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Ocular Disease > Eyelids and Adnexa > Flashcards

Eyelids and Adnexa Flashcards

1
Q

macule

A

colour change without infiltration or elevation (ex. freckle, cafe au lait spots)

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2
Q

papule

A

small solid elevation of skin (<1cm)

ex. cherry angioma, common warts

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3
Q

nodule

A

small solid elevation of ski (>1cm)

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4
Q

ulcer

A

circumscribed area of tissue loss, extends through epidermis into dermis (ex. in basal cell carcinoma)

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5
Q

cyst

A

nodule with an epithelial lined cavity, filled with fluid or semi-solid material

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6
Q

Which is translucent and which is not: cyst of Zeis and cyst of Moll?

A

Cyst of Zeis is non-translucent, cyst of Moll is translucent (also called apocrine hidrocystoma)

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7
Q

pustule vs. vesicle

A

pustule is a small pus-filled lesion, vesicle is a small serous fluid-filled lesion (ex. in Herpes)

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8
Q

Herpes zoster ophthalmicus skin changes:

A

-viral release from the sensory nerve endings results in a macular rash, which becomes papular, then vesicular which develop (~4 days) to become pustular and eventually rupture. When acute phase subsides, the rash crusts over and dissipates.

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9
Q

Contact Dermatitis

A

common inflammatory disorder that often involves the thin skin of the eyelid, associated with hypersensitivity response or direct irritation

can caused periocular skin to be red, edematous, scaly or fissured

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10
Q

treating Contact Dermatitis

A

topical corticosteroids and removal of offending agents

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11
Q

rosacea dermatitis

A

common, chronic inflammatory eruption of the face (forehead, nose, cheeks) can involve malar flushing, telangiectasia, papules, pustules, sebaceous gland hypertrophy, rhinophyma, etc.

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12
Q

ocular rosacea

A

in about 50% rosacea cases

symptoms: burning, photophobia, FBS

blepharitis and MGD are most common findings

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13
Q

treating Ocular Rosacea

A

avoiding foods and environments that worsen flushing

oral antibiotics (tetracycline, doxy, azithromycin) topical metronidazole cream/gel on skin

topical corticosteroids

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14
Q

collarettes (on eyelashes)

A

ring-like formation around lash-shaft, mucous debris and dead epithelium

can be caused by phthirus pubis or demodex mites

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15
Q

trichiasis

A

posteriorly misdirected lashes rubbing against globe, chronic rubbing can lead to corneal problems

may be secondary to scarring - from trauma, mucous membrane pemphigoid, Stevens-Johnson syndrome

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16
Q

treating Trichiasis

A
  • epilation!
  • electrolysis
  • cryotherapy
  • argon laser ablation
  • surgery
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17
Q

distichiasis

A

partial or complete second row of lashes - emerge at or behind a meibomian gland orifice (cells differentiate into a pilosebaceous unit instead of MG cell)

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18
Q

trichomegaly

A

excessive eyelash growth, may be congenital or acquired, can be induced by drugs (prostaglandins), malnutrition, AIDs, hypothyroidism

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19
Q

madarosis

A

decrease in the number of lashes, can be caused by: chronic lid margin disease, lid tumour, burns, alopecia, psoriasis, SLE, syphilis, leprosy, trichotillomania,etc.

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20
Q

poliosis

A

premature whitening of hair which can involve lashes and brows

ocular causes - chronic blepharitis, idiopathic uveitis

systemic causes - vitiligo, Vogt Koyanagi Harada syndrome, Marfans, TB

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21
Q

potentially malignant characteristics of anterior eyelid:

A
  • nodular pearly consistency
  • ulceration
  • induration/hardening
  • irregular borders
  • suspicious telangiectasias
  • madarosis
  • loss of lid architecture
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22
Q

meibomian gland dysfunction

A

-increased lipid viscosity and opacity, needs heat (warm compresses)

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23
Q

congenital ptosis

A

unilateral or bilateral, superior VF defect

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24
Q

aponeurotic ptosis

A

most common form of ptosis, usually bilateral, associated with age (involutional), eye sx, trauma, pregnant, chronic swelling, etc. Levator aponeurosis stretching (functions fine), symptoms worse at the end of the day as Muller’s muscle fatigues after trying to compensate

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25
Q

treating involutional ptosis

A

Upneeq (oxymetazoline) a direct-acting alpha-adrenergic receptor agonist, targets Muller’s muscle to elevate the upper eyelid

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26
Q

mechanical ptosis

A

decreased elevation of the eyelid secondary to eyelid mass or scarring

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27
Q

myogenic ptosis

A

ptosis secondary to inherent levator or Muller muscle dysfunction, weakness of the actual muscle - from chronic progressive external ophthalmoplegia, myotonic dystrophy, myasthenia gravis, etc

