Eyelids Flashcards by Anna Annett

What are the five main components of the eyelid?

Skin
Orbicularis oculi
fibrous layer
Levator palpebrae superioris muscle
Muller muscle

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What is the skin adnexa and what are its components?

The adnexa lies deep to the dermal layer of the eyelid and includes the eyelashes, eccrine, apocrine and holocrine glands.

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Where is the upper eyelid located?

2mm inferior to the superior limbus

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Where is the lower eyelif located?

Sits on the inferior limbus border

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What is the role of the eccrine glands?

These are the sweat glands of the eyelid

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What do the holocrine glands secrete? Give some examples of holocrine glands q

Lipids and oily substances
Meibomian glands
Gland of Zeis

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What are the apocrine glands?

E.g. gland of moll

These are modified sweat glands

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What is the sensory supply to the upper eyelid?

Laterally - lacrimal nerve (CNV1)

Medially - Supraorbital and Supratrochlear nerves (these are branches of the frontal nerve CNV3)

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What is the sensory supply to the lower eyelid?

Infraorbital nerve - branch of CNV2

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What is the sensory supply to the medial canthal area of the eyelids?

Infratrochlear nerve - this is a branch of the nasociliary nerve of CNV1

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What is the name of the striated muscle whose main function is to close the eye?

The orbicularis oculi

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What are the four segments of the orbicularis oculi?

Palpebral
Orbital
Lacrimal
Ciliary

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What nerves supply the orbicularis oculi?

Temporal and Zygomatic branches of CNVII

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The fibrous layer is split into the tarsal plate and the orbit septum. What are the functions of the tarsal plate?

Tarsal plate: Structural support to the eyelids

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What muscle is responsible for eyelid retraction?

Levator palpebrae superioris

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What is the origin and insertion for the Levator palpebrae superioris

Origin - lesser wing of the sphenoid

Inserts - tarsal plate

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What is the nerve supply to the Levator palpebrae superioris

CN III superior division

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Give the name of a smooth muscle, which has sympathetic innervation, that contributes to eyelid retraction?

Muller Muscle

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Where does the Muller muscle originate and insert?

Origin - Levator aponeurosis

Insert: tarsal plate

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List the three ways the blinking reflex can be stimulated:

Corneal stimuli
Light stimuli
Auditory stimuli

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How is the corneal stimuli elicited?

Afferent - CNV1

Efferent - CNVII

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How is the light stimuli elicited?

Afferent - CN II

Efferent - CN VII

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How is the auditory stimuli elicited?

Afferent - CNVIII

Efferent - CNVII

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Define Bell’s phenomenon:

This is a physiological term describing the upward and outward rotation of the globe during forced lid closure. It is considered a defence mechanism.

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When might Bell's phenomenon be easily observed?

In CNVII palsy. The lid will remain open when the patient is asked to close their eyes.

What is a chalazion?

This is a lipogranuloma that occurs due to obstruction of the Meibomian gland (and occasionally around the gland of Zeis) Presents as a painless round nodule on the eyelid - can become infected

What conditions might be associated with chalazion?

Blepharitis | Acne rosacea

What is the management of a chalazion?

Hot compress twice daily Oral antibiotics if infected incision and curettage may be required

What is the name given for a congenital malformation of the dermis which presents as a pink/purple well demarcated patch?

Port Wine Stain | a.k.a naevus flammeus

What is significant about Port wine stains?

They do no blanch on applied pressure and never cross the midline

What is the typical distribution of a port wine stain?

Distribution across the choroidal neovascularisation (CNV)

What syndrome might a port wine stain be associated with?

Sturge-Weber syndrome

What is lid coloboma?

This is when there is incomplete development of the eyelids due to failure of lid fold fusion. It can occur in both the upper and lower eyelids

What is the most common malignant eyelid tumour and what is its histopathology?

Basal cell carcinoma | Clusters of darkly staining basaloid cells with peripheral palisading arrangements

Where is a BCC found in the eyelid? (from most to least common sites)

Lower lid > medial canthus > upper lid > lateral canthus

What is the most appropriate management of an eyelid BCC?

MOHS surgery

What are the features of an SCC?

