from OKAP review Flashcards by Lech Sedlak

most common epithelial tumor of the lacrimal gland, treatment

benign mixed tumor (pleomorphic adenoma), complete excision

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the most common ocular finding in Parkinson

decreased blink

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most common primary malignancy of lacrimal sac

squamous cell carcinoma

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organism responsible for necrotizing fascitis

group A streptococcus

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Marcus Gunn Jaw winking

the pterygoid muscle is synkinetic with the levator muscle

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meibomian glands - what type of secretion

HOLOCRINE

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orbital volume

30 cc

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orbital widest part

1 cm post to orbital rim

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orbital shortest wall

Floor

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orbital lymphoma - most common location

Lacrimal gland fossa

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orbital lymphoma - vast majority are of which type

Mon-Hodgkin B-cell, MALT

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orbital lymphoma - how to send biopsy

fresh tissue for fluorocytometry

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a lymphoprolfierative lesion arising in this peiocular site gives thre highest risk of developing a systemic NHL

eyelid

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locations of eyelid BCCs - list from most to least common location

lower lid, medial canthus, upper lid, lateral canthus

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drug for BCC, mechanism, side effect

VISMODEGIB, inhibitor of the sonic hedgehog pathway, skin changes, hair loss

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malignant melanoma of eyelid - most important prognostic factor for patient survival

tumor thickness

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oculodermal melanocytosis (nevus of Ota) - risk of oveal melanoma

1/400

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oculodermal melanocytosis (nevus of Ota) - risk of oveal melanoma - what % get glaucoma

10%

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risk of uveal melanoma among general population

6 in milion

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Epiblepharon

pretarsal muscle and skin ride above the eyelid margin to form a horizontal fold of tissue that causes the cilia to assume a vertical position. It can involve either the upper or lower eyelid, but is most commonly seen involving the lower eyelid. Can grow out of it

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Ankyloblepharon

partial or complete fusion of the eyelids by webs of skin

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Euryblepharon

bilateral horizontal enlargement of the palpebral fissure with vertically shortened eyelids, lateral canthus malpositioning and lateral ectropion

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blepharophimosis syndrome - components

blepharophimosis, ptosis, telecanthus, epicanthus inversus

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Telecanthus

increased distance between the medial canthi

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fold most prominent along upper eyelid

Epicanthus tarsalis

Defect 33% to 50%

Lateral canthotomy and semicircular flap

Defect greater than 50% - upper lid

Cutler-Beard

Defect greater than 50% - lower lid

Hughes flap

How many times TED more common in women

TED - most commonly seen ocular finding

Lid retraction

Eyelid ca simulation chalazion, why does it look like papillary conjunctivitis? management? tissue gandling/staining

SEBACEOUS CELL carcinoma, pagetoid spread (upward spreading). excision with sentinel node bx, fresh tissue, Oil red O stain

SEBACEOUS CELL carcinoma arises from which gland?

Meibomian and Zeis

kid, ptosis, superonasal lid fullness with bruise

rhabdomyosarcoma

rhabdomyosarcoma, derives from

undifferentiated pluripotent mesenchymal cells

Ankyloblepharon

partial or complete fusion of the eyelids by webs of skin

Defect 33% to 50%

Lateral canthotomy and semicircular flap

Defect greater than 50% - upper lid

Cutler-Beard

Defect greater than 50% - lower lid

Hughes flap

How many times TED more common in women

TED - most commonly seen ocular finding

Lid retraction

SEBACEOUS CELL carcinoma arises from which gland?

Meibomian and Zeis

kid, ptosis, superonasal lid fullness with bruise

rhabdomyosarcoma

rhabdomyosarcoma, derives from

undifferentiated pluripotent mesenchymal cells

rhabdomyosarcoma - management

chemo and radiation

rhabdomyosarcoma - average age

8 yo

neuroblastoma - average age

2 yo

rhabdomyosarcoma - stains for cells

Desmin

Orbital septum arises from

PERIOSTEUM

Orbital septum fuses where (caucasians) upper lid

To levator ~2-5 mm above tarsus

Orbital septum fuses where (caucasians) lower lid

At inferior border of tarsus

Muller's muscle - inserts where

Superior border of Tarsal plate

Levator - inserts where

inferior one half of the anterior tarsus

Which optic nerve segment is most susceptible to injury

Intracanalicular

Which bone makes up optic canal

LESSER wing of the Sphenoid

NLD trajectory

INFERIORLY, POSTERIORLY, LATERALLY

Doing retrobulbar block - which muscle is not affected

Superior oblique (outside muscle cone)