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28
Q

neurogenic ptosis

A

caused by Horner’s syndrome or CN3 palsy -innervation defect

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29
Q

ICA aneurysm ocular signs

A

ptosis, pupil mid-dilated minimally reactive to light

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30
Q

pseudoptosis

A

false ptosis due to decreased orbital volume, contralateral lid retraction, ipsilateral hypotropia, or dermatochalasis

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31
Q

eyelash ptosis

A

downward sag of upper eyelid lashes (no turning in of the lid margin)

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32
Q

brow ptosis

A

excessive skin on the brow and forehead leading to a pseudoptosis, may be due to CNVII palsy, often accompanies dermatochalasis

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33
Q

Bell’s palsy

A

acute facial nerve palsy of unknown etiology, sudden, temporary weakness in facial muscles, typical recovery in ~6 months

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34
Q

involutional ectropion

A

outward rolling of lower lid due to horizontal lid laxity, medial/lateral canthal tendon laxity, may present gradually with tearing, redness, irritation, tear film abnormalities, dry eye, or conjunctival keratinization

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35
Q

cicatricial ectropion

A

due to scarring and contracture, trauma, burns, chronic inflammation, pulls lid away from eye

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36
Q

paralytic ectropion

A

due to ipsilateral CNVII palsy, can be temporary, may cause exposure keratopathy and epiphora

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37
Q

mechanical ectropion

A

lesion on or near lid margin, the weight causes lid eversion

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38
Q

involutional entropion

A

horizontal lower eyelid laxity, contraction of pretarsal orbicularis oculi fibres forces the lower lid margin inward

presents with more acute pain, FBS, photophobia, etc.

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39
Q

treating involutional entropion

A

temporary - lubricants, lid taping, BCL, botox

Surgical techniques - everting sutures and canthal slings

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40
Q

congenital entropion

A

mechanical effects of microphthalmos (if involving the upper lid), can involve lower lid due to improper development of inferior retractor aponeurosis

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41
Q

epiblepharon

A

congenital condition, redundant skin and muscle override the lid margin and force eyelashes against the eye

42
Q

cicatricial entropion

A

scarring of palpebral conjunctiva - traction on upper or lower lid leading to rolling in of lid towards the globe - secondary to trauma, chemical burn, cicatrizing conjunctivitis, or trachoma

43
Q

trachoma

A

bacterial infection, the leading cause of preventable, irreversible blindness in the world, related to poverty, overcrowding, poor hygiene

44
Q

floppy eyelid syndrome

A

increased upper and lower eyelid laxity, typicaly affects obese middle-aged men - rubbery, floppy, easily everted tarsal plates - prominent upper palpebral conj papillary reaction

45
Q

what can cause floppy eyelid syndrome?

A

primarily a disorder of sleeping position - face down pressing eyes against pillow

other associations - obstructive sleep apnea, hyper elastic skin, joint hypermobility, diabetes

46
Q

dermatochalasis

A

laxity and redundancy of upper lid tissue (age related) often associated with prolapse of orbital fat - pseudoptosis, superior VF defect, heavy sensation, brow ache, tx: blepharoplasty

47
Q

blepharochalasis

A

uncommon, recurrent episodes of painless edema of upper lids that resolve spontaneously in 1-2 days, onset at puberty

complications - redundant skin, orbital fat prolapse, ptosis (from stretching of levator and canthal tendons)

48
Q

characteristics of benign eyelid neoplasms

A

more common than malignant, more varied, lack of induration or ulceration, uniform colour, limited/no growth, regular border, preservation of normal lid margin structure

49
Q

chalazion

A

-meibomian cyst, due to retained sebaceous secretion, chronic, sterile (non-infectious), granulomatous, inflammatory - gradually enlarging painless nodule, MGD and rosacea are at higher risk

50
Q

treating chalazion

A

monitor - 1/3 resolve spontaneously, surgical curettage, steroid injection (triamcinolone and lidocaine injected into lesion through conjunctiva, preferred if near punctum), doxycycline prophylaxis

51
Q

what to look for in a chalazion that may suggest sebaceous gland carcinoma instead…

A

re-occurring, older pt, lid thickening, unilateral chronic blepharitis*, madarosis, poliosis

52
Q

hordeolum

A

infection of an eyelid gland, can be internal (meibomian gland) or external (zeis or Moll), redness, acutely tender

53
Q

epidermal inclusion cyst

A

slow growing, round, firm, superifcial or subcutaneous lesions, implantation of epidermal cells into dermis following trauma or surgery - tx: excision

54
Q

sebaceous cyst

A

blocked pilosebaceous follicle, rarely seen on the eyelid, is usually on medial canthus -tx: excision

55
Q

milia

A

small, raised, white, round, superficial cystic lesions (retained keratin), common in newborn infants, occur in crops - tx: incision of overlying skin and expression of contents