Keratotic ill defined nodule which may ulcerate | Dome shaped nodule with a keratin filled crater.

What is the name given to the misdirected growth of the eyelash follicles which leads to eyelashes growing toward the cornea / sclera?

Trichiasis

What are the common causes of trichiasis?

Herpes zoster opthalmicus and blepharitis

What term refers to the development of a posterior row of eyelashes?

Distichiasis

What may cause distichiasis?

Chemical poisoning AD congenital syndrome Stevens-Johnson syndrome Ocular cicatricial pemphigoid

What type of tumour may arise from the Meibomian or Zeis glands?

Sebaceous Gland carcinoma

What is the histopathology of a sebaceous gland carcinoma?

Foamy vacuolated lipid containing cytoplasm with a hyperchromatic nuclei

What group of people are sebaceous gland tumours likely to be seen?

Elderly women

What is anterior blepharitis?

Inflammation of the skin around the base of the eyelashes. | divided into staphylococcal and seborrheic

What is posterior blepharitis?

Inflammation of the Meibomian gland around the eyelid margins due to gland dysfunction. (can be associated with ocular rosacea)

What are the risk factors for blepharitis?

Dry eyes Seborrheic dermatitis Long term contact lens wear Demodex folliculorum (assoc. w/ ocular rosacea )

What are the clinical symptoms of blepharitis?

Bilateral, symmetrical dry gritty, crusty, red eyes.

What are the clinical signs of anterior blepharitis;

Staph: Hard crusty plaques, lip hyperlipidaemia and swelling, tear film instability, dry eye syndrome, trichiasis Seborrheic: assoc. w/ seborrheic dermatitis. Soft scales and oily margins

What are the clinical signs of posterior blepharitis?

Assoc. w acne rosacea Foamy and unstable tear film Posterior lid margin hyperaemia and telangiectasia

What is the treatment for blepharitis?

Eyelid hygiene Antibiotics e.g. tetracyclines Tea tree oil

Define ptosis:

This term is used to describe the dropping of the upper eyelid

List some causes of ptosis:

Neurogenic: Horner's syndrome (CN3 palsy) Myogenic: Myasthenia gravis, myotonic dystrophy Congenital: Failed Levator development Involutional: age related

What is the name of the condition which may occur in 5% of patients who have congenital ptosis and what is it?

Marcus Gunn jaw-winking syndrome Presents as a ptotic lid that retracts when the ipsilateral pterygoid muscle is stimulated (chewing)

What is phthisis bulbi?

An atrophic non functioning eye which occurs as a result of severe ocular disease and can lead to pseudoptosis.

What is the term used for excessive skin in the upper eyelid that leads to sagging, classically known a lateral hooding?

Dermatochalasis

What bilateral condition caused by abnormal elastic eyelids causes recurrent episodes of painless oedema of the upper eyelids and what are the consequences of this?

Blepharochalasis. Leads to stretching and atrophy of the skin, causing subsequent skin folds and ptosis.

What is a condition, commonly found in obese middle aged men with sleep apnoea where the upper eyelid becomes extremely lax? What are the consequences of this?

Floppy eyelid syndrome | Leads to papillary conjunctivitis and keratopathy

List some causes of lid retraction:

``` Grave's disease Third nerve misdirection Collier sign of parinaud syndrome Marcus gun jaw winking syndrome Down syndrome Progressive supranuclear palsy Congenital hydrocephalus ```

Where in the upper eyelid would the lid coloboma occur and what syndrome is associated with this?

At the junction of the middle and inner thirds of the upper eyelid. Associated with Goldenhar syndrome

What is Goldenhar syndrome?

A sporadic condition characterised by upper lid coloboma, microphthalmia, optic disc coloboma, maxillary and mandibular hypoplasia and limbal dermoids.

What is a hordeolum and how is it managed?

Aka Stye This is an infection of the glands of Zeis or Moll when external and the Meibomian gland if internal. Staphylococcal infection is usually the cause Hot compress and antibiotics. Good eye hygiene

Where in the lower lid does a coloboma occur?

Junction between the middle and outer thirds of the eyelid

What syndrome might a lower lid coloboma be associated with?

Treacher Collins syndrome