Kanski signs - eyelids

Question 1

Madarosis (loss of lashes)

Answer 1

local (anterior lid margin dz, lid tumors, burns)
following removal
generalized skin disease (alopecia, psoriasis, atopic dermatitis, ichthyosis)
systemic dz (myxedema, SLE, syphilis, leprosy)

Question 2

Poliosis

Answer 2

Idiopathic -

Local conditions -

• chronic anterior blepharitis
• sympathetic ophthalmitis
• lid margin tumors
• herpes zoster ophthalmicus
• alopecia

Systemic conditions -

• VKH
• Waardenburg syndrome
• Marfan
• tuberous sclerosis

Question 3

ocular associations of atopic dermatitis

Answer 3

chronic staphylococcal blepharitis
angular blepharitis
vernal conjunctivitis in children
atopyic keratoconjunctivitis in adults
keratoconus
anterior shield-like cataract
RD (?)

Question 4

blepharochalasis

Answer 4

uncommon, usually bilateral condition which typically affects young individuals characterized by recurrent attacks of non-pitting edema of the upper and the lower eyelid

Question 5

myexdema

Answer 5

swelling typically involves the lower lids

Look for hyercholesterolemia - xanthelasma, arcus senilis

Question 6

adult onset periocular xanthogranuloma

Answer 6

rare histocytic granulomatous disease assoc/w/asthma
signs: bilateral diffuse eyelid infiltration
look for: subconjunctival infiltrates

Question 7

Sturge-Weber syndrome

Answer 7

port-wine stain (nevus flammeus along trigeminal) and ipsi/L leptomeningeal hemangioma
Also: conj telangiectasias, glaucoma, iris hyperchromia, diffuse choroidal hemangioma

Question 8

Lentigo maligna (Hutchinson freckle)

Answer 8

pre-invasive stage of melanoma that typically affects elderly patients

Signs: slowly expanding pigmented macule
Nodular thickening = indicative of transformation into frank melanoma

Question 9

Marcus-Gunn jaw-winking syndrome

Answer 9

condition 2/2 synkineses between levator and pterygoid muscles

transient lid retraction 2/2 stimulation of the pterygoid muscles by opening the mouth
less common stimuli = jaw protrusion, smiling, swallowing/clenching of teeth

Question 10

Parinaud syndrome causes

Answer 10

kids = pinealoma, aqueduct stenosis, meninigitis
young adults = demyelination, trauma, AV aneurysm
elderly = midbrain vascular accidents, mass lesions involving periaqueductal grey matter, posterior fossa aneurysm

Question 11

Horner syndrome - first order

Answer 11

central lesions = brainstem tumor, syringomyelia, lateral medullary (Wallenburg) syndrome, upper spinal cord tumor

Question 12

Horner syndrome - 2nd order

Answer 12

preganglion lesions =
neural crest tumor
neck lesions
intrathoracic lesions (pancoast tumor, enlarged glands, aneurysm)

Question 13

Horner syndrome - 3rd order

Answer 13

post-ganglion lesions - 
cluster headache
nasopharyngeal
otitis media
cavernous sinus mass
internal carotid dz