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Eyelids Flashcards

1
Q

Parts of eyelid and position of eyelids

A

Orbital and tarsal parts

UL covers 1/6th of cornea and LL touches the limbus

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2
Q

Lid margin is divided how?

A

Puntum divides lid margin into medial(devoid of lashes nd glands)
lateral(contains lashes and glands)

Grey line divides intermarginal strip into Ant - skin,subcut t,muscles
Post - tarsal plate,Palpebral conj

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3
Q

Striated muscles of eye lid and functions?

A

1.Orbicularis oculi - orbital,preseptal,pretarsal(Hornerks muscle nd
Muscle of rion)
(Closure of eyelids)

2.LPS only in upper eyelid(elevation of UL)

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4
Q

What is the non striated muscle in eyelid?

A

Muller’s muscle(elevation of UL)

UL - from LPS
LL - from IR

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5
Q

Nerve supply of muscles of eyelid and associated conditions?

A
  1. Orbicularis oculi-zygomatic branch of facial(7th)-Lagophthalmos
  2. LPS-oculomotor nerve-Ptosis
  3. Muller’s muscle-sympathetic - Ptosis/Horner’s syndrome
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6
Q

Glands of eyelid?

A
  1. MG/tarsal gland - seb - lipid layer of tear film
  2. Zeis - “ “
  3. Moll - sweat
    * krause @ fornices and wolfring @ up border of tarsal plate
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7
Q

Anaesthesia of eyelid given @?

Arterial supply?

A

Submucous Areolar tissue layer

Marginal arterial arcade

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8
Q

Failure of development of eyelids?

A

Crypt-ophthalmos

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9
Q

MCC of bacterial Blepharitis ?

Other names?

Complications?

Treatment?

A

Staphylococcus aureus

Chronic anterior B (or) Ulcerative B

Lash abnormalities,Tylosis,Epiphora,Dry eye,Recurrent styles

  1. Lid hygiene with hot compresses and removal of crusts
  2. Local Abs
  3. Oral abs in unresp nd complicated cases
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10
Q

Cause of Seborrhoeic/squamous blepharitis?

A

Corynebacterium acne

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11
Q

Acute inflammation of Zeis gland?

Acute inflammation of MG?

Chronic inflammation of MG?

A

Hardeolum externum (or) style

Hardeolum internum

Chalazion…..(CML)***

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12
Q

Painful swelling @ lid margin?

Painless swelling away from lid margin?

A

Style

Chalazion

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13
Q

Signs of style?

A

Stage of cellulitis - red,tender,firm swelling

Stage of abscess formation - pus point

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14
Q

Causes of recurrent hardeola?

A
  1. Childrnen -refractory error
  2. Adults - Diabetes
  3. Elderly - Sebaceous gland Carcinoma
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15
Q

Symptoms of chalazion?

Signs of chalazion?

A
  1. Painless swelling
  2. Heaviness of the lid
  3. Epiphora d/t pun time eversion
  4. Decreased vision d/t astigmatism
  5. Hard,non-tender nodule,away from the margin
  6. Reddish-purple area on lid eversion
  7. Projection on skin
  8. Marginal in some
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16
Q

Different treatments of chalazion?

A
  1. Conservative t/t for small
  2. Intralesional TRIAMCINALONE - 50%cases cure
  3. I & Curretage……2%xylocaine,chalazion scoop….vert I on conj
  4. Diathermy in Marginal chalazion
  5. Tetracycline as prophylaxis in recurrent cases
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17
Q

Difference between trichiasis and pseudotrichiasis?

A

Inward turning of lashes without eyelid - Trichiasis

- Pseudotrichiasis

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18
Q

Absence of development of eyelids?

Extra row of eye lashes and causes?

A

Cryptophthalmos

Distichiasis-cong/acq(SJS,OCP,late cicat stage of chemical injury)

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19
Q

Causes of Madarosis?

Causes of Trichomegaly?

Causes of Poliosis?

A
  1. M - Blepharitis,CryoSx (or) hypothyroidism,leprosy
  2. T - PG analogues,Cyclosporin
  3. P - VKH,vitiligo,marfan’s …ant blepharitis
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20
Q

Causes of trichiasis?

Signs of trichiasis?

A
  1. Cicatricial trachoma
  2. Operative eyelid scar
  3. Ulcerative Blepharitis
  4. Styles
  5. Mech/thermal injuries

1.Can see the cause
2.Misdirected cilia
3.Reflex blepharospasm
&
Photophobia ……….if cornea abraded

21
Q

Treatment for trichiasis?

A
  1. Epilation
  2. Electrolysis….2mA for 10 sec
  3. Cryosurgery….cryoprobe(-20^c for 25 sec)
  4. Surgical correction if multiple misdirected cilia
22
Q

Symptoms and signs of Entropion?

A

Symptoms - FBS,irritation,Lacrimation,PP

Signs
1.Inturning

  1. Causative factor seen
  2. Complications seen(CU,CO)
23
Q

Symptoms and signs of Ectropion?

A

Symptoms - Epiphora and irritation,PP

Signs

  1. Outrolling
  2. Causative factor seen
  3. Cx - Exposure K, Eczema d/t Epiphora
    * *In Involutional - laxity of horizontal lid/ Medial(or) lateral cantonal tendon
24
Q

Management of congenital entropion?

A

Spont recovery
(Or)
HOTZ procedure

25
Q

Management of cicatricial entropion?

A
  1. Anterior lamellar resection
  2. Tarsal wedge resection
  3. Tarsal Fracture (or) Transposition of Tarso-conjunctival wedge
  4. Posterior lamellar graft
26
Q

Management of cicatricial ectropion?

