Eyes

Question 1

Eye comparments

Answer 1

nasal, central upper (whitnall ligament separates the nasal whiter fat from the medial compartment)
nasal central lateral lower (inferior rectus separates the central and nasal, while the arcuate expansion of lockwoods ligament separates the central and lateral)

lamella -lower eyelid is anterior skin/orbic, posterior conjunctiva and tarsus, middle with septum and orbital fat
upper lacks the middle

Question 2

avoiding chemosis

Answer 2

fluorometholone drops QID for 1 week, and frost suture for 4 days

Question 3

lateral canthotomy/canthopexy

Answer 3

5-0 vicryl
release the lower lateral cantonal tendon, reposition it

Question 4

ectropion

Answer 4

1 finger laterally improves - do canthotomy/canthopexy
lateral and medial - do palatal graft
any additional support to cheek to a mid cheek lift preperiosteal to elevate the lid/cheek junction

cicatricial ectropion - lubricate eye during day with drops and lubricant at night

Question 5

palatal graft

Answer 5

incisive foramen
thrombin gel foam

Question 6

congenital ptosis

Answer 6

opttho eval for ambyplopia - blindness from that eye
failure of neural migration within the levator muscle complex

if levator function >4mm then resect levator and reapproximate
if levator is less than 4mm in excursion then you can do a frontalis sling

Question 7

involutional ptosis

Answer 7

disinsertion or dehiscence of levator aponeurosis
can happen with younger patients from contact use, ocular trauma, ocular surgery
super lid crease is elevated
normal levator function

Question 8

neurogenic ptosis

Answer 8

innovational defect due to oculomotor nerve palsy
no levator function
need to be evaluated for pathology - opt, CNS aneurysms, DM, HTN, or trauma

Question 9

myogenic ptosis

Answer 9

defects in the neuromuscular junction - MG or muscular dystrophy
mechanical ptosis results from gravity mass effects or contraction from a scar

Question 10

normal levator function

Answer 10

14mm
close eye, use a ruler, measure excursion while holding frontalis in place
normal MRD1 - 4
normal palpebral fissure 7-12mm

Question 11

Hering law

Answer 11

levator muscles work synchronisly
input from one affects the other
Can see pseduoretraction where the ptosis on the abnormal side appears in normal position due to compensatory elevation from frontalis etc and the normal side is abnormally high

If preoperatively you do not do a good exam, there can be ptosis of the previous normal side due to herring law

How to test preop? Manual elevation test -elevate ptotic side to normal position, this removes the stimulus to the contralateral side and it will find its true position, once released stimulus goes back

Question 12

blepharochalasis

Answer 12

inflammatory condition that is a result of swelling and edema of upper lids

Question 13

normal anatomy

Answer 13

upper eyelid covers the upper limbus 2-3mm
upper eyelid crease 7-10mm
male 6-8
lower eyelid ideally covers the lower limbus 0.5mm
normal MRD2 - 5mm

Question 14

grades of ptosis

Answer 14

mild 2 - Fasanella Servat (can excise conjunctiva/mueller muscle with tarsal strip at the most superior edge of the tarsal plate)
moderate 1- levator advancement
severe <1 frontalis sling

Question 15

schemer test

Answer 15

use tetracaine drops
filter paper at the inferior forex, and the eyes are closed for 5min
15mm of absorption is normal

Question 16

history questions

Answer 16

ocular irritation, conjunctiva infection, epiphora (excessive tearing), trauma, surgery, evidence of paralysis

PE of examining upper eyelid for ptosis, MRD1, brow position, hiring law with manual elevation test, lower eyelid for snap back lateral tendon laxity via distraction test, medial cantonal tendon laxity by distractiion of the puncture abnormal is more than 1mm, presence of Bell phenomemon

can combine lateral canthal procedures with medial spindle procedure where you excise strip of conjunctiva and lower lid retractors and suture them. Can use double arm chronic sutures to bring the knot out through lower lid at cheek junction to invert the puncture further
This above is called medial spindle procedure