56
Q

syringoma

A

benign proliferations, arise from eccrine sweat glands, more common in young female

57
Q

pilomatricoma

A

benign skin tumour derived from hair follicle - most common proliferation of hair cells seen in ophthalmologic setting - seen in younger pts, pink/purple mobile, firm, irregular lesions

58
Q

squamous cell papilloma (acrochordon, skin tag)

A

hyperkeratotic filiform projection from skin surface, very common, variable appearance, can be pedunculated or sessile, flesh coloured or raspberry-like - tx: excision

59
Q

basal cell papilloma (seborrheic keratosis, seborrheic wart, senile verruca)

A

very common, slow-growing, in elderly pts, lesions that can appear on face or eyelids. facial lesions appear smooth and greasy; eyelid lesions appear lobulated, papillary, or pedunculated, with friable cerebriform excrescences on the surface

60
Q

actinic keratosis (solar or senile keratosis)

A

common, slow-growing lesion, elderly pts, fair-skinned in excessive sunlight, most common on forehead and backs of hands - low risk of turning into SCC

hyperkeratotic plaque, distinct border, scaly, nodular or wart-like - tx: biopsy, excision, or cryo

61
Q

freckle (ephelis)

A

brown macule, excessive melanin production in basal layer of epidermis, sunlight exposed areas, no malignant potential, no tx required

62
Q

congenital nevus

A

benign melanocytic lesion, large ones may become malignant

63
Q

nevocellular nevi (aquired melanocytic nevus)

A

can be junctional (flat), compound (raised, extends from epidermis into the dermis), or intradermal (most common, little pigment, may have lashes in it, cells confined to the dermis)

64
Q

kissing nevus

A

very rare type of compound nevus that results from deposition of nevus cells in the eyelid fold while the lids are fused during embryogenesis

65
Q

which nevi have the capacity to evolve into melanoma?

A

junctional and compound, the younger the patient and the larger the size of the nevus shows an increased melanoma risk

66
Q

oculodermal melanocytosis (nevus of Ota)

A

unilateral, bluish discoloration of eyelid and skin, proliferation of dermal melanocytes, found in V1 and V2, present at birth, very small risk to become melanoma

67
Q

xanthelasma

A

relatively common, bilateral, yellow subcutaneous plaques on the medial aspects of eyelids, older pts, associated with hyperlipidemia, can be seen with corneal arcus (deposition of lipid in the cornea) as well

68
Q

pyogenic granuloma

A

fast-growing, vascularized, occasionally painful, polypoidal red lesion, possible bleeding, composed of granulation tissue, secondary to sx, trauma, infection - tx: excision

69
Q

neurofibroma

A

benign nerve sheath tumour, can occur anywhere in the body, comprised of schwann cells, fibroblasts and nerve axons, plexiform neurofibromas typically affect children with NF1, typically affects upper lid and makes an S-shaped deformity

70
Q

molluscom contagiosum

A

common self-limiting cutaneous viral infection in healthy children and young adults, caused by poxvirus

71
Q

verruca vulgaris

A

benign epithelial hyperplasia of viral origin (HPV), common, low risk of malignancy, variable colour, can be round and flat or finger-like projection from a broad base - tx: excision

72
Q

Port Wine Stain (nevus flammeus)

A

rare congenital, subcutaneous lesion, usually unilateral, most often on face, composed of dilated capillaries (congenital weakness of capillary walls), well-demarcated soft pink patch with no blanching, hypertrophy of overlying skin becoming nodular and friable

73
Q

how can a port wine stain affect glaucoma?

A

when port wine stain involves upper lid, glaucoma may result from ocular vascular hamartomas causing increased episcleral pressure

74
Q

sturge-weber syndrome

A

represented by facial nevus associated with leptomeningeal angiomatosis or ocular vascular hamartomas (such as choroidal hemangioma)

75
Q

basal cell carcinoma

A

most common malignant eyelid tumour (90% of all eyelid malignancies) in the elderly M>F, slow-growing, locally invasive, rarely metastatic, madarosis, three main types: nodular, noduloulcerative, morpheaform/sclerosing

76
Q

which are the prevalent locations for eyelid basal cell carcinoma?

