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Duke Elder Revision > Eyelids > Flashcards

Eyelids Flashcards

1
Q

Eyelid tissue layers from anterior to posterior

A
  1. Skin
  2. Orbicularis muscle
  3. Tarsal plate
  4. Levator muscle
  5. Muller muscle
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2
Q

How is the eyelid anatomically divided into the lamellae?

A

Gray line - outermost margin of the orbicularis muscle

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3
Q

contents of anterior lamella

A

skin and orbicularis

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4
Q

contents of posterior lamella

A

tarsal plate and conjunctiva

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5
Q

what is the normal position of the eyelids in comparison to the limbus?

A

the upper lid is 2mm below the superior limbus and the lower lid is level with the inferior limbus

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6
Q

muscles of eyelid retraction

A

levator palpebrae superioris
Mullers muscle
frontalis

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7
Q

innervation of levator palpebrae superioris

A

CN III

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8
Q

innervation of Mullers muscle

A

sympathetic innervation

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9
Q

innervation of frontalis

A

CN VII

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10
Q

muscle of eyelid closure

A

Orbicularis oculi

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11
Q

innervation of orbicularis oculi

A

CN VII

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12
Q

Muscle involved in lacrimal pump mechanism

A

orbicularis muscle

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13
Q

afferent limbs of the blink reflex

A

Corneal stimulus via CNV1
Light stimulus via CN II
Auditory stimulus via CN VIII

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14
Q

Efferent limb of blink reflex

A

CN VII to the orbicularis oculi muscle

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15
Q

Bell’s phenomenon

A

where the globe rotates up and out during forced lid closure

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16
Q

where does the lacrimal sac lie?

A

between the limbs of the medial canthal tendon

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17
Q

palpebral fissure

A

gap between the upper and lower eyelid margins

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18
Q

presentation and mechanism of thyroid eye disease

A

Retraction due to muller contraction

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19
Q

presentation and mechanism of horner syndrome

A

ptosis due to muller relaxation

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20
Q

presentation and mechanism of CN VII palsy

A

lagophthalmos due to orbicularis spasm

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21
Q

presentation and mechanism of CN III palsy

A

ptosis due to levator relaxation

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22
Q

Lagophthalmos

A

inability to fully close the eyelids

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23
Q

priority order of skin graft sites for eyelids

A
  1. Other lid
  2. Preauricular
  3. Post auricular
  4. Under arm
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24
Q

Can you repair both lamellae with grafts?

A

No because there would be no blood supply

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25
Q

Anterior lamella advancement

A

incise and stretch tissue over laceration

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26
Q

Anterior lamella transposition

A

move tissue from the other lid

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27
Q

Anterior lamella rotation

A

rotated skin from the cheek

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28
Q

anterior lamella glabella

A

rotated diamond-shaped forehead skin

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29
Q

posterior lamella hughs flap

A

flap taken from the upper lid

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30
Q

posterior lamella free tarsal graft

A

tissue taken from the other eye

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31
Q

blepharitis

A

chronic inflammation of the eyelid typically associated with staphylococcus aureus infection

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32
Q

blepharitis classification

A

Anterior (seborrheic or staphylococcal) and posterior

33
Q

Guess the condition:
bilateral crusting of the lids and foamy tear film

A

blepharitis

34
Q

recurrent unilateral blepharitis should be investigated for which condition?

A

sebaceous cell carcinoma

35
Q

Blepharitis type associated with atopic dermatitis

A

staphylococcal

36
Q

Blepharitis type associated with seborrheic dermatitis

A

seborrheic

37
Q

Blepharitis type associated with acne rosacea

A

posterior

38
Q

blepharitis management

A

lid hygiene, warm compress, topical lubrication and tetracyclines

39
Q

function of tetracyclines in blepharitis

A

limit fatty acid production which can decrease inflammatory secretions

40
Q

meibomian gland dysfunction

A

chronic disorder of meibomian glands that overlaps with posterior blepharitis. Characterised by duct obstruction and abnormal glandular secretions.

