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Ocular Disease 3 - Final > Facial Asymmetries > Flashcards

Facial Asymmetries Flashcards

1
Q

what is included in the upper division of the face?

A

forehead, eyebrows, orbicularis oculi

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2
Q

what is included in the lower division of the face?

A

orbicularis oculi, orbicularis oris and cheeks

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3
Q

where is the boundary between the upper and lower divisions of the face?

A

it varies among people

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4
Q

how do you check the upper division of the face for symmetry?

A

have patient raise eyebrows and/or close eyes tightly = check for asymmetry in appearance and strength by pushing down or prying eyes open

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5
Q

how do you check the lower division of the face for symmetry?

A

blow out/puff out cheeks, smile, frown, and look at naso-labial folds

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6
Q

what are some facial asymmetries observed in the adnexa?

A

one eye is higher than other, lumps/bumps, exophthalmos, enophthalmos, apparent eye size difference

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7
Q

what are some facial symmetries observed in with the palpebral aperture?

A

ptosis, pseudoptosis, lid retraction, exophthalmos and enophthalmos

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8
Q

what do you do to determine if the ptosis is neuro vs. non-neuro?

A

check the pupils

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9
Q

what are the 3 steps taken if a patient has a facial asymmetry?

A
  1. measure palpebral apertures with PD ruler
  2. measure extension of the globe with exophthalmometry
  3. have patient return with old photos (family album imaging or FAI)
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10
Q

what is the normal palpebral aperture size?

A

10-12mm

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11
Q

where is the normal location of the upper lid?

A

2mm below the superior limbus

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12
Q

where is the normal location of the lower lid?

A

1mm above the inferior limbus

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13
Q

how much difference is normal between OD and OS in exophthalmometry?

A

+/- 1 mm (more than 2mm is abnormal)

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14
Q

what is the normal exophthalmometry measurement in European americans?

A

15-20 mm

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15
Q

what is the normal exophthalmometry measurement in African Americans?

A

up to 24 mm

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16
Q

what is the normal exophthalmometry measurement in Asians?

A

about 3mm less than Caucasians

17
Q

what is levator dehiscence?

A

weakening of the connection between the levator and the tarsal plate in the upper lid (seen often in elderly) = unequal palpebral apertures not associated with exophthalmos

18
Q

what are the 4 causes of lid retraction?

A

dorsal midbrain syndrome, thyroid related orbitopathy, aberrant regeneration syndrome and pseudo-lid retraction

19
Q

what is dorsal midbrain syndrome?

A

urgent referral = lid retraction, palsy of up gaze, retraction nystagmus on attempted up gaze (all EOMs contract at once), and tectal pupils

20
Q

what are tectal pupils?

A

both pupils are sluggish, mydriatic and have a near response > light response

21
Q

what can cause enophthalmos with equal or unequal palpebral apertures?

A

blow out fracture - orbital contents go into a sinus and the IR gets trapped

22
Q

what percentage of unequal palpebral apertures are associated with thyroid disease?

A

about 90%

23
Q

what are the conditions that have unequal palpebral apertures that are not thyroid related?

A

orbital mass, venous statsis, EOM paralysis, orbital cellulitis, orbital pseudotumor, orbital surgery/trauma, and other

24
Q

what are the TRO symptoms?

A

binocular diplopia, ocular irritation, and “my eyes look funny”

25
Q

what are the TRO signs?

A

exophthalmos, stare/lid retraction, inferior punctate staining, abnormal eye movements, sector injection (MR is inflamed), elevated IOP/optic neuropathy, and lid edema

26
Q

what are the TRO lab tests?

A

TSH, elevated T4 (not T3), thyroid stimulating antibody and orbital CT scans

27
Q

what are the TRO specific procedures?

A

educate the patient, exophthalmometry, measure palpebral apertures, check for corneal staining and TBUT, muscle field, IOP and communicate with an endocrinologist

28
Q

what are some TRO interventions during the progression of the condition?

A

tarsorrhaphy, orbital decompression, systemic steroids, monocular occlusion

29
Q

what are some TRO interventions when the progression has stopped?

A

lid reconstruction for cosmesis and alleviate the diplopia

30
Q

what is recommended for TRO management?

A

co-manage with endocrinologist, protect cornea (lubricants, tape lids at night), protect optic nerve and help patient cope with diplopia and cosmesis

31
Q

can you prescribe prisms for patients with TRO?

A

yes - if they have acquired strabismus, comitant deviations or incomitant deviations (need multiple pairs of glasses)

Ocular Disease 3 - Final (6 decks)

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