about underlying cause?

A

Suggests blockage is in the canalicular system, or lacrimal duct, fluroscein doesnt go through.

76
Q

Is ultra sound used as an imaging technique for lacrimal drainage system?

A

No - doesn’t penetrate through bones.

77
Q

What does meibomian gland dysfunction lead to?

A

Increased tears production

78
Q

Lacrimal pump failure is due to?

A

Lid laxity and punctal eversion

79
Q

How to deal with small punctum?

A

Enlarge surgically

80
Q

Is it alarming to have swelling above medial tendon?
What is this swelling called?

A

YES- could cause cancer of px’s nasal mucosa.
Acute dacryocytitis

81
Q

What is canaliculitis?
Cause?

A

Infection of caniculus
CAUSE: Due to obstruction of nasal lacrimal system. Needs urgent referral to prevent celluitis.

82
Q

What causes congenital nasal lacrimal duct obstruction (NLDO)?
Signs?
Tx?

A

Valve of Hasner doesn’t open.
Child complains of watering with no other cause found.
TX: nothing is done for 12 months- just massage over lacrimal system. However, need to check for congenital glaucoma.

83
Q

What are the 7 P’s for orbital history examination?

A
  1. Pain
  2. Proptosis
  3. Progression- mins/ days/ weeks
  4. Past medical history
  5. Perception
  6. Palpable mass
  7. Periorbital abnormalities- sensory changes, weakness, redness, watering.
84
Q

What 4 clinical conditions affect the orbit?

A
  1. Infection
  2. Inflammation
  3. Vascular
  4. Tumour
85
Q

Are orbital infections life threatening?

86
Q

Optic nerve dysfunction is a feature of orbital or pre-septal cellulitis?

87
Q

What is Thyroid Eye Disease (TED)?

A

TED is an autoimmune disease in which the eye muscles and fatty tissue behind the eye become inflamed.

88
Q

TED Presentation?

A

This inflammation can push the eyes forward (“staring” or “bulging”) or cause the eyes and eyelids to become red and swollen.

89
Q

TED Management?

A

Blood check- for antibodies
Imaging- CT
Orthoptic review
MDT
Educate px about smoking, chronic nature of disease, supportive groups

90
Q

Risk factors for TED?

A
  1. Older age of onset
  2. Males
  3. Smokers
  4. Diabetes
  5. Reduced VA
  6. Rapid progressive onset
  7. Longer duration of active disease
91
Q

Which muscles are involved in TED?

A

Inferior rectus, medial rectus, superior rectus, lateral rectus.

91
Q

Carotid Cavernous Fistula (CCF) - how does it look?

A

RAPD, Pulsatile proptosis, orbital oedema, injected conj, raised IOP, Wiggly arteries and veins (Engorgmenet)

91
Q

Which muscles are first affected by TED?

A

Inferior Rectus

OP3104- AOC- YR 3 (8 decks)

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