41
Q

pathophysiology behind meibomian gland dysfunction

A

secretion of meibomian oil is obstructed -> stagnation within glands leads to inflammation -> staphylococcal colonisation leads to chronic inflammation and scarring

42
Q

Guess the condition:
foamy tear film, crusty eyelashes and gritty irritated eyes, TBUT < 5s

A

Meibomian gland dysfunction

43
Q

Management of MGD

A
  1. dietary increase in omega 3 and lid hygiene and warm compress
  2. topical lubricants, increase humidity and lysosomal sprays
  3. Oral tetracycline
  4. Anti-inflammatory therapy for dry eye
44
Q

Trichiasis

A

inward misdirection of the eyelashes

45
Q

Distichiasis

A

congenital abnormality where there are 2 rows of eyelashes
Can be associated with Meige syndrome

46
Q

Acquired metaplastic lashes

A

Abnormally positioned lashes due to inflammation such as meibomitis and scarring

47
Q

Pseudotrichiasis

A

Inwardly projecting lashes due to entropion

48
Q

Management of trichiasis

A
  1. Epilation
  2. Lash destruction by electrolysis/laser/cryotherapy
  3. Surgery
49
Q

external hordeolum

A

abscess of Zeis or Moll glands

50
Q

internal hordeolum

A

abscess of Meibomian gland

51
Q

Management of hordeolum

A

hot compress and oral antibiotics

52
Q

pathology of chalazion

A

obstruction of meibomian or Zeis glands leads to sterile lymphogranuloma formation

53
Q

management of chalazion

A

hot compress
surgical incision and curettage

54
Q

Cyst of Moll

A

Chronic translucent cyst arising from blockage of Moll glands

55
Q

Cyst of Zeis

A

Chronic non-translucent cysts arising from blockage of Zeis glands

56
Q

commonest cancer in ophthalmology

A

basal cell carcinoma

57
Q

Vismodegib

A

medication that works through the hedgehog pathway for BCC non-resectable cases

58
Q

ophthalmology cancer associated with HPV and immunocompromise

A

Squamous cell carcinoma

59
Q

Vemurafenib

A

kinase inhibitor with FDA approval for unresectable melanoma tumours

60
Q

Where do ophthalmology melanoma?

A

most likely arise from the choroid inside the eye
can spread to the liver

61
Q

commonest type of ectropion

A

involutional

62
Q

involutional ectropion

A

Caused by horizontal lid laxity and often seen in the elderly.

63
Q

cicatrical ectropion

A

Shortening of the anterior lamella by inflammation and scarring. It is caused by underlying conditions such as burns and dermatitis.

64
Q

paralytic ectropion

A

Orbicularis weakness caused by facial nerve palsy.

65
Q

congenital ectropion

A

Typically due to a shortage of skin. Can be seen in Down syndrome and prematurity.

66
Q

management of horizontal lid laxity

A

lateral tarsal strip

67
Q

management of vertical lid laxity

A

diamond excision

68
Q

management of cicatrix

A

skin gaining procedures such as grafts and flaps

69
Q

involutional entropion

A

commonest type caused by lower retractor weakness/dehiscence

70
Q

cicatrical entropion

A

caused by shortening of the posterior lamella by vertical scarring
Most commonly caused by trachoma

71
Q

management of entropion

A

Retractor weakness → Everting sutures, transverse tarsotomy, or Jones procedure
Scarring → Membrane graft or posterior lamella reconstruction

72
Q

involutional ptosis

A

The most common type.
Caused by dehiscence of the levator palpebrae superioris from its attachment to the levator aponeurosis.

73
Q

treatment of involutional ptosis

A

anterior levator advancement surgery

74
Q

neurogenic causes of ptosis

A

CN III palsy
Horner Syndrome
Myasthenia Gravis

75
Q

management of ptosis due to horner syndrome

A

levator resection or mullerectomy

76
Q

management of isolated congenital ptosis

A

Poor function → frontalis suspension.
Preserved function → anterior levator resection.

77
Q

blepharophimosis syndrome

A

Characterised by a shortened horizontal palpebral fissure and telecanthus.
AD inheritance

78
Q

Marcus Gunn Syndrome

A

Characteristic elevation of the ptotic lid whilst chewing.
Thought to be caused by developmental CN5 misdirection to the levator palpebrae superioris.

79
Q

causes of pseudoptosis

A

Blepharochalasis
Dermatochalasis
Brow Ptosis

Duke Elder Revision (12 decks)

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