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Ocular Disease > Eyelids 2 > Flashcards

Eyelids 2 Flashcards

1
Q
A

Congenital Ptosis

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2
Q
A

Acquired Ptosis

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3
Q

Why does congenital ptosis usually occur?

A

Dystrophic levator muscle causing a ptosis that decreases in down gaze resulting in a weak or no crease in the eyelid

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4
Q

Where does the crease appear in acquired ptosis?

A

Higher than usual

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5
Q

How is an acquired ptosis affected in downgaze?

A

Level with or lower than normal lid in downgaze

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6
Q

How is an acquired ptosis affected throughout the day?

A

May increase with stress, fatigue (diurnal variation)

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7
Q

What is the normal cutoff for palpebral fissure measurement?

A

7mm

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8
Q

What is the normal cutoff for marginal reflex distance 1?

A

4mm

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9
Q

What is the normal cutoff for levator function?

A

11mm

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10
Q

What is the normal cutoff for marginal crease distance?

A

8mm

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11
Q

What is pseudoptosis?

A

Something that looks like a ptosis but actually isn’t

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12
Q

What is a common cause of pseudophthalmos?

A

Thyroid Eye Disease

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13
Q

What should you do if you find pseudoptosis?

A

Consider exophthalmometry

Check for Lagophthalmos

Probe for systemic symptoms

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14
Q

What is dermatochalasis and how much it cause pseudoptosis?

A

Loose and redundant tissue that may drape over the superior lid tissue over septum or lid margin. Usually occurs bilaterally.

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15
Q

Who does dermatochalasis normally occur in?

A

Middle to older age groups

Familial tendancy

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16
Q

Why might this abnormality occur?

A

CN3 palsy secondary to cavernous sinus meningioma.

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17
Q

In a ptosis workup what should you assess with the slit lamp?

A

Upper eyelid via eversion

Tears

Cornea

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18
Q

Should you test visual fields in a ptosis patient?

A

Yes, with and without eyelid taping

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19
Q

What are some other studies you can conduct for your ptosis workup?

A

Ice Pack Test (Myasthenia gravis)

Cocaine test (Horner’s syndrome)

Imaging (CT/MRI: for suspected orbital mass)

Labs

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20
Q

What is a neurogenic ptosis?

A

Nerve issue

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21
Q

What is a myogenic ptosis?

A

Dysgenesis of the levator muscle

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22
Q

What is an aponeurotic ptosis?

A

When the levator aponeurosis dislodges or isn’t functioning correctly

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23
Q

What is a mechanical ptosis?

A

Caused by excess weight of the upper lid.

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24
Q
A
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25
Q

What is ectropion?

A

Outwardly turned eyelid margin

26
Q

What are the signs and symptoms of ectropion?

A

Epiphora

Irritation

Redness

27
Q

What are the common etiologies of ectropion?

A

Involution

Paralytic

Cicatricial

Mechanical

Allergic

Congenital

28
Q

What nerve palsy may cause ectropion?

A

CN 7 palsy

29
Q

What would you expect to see under the slit lamp in a patient with ectropion?

A

Conjunctival injection

Exposure keratopathy

30
Q

What is the common treatment for ectropion?

A

Artificial tears

Lubricating ointment

Eyelid taping at night

31
Q

How do you treat ectropion if the eyelid is inflammed?

A

Warm compresses

Bacitracin or Erythromycin TID

32
Q

When do you refer ectropion to oculoplastics?

A

Long-standing, stable

Significant corneal exposure

33
Q

What is entropion?

A

Inwardly turned eyelid margin that pushes otherwise normal lashes into globe

34
Q

What are some signs and symptoms of entropion?

A

Irritation

Foreign body sensation

Tearing

Redness

35
Q

What should you expect in slit lamp examination of entropion?

A

Eyelid scarring

Conjunctival injection

Corneal involvement (PEE/SPK)

Corneal Thinning/Ulceration

36
Q

What are the treatment for entropion?

A

Artificial tears

Bandage soft contact lens

Eyelid taping

Treatment for PEE (erythromycin or bacitracin TID)

37
Q

When do you refer entropion to oculoplastics?

A

Permanent correction or significant corneal damage

38
Q
A

Floppy Eyelid Syndrome

39
Q

How does Floppy Eyelid Sydrome present?

A

Chronically red irritated eyes

Mild mucous discharge

Usually bilateral, asymmetric

Typically seen in obese males

40
Q

Why are symptoms of floppy eyelid syndrome worse upon awakening?

A

Due to eyelid eversion at night

41
Q

What are the suspected etiologies of Floppy Eyelid Syndrome?

A

Abnormality of collagen and elastin fibers

Spontaneous eversion of the upper eyelid during sleep

Superior palpebral conj rubs against the pillow or sheets

42
Q

What are some common associations with Floppy Eyelid Syndrome?

A

Keratoconus

Skin hyperelasticity and joint hypermobility

Obstructive sleep apnea (Normal tension glaucoma)

Diabetes

Mental Retardation

43
Q

What questionnaire is used in diagnosing sleep apnea?

A

Snoring

Tired

Observed

Blood Pressure

BMI

Age

Neck Circumference

Gender

44
Q

How do you treat floppy eyelid syndrome?

A

Avoid sleeping facedown

Eye shields or eyelid taping

Lubricating ointment

Treatment for PEE (erythromycin or bacitracin)

45
Q
A
46
Q

What bacteria cause anterior blepharitis?

A

Staphylcoccal

Sebhorrhoeic

47
Q

What are the symptoms of blepharitis?

A

Burning

Grittiness

Associated dry eye symptoms

48
Q

What is this staphylococcal sign?

A

Collarettes

49
Q

What is this staphylococcal sign of blepharitis?

A

Increased vascularization

50
Q

What is this staphylococcal sign of blepharitis?

A

Trichiasis and irregular lid margin

51
Q

What are the seborrhoeic signs of blepharitis?

A

Greasy anterior lid margin

Stuck together lashes

Soft scales

52
Q

What is blepharitis treatment?

A

Use a washcloth to wipe gently against lashes and lid margins

Topical antibiotic ointment (erythromycin or bacitrcin oph ung)

53
Q

Why should you be wary of intractable, unilateral or asymmetric blepharitis?

A

Manifestation of sebaceous carcinoma of the eyelid.

54
Q

What causes Posterior blepharitis/meibomitis?

A

Meibomian gland dysfunction

Changes in meibum

55
Q

What does meibomitis lead to?

A

Ocular surface irritation

Increased tear evaporation

Hyperosmolarity

Unstable tear film

56
Q
A

Seborrhoeic

57
Q
A

Meibomitis

58
Q

What are the symptoms of meibomitis?

A

Burning

Grittiness

Associated dry eye symptoms

59
Q
A

Meibomitis

60
Q

What are some treatments for meibomitis?

A

Hot compresses and massage

Tetracyclines

61
Q

What are the contraindications of tetracyclines?

A

Pregnant/nursing women

Children <2 years old

Consider erythromycin 200mg BID

Ocular Disease (7 decks)

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