A
  1. V shaped incision with Y shaped suturing operation
  2. Z-Plasty (or) Elshnig operation
  3. Excision and full thickness grafting - in severe cases
27
Q

Specific feature
Etiology and
Management of Involutional/Senile entropion?

A
  • Only in Lower Lid
  • Horiz/vertical laxity,Over-riding of pretarsal by preseptal

Management

  1. Transverse (or) Everting sutures
  2. Weis operation-Horiz split+everting sutures
  3. Jones operation- severe cases
  4. Quickert procedure - weis + Horizontal lid shortening
28
Q

Management of involutional ectropion?

A
  1. Medial conjunctivoplasty
  2. Horizontal lid shortening with pentagonal incision
  3. Bryon smith’s Kuhnt-Szymanowski operation
29
Q

Causes and management of paralytic ectropion?

A

7th nerve palsy d/t bellks/head inj/ME infection

Spont in 6 months
(Or)
1.Temporary-Top lubricants,Taping,Suture tarsoraphy

2.Permanent - Horizontal lid tightening
Palpebral sling operation

30
Q

What is symblepharon?

What is ankyloblepharon?

A

Adhesion btw lids and eyeball

  • restricted movements=>Diplopia and Lagophthalmos
  • t/t - Mobilising conjunctiva (or) Grafting in severe cases

Adhesions btw eyelids

31
Q

What is lagophthalmos?
Causes?
Cx?
T/t?

A

Inability to close eyelids VOLUNTARILY

Etiology

  1. Oo paralysis
  2. Symblepharon
  3. Ectropion
  4. Physiological

Exposure keratitis and conjunctival xerosis

Tear drops,soft contacts,Tarsorrhaphy

32
Q

What is Blepharospasm?
Types?
Clinical features?
Treatment?

A

Involuntary,forceful,sustained closure of eye lids

  1. Essential-idiopathic(spontaneous)…..botox(or)facial denervation
  2. Reflex - t/t disease

1.Persistent Epiphora 2.Oedema of lids
3.Spastic entropion in elderly 4.Blepharophimosis
Spastic ectropion in young

33
Q

What is blepharophimosis?

Signs seen in blepharophimosis?

A

Decrease in height and width of Palpebral fissure

  1. Epicanthus in versus
  2. Telecanthus
  3. Lateral ectropion
34
Q

What is blepharophimosis syndrome?

Treatment?

A 
Blepharophimosis 
        \+
Mild ptosis 
        \+
Epicanthus inversus 
        \+
Telecanthus

T/t = Canthoplasty

35
Q

What is Horner’s syndrome?

A
  1. Mild Ptosis (muller px)
  2. Miosis (sphincter pupillae px)
  3. I/L decreased sweating (Anhydrosis)
  4. Other - enophtalmos,heterochromia
36
Q

Features of congenital Ptosis?

Other associations?

A
  1. Drooping of eyelid
  2. Absence of lid crease
  3. Lid lag on down gaze
  4. LPS function - fair/poor
  5. Simple
  6. With superior rectus weakness
  7. Blepharophimosis syndrome
  8. Congenital Synkinetic Ptosis
37
Q

Cause of congenital synkinetic ptosis?

A

It is d/t Trigemino-oculomotor synkinesis

It is also known as Marcus Gunn jaw winking Ptosis.

38
Q

Acquired causes of ptosis?

And their treatment?

A
  1. Neurogenic - 3rd N palsy, Horner’s syndrome
    - conservative t/t for 6 months at least
  2. Myogenic - MG,Myotonic dystrophy
  3. Aponeurotic - Involutional/Senile and postop and traumatic dehiscence
  4. Mechanical - d/t weight of tumours or chalazia
39
Q

How to treat Neurogenic cases of Ptosis?

A

6 months of conservative treatment should be done and then surgery

  • 3rd Nerve palsy = Frontalis sling operation
  • Horner’s syndrome = Fasanella servat operation
40
Q

What is pseudo Ptosis?

Examples?

A

I/L = Micro,nano,enophthalmos

C/L = Retraction,High myopia,Exophthalmos,Proptosis

41
Q

Degree of ptosis?

A

2mm - mild
3mm - moderate
4mm - severe

42
Q

How to assess LPS function and what is the method used?

A

BURKE’s method

Pt look down-> finger on eyebrow->look up

15mm = normal
8mm = good
5-7mm = fair
=4mm = poor
43
Q

Ix done for ptosis in MG?

Ix done for ptosis in Horner’s syndrome?

A

Edrphonium test

Phenylephrine test

44
Q

Treatment procedures for congenital ptosis?

A
  1. Fasanella-servat operation(Tarso-conjunctivo-mullerectomy)
    - done in mild Ptosis with good lev function

2.Levator resection =Blaskowic’s(conj) and Everbusch(skin)
- in moderate with good/fair/poor func
&
in severe Ptosis with fair lev func
*C/I in severe with poor

3.Frontalis sling operation/Brow suspension - severe cases with no lev func

45
Q

Slings used in Frontalis sling operation?

A
  1. Fascia Lata
  2. Supramide suture
  3. Silicon rod
46
Q

Treatment for Marcus gun jaw winking Ptosis?

A

Levator resection
+
Frontalis sling operation

47
Q

Treatment for blepharophimosis syndrome?

A 
Frontalis sling operation 
              \+
Telecanthus correction 
              \+
Lateral cantholysis
48
Q

Ptosis in CPEO?

What is the syndrome associated?

A

Chronic progressive external ophthalmoplegia

Bilateral ptosis with all EOMs affected in all gazes

***If associated with Retinitis pigmentosa =>Kearn Sayre syndrome

49
Q

What is cogon lid twitch sign?

A

Overshoot of eye when looked from down gaze to primary gaze

Ophtha (4 decks)

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