Structures going through superior orbital fissure (inside nad outside Zinn)

Inside Zinn: III, nasociliary n. (V1), VI. Outside: IV, Lacrimal n., Frontal n. (V1), Superior ophthalmic vein

Frontal nerve branches into

Supraorbital, Supratrochlear

Inferior orbital fissure contents

Inferior Orbit Gets Infra-Orbital Nerves and VeinZ: IO: inferior ophthalmic vein G: ganglionic branches from pterygopalatine ganglion to maxillary division of trigeminal nerve ION: infra-orbital nerve (branch CN V2) A: infra-orbital artery (branch maxillary artery) V: infra-orbital vein (drains inferior orbit, communicates with inferior ophthalmic vein, tributary to pterygoid venous plexus) Z: zygomatic nerve (branch CN V2)

Inferior orbital fissure bounds

greater wing of sphenoid, inferiorly by maxilla and orbital process of palatine bone and laterally by the zygomatic bone

Structures passing through optic canal

optic nerve, ophthalmic artery, sympathetics

this sinus is directly adjacent to the optic nerve

Sphenoid

Eyelid venous drainage - MEDIAL PRETARSAL

ANGULAR VEIN

Eyelid venous drainage - LATERAL PRETARSAL

SUPERFICIAL TEMPORAL VEIN

Eyelid venous drainage - POST-TARSAL

ORBITAL VEINS, DEEP BRANCH OF ANTERIOR FACIAL VEIN, PTERYGOID PLEXUS

Orbital septum fuses where (caucasians) upper lid

To levator ~2-5 mm above tarsus

Orbital septum fuses where (asians) upper lid

Between margin and upper border of tarsus (low crease)

Minimum amount of skin to leave with blepharoplasty

20 mm of skin between the inferior border of the brow and the upper eyelid margin

Fat pads of lower eyelid

Fat pads of upper eyelid

2: Central (preaponeurotic) and Medial

Fat pads and inferior oblique

between the Central and Medial

3 main causes of involutional entropion

Horizontal laxity, Disinsertion of lower eyelid retractors, overriding orbicularis

Fat pads of lower eyelid

Fat pads of upper eyelid

2: Central (preaponeurotic) and Medial

Fat pads and inferior oblique

between the Central and Medial

3 main causes of involutional entropion, how to corrent

Horizontal laxity, Disinsertion of lower eyelid retractors, overriding orbicularis. Lateral tarsal strip with retractors advancement

The __ canthus is positioned about _ mm higher than the __ medial canthus

lateral 2 mm medail

Peripheral arterial arcade - location

between Muller's muscle and levator, and situated just superior to superior tarsal plate

Thinnest portion of maxillary bone in orbital floor

POSTEROMEDIAL

What should you not use intraop?

MONOPOLAR CAUTERY

What is the mechanism of action of lidocaine

Blocks sodium channels

What is the mechanism of action of botulinum toxin

inhibits release of Acetylocholin at the neuromuscular junction

DCR - which 2 bones are you going through

Lacrimal, Maxillary

DCR - where should you be entering nasal cavity

Middle meatus

DCR - 4 weeks post-op

Atypical mycobacteria

Orbital metastases - most common in MEN and WOMEN

Lung, breast

most common cause of proptosis in kids

orbital cellulitis

Lower eyelid structure analogous to leator in upper lid. arises from? inserts where?

Capsulopalpebral fascia, arises from Inferior rectus, inserts to lower tarsal border (LL retracction after IR recession)

Accessory lacrimal glands - Location

Wolfring - Non-marginal tarsal borders. Krause - Fornices (deeper)

Accessory lacrimal glands - type of secretion

EXOCRINE

Epicanthal Folds - involves both upper and lower eyelids

Epicanthus palpebralis

Epicanthal Folds - fold originates from the brow and follows down to the lacrimal sac

Epicanthus superciliaris