Eyelids

Question 1

What are the 4 types of ptosis?

Answer 1

Neurogenic
Myogenic
Aponeurotic
Mechanical

Question 2

What are some causes of pseudoptsosis?

Answer 2

1. lack of support of the lids by the globe
2. contralateral lid retraction
3. ipsilateral hypotropia
4. brow ptosis
5. dermatochalasis (excessive skin)

Question 3

How do we measure ptosis?

Answer 3

Margin-reflex distance
Palpebral fissure height
Levator function
Upper lid crease
Pretarsal show

Question 4

What are some associated signs to check if someone comes in with ptosis?

Answer 4

Increased innervation to contralateral normal levator
Fatigability
Ocular motor defects (superior rectus)
Jaw-winking phenomenon
Bell phenomenon (manual hold lids open and ask patient to close eyes-globe should rotate upward and outwards)

Question 5

Surgical options for treating ptosis?

Answer 5

Conjunctiva-muller resection (levator function of >10mm)
Levator resection (levator function >5mm)
Brow suspension (levator function <4mm)

Question 6

What is blepharitis?

Answer 6

An abnormal cell mediated response to staph aureus/seborrhoeic dermatitis causing inflammation/scales/scarring around the base of eyelashes
Can be anterior or posterior

Question 7

Treatment steps for anterior blepharitis

Answer 7

Lid hygiene
Topical sodium fusidic acid
Oral azithromycin
Weak topical steroid
Tear substitutes

Question 8

Treatment of posterior blepharitis

Answer 8

Lid hygiene-including milking the meibomian gland gunk out
Systemic tetracyclines
Plus topical antibiotics/steroids/tear substitutes