A

in order: lower lid, medial canthus, upper lid, lateral canthus

77
Q

nodular BCC

A

shiny, firm pearly nodule, small dilated surface vessels (telangiectatic), initially very slow growing but can develop an ulcer and become noduloulcerative BCC

78
Q

noduloulcerative BCC

A

increased radial growth, the interior of the tumor may outgrow its blood supply, leading to central ulceration. border becomes indurated and seem to roll over, dilated vessels at margins, (rodent ulcer)

79
Q

morpheaform (sclerosing) BCC

A

less common, lateral infiltration beneath the epidermis, indurated plaque, margins difficult to delineate, looks like chronic blepharitis

80
Q

typical presentation of basal cell carcinoma

A

lump that doesn’t go away, up to 4 years history, very slow growing, like a wound that won’t heal, usually only locally invasive, metastasis is <0.1%

81
Q

treating BCC:

A

complete excision and biopsy, referral to oncology for systemic workup and follow-ups with dermatology, avoid further sun damage

82
Q

actinic keratosis

A

proliferations of transformed keratinocytes, premalignant, induced by UV exposure, risk of malignancy is <0.24% but if several spots over 10 years risk is 16.9%

83
Q

Bowen’s disease (carcinoma in situ)

A

isolated, slightly elevated, red lesion with well-demarcated borders that fail to heal, scaly patch or plaque, can appear in non-sun exposed areas of the body

5% of Bowen’s disease lesions may progress to invasive SCC

84
Q

Squamous cell carcinoma

A

less common (<10% of eyelid malignancies), more aggressive than BCC, metastatic in 20% of cases, most common on lower lid and lid margin, possible link to HPV

painless plaques or nodules, may be scaly, crusty or ulcerated

85
Q

treating SCC:

A

biopsy to confirm dx, surgical excision with microscopic monitoring of tissue margins (Moh’s sx), radiation or cryo as alternative to sx, refer for oncology workup, avoid further sun damage

86
Q

observing differences bw eyelid malignancies on slit lamp:

A

malignancies: loss of lashes, distortion or destruction of Meibomian orifices

BCC - more likely to be translucent, white, or flesh-coloured lesion stretching the skin

SCC - more likely to look flakey on surface, diameter of 1 cm attained in <3mo, grows fast

87
Q

keratoacanthoma

A

rare, possibly a spectrum of SCC, higher incidence in immune comprised pts, pink, rapidly growing, hyperkeratotic lesions, lower lid frequently

2x/3x in size in a few weeks, growth cessation for 2-3mos, spontaneous involution - keratin filled crater, significant scar

88
Q

treating keratoacanthoma:

A

complete surgical excision, hard to differentiate from SCC

89
Q

sebaceous (cell/gland) carcinoma

A

very rare, slow-growing, generally hard yellowish lesion due to presence of lipid, can be misdiagnosed as recurrent chalazion, arises from MGs more common on upper lid

90
Q

major difference bw sebaceous cell carcinoma and chalazion

A

sebaceous carcinoma is rock hard and immobile whereas chalazion is more rubbery and not adherent to the skin

91
Q

what is pagetoid spread?

A

sebaceous cell carcinoma nodule enlarges, erupts toward eyelid skin and spreads, may look like blepharitis - mistaken for unilateral chronic blepharoconjunctivitis

92
Q

treating Sebaceous cell carcinoma:

A

full thickness biopsy, map biopsies, total resection, exenteration may be necessary, palliative radiation

93
Q

What is the most common cutaneous malignancy?

A

Basal cell carcinoma (86%)

others are Squamous cell (7%) and Sebaceous (3%)

94
Q

malignant melanoma

A

most lethal primary skin tumor, pigmented or not, plaque or lesion, highly metastatic

3 main types: lentigo maligna, superficial spreading, or nodular

95
Q

suspicious findings for melanoma (ABCDE)

A

asymmetry, irregular border, inconsistent colour, diameter >6mm, evolving and elevated

scaliness, itching, oozing, pain

96
Q

lentigo maligna melanoma

A

10% of melanoma cases, flat tan-brown plaque with irregular borders, occurs on sun-exposed skin, enlarges radially

can form from premalignant Hutchinson’s melanotic freckle (lentigo maligna)

97
Q

superficial spreading melanoma

A

most common form of melanoma (70%), plaque with irregular border, pigment variable and inconsistent, quickly develops into a raised nodule

*primarily involves non-exposed skin surfaces (upper back, anterior tibia)

98
Q

nodular melanoma

A

bluish black nodule, surrounded by normal skin, aggressive, rare on eyelids, worst prognosis :(

99
Q

Merkel cell carcinoma

A

very rare, highly malignant (50% already have metastatic spread at dx) common to lymph nodes, poor prognosis >65% mortality

firm, non-tender, red nodule, smooth surface and shiny

100
Q

AEIOU signs of Merkel cell carcinoma

A

common features: AEIOU: asymptomatic, expansion-rapid, immunosuppression, older than 50yrs, UV exposed skin as location

101
Q

treating Merkel cell carcinoma:

A

complete excision, lymph node resection, chemo/radiation therapy likely

102
Q

Kaposi sarcoma

A

vascular tumor typically assoc. w/ AIDS (occurring in approx. 24-35% of AIDS pts), very malignant, pink/red/violet lesion on face or eyelids, tx-excision or chemo/immunotherapy

Ocular Disease (14 decks)

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