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Oculoplastics > Keys > Flashcards

Keys Flashcards

1
Q

Is basal cell carcinoma inherited?

A

(1) Gorlin-Goltz’s syndrome – AD - BCC, jaw cysts, minor skeletal changes (fifth phakomatosis)
(2) Bazex’s syndrome – XL - BCC, congenital hypotrichosis, follicular atrophoderma
(3) Xeroderma pigmentosa – AR - abnormal UV repair

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2
Q

List the causes of lid retraction in TED.

A

(1) Humorally-induced overaction of Müller muscle (2) Fibrotic contracture of LPS
(3) Secondary overaction of LPS-SR complex to counter fibrotic IR
(4) Proptosis

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3
Q

What are the systemic associations of limbal dermoids?

A

(1) Goldenhar Syndrome

(2) Linear Sebaceous Naevus Syndrome (3) Treacher-Collins Syndrome

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4
Q

List conditions where proptosis is exacerbated by valsalva.

A

Orbital varices; cap haemangioma;

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5
Q

List conditions associated with bilateral exophthalmos.

A

TED; CCF; Cavernous sinus thrombosis; Wegener’s; Lymphoma; Sarcoid; Craniosynostosis; IOIS;

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6
Q

List conditions causing enophthalmos.

A

Sclerosing tumours (metastatic breast ca), orbital varix, orbital wall fractures

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7
Q

How do you differentiate clinically and radiologically between the two main lacrimal gland tumours?

A

Pleomorphic Adenoma – Benign; painless, single/solid bosselated surface; (incomplete excision bad); bone remodelling
Adenoid Cystic Ca. – no intact capsule; “swiss cheese”; faster onset; painful; Ca++; bone erosion; amorphous post extension

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8
Q

How are nasolacrimal duct obstructions diagnosed in children?

A

NB. Must exclude congenital glaucoma

Epiphora; increased tear lake; mucopurulent discharge in absence of URTI; dye disappearance test

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9
Q

List clinical or radiological features of silent sinus syndrome.

A

CLINICAL: Spontaneous enophthalmos & hypoglobus. Eyelid retraction/lid lag/lagophthalmos, Deepening superior orbital sulcus, Normal vision is unaffected.
RADIOLOGICAL: partial or complete maxillary opacification, reduction of maxillary sinus volume & orbital volume enlargement. Inferior bowing of maxillary roof

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10
Q

How do you classify ptosis?

A

NB. Must examine pupils + EOM

  1. Neurogenic (3rd; Horners; MGJWS, blepharophimosis ptosis epicanthus inversus synd FOXL2)
  2. Myogenic (MDdystro; Simple Congenital, CPEO; Neuromuscular: MG, botox)
  3. Aponeurotic (involutional; post surg)
  4. Mechanical (tumours; dermatochalasis; oedema; orbital lesions; scarring)
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11
Q

Compare congenital myogenic to acquired aponeurotic ptosis.

A

(1) ULC: Weak/absent crease in normal position (congenital) vs. Higher than normal (acquired)
(2) Levator Function: Reduced (congenital) vs. Normal (acquired)
(3) Down gaze: Eyelid lag (congenital) vs. Eyelid drop (acquired)

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12
Q

What are the causes for pseudo-ptosis?

A

Hypoglobus/tropia, dermatochalasis, Enophthalmosis (phthisis/wall #); Contralat. proptosis; Contralat. UL retraction (TED)

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13
Q

How do you classify acquired ectropion?

A
  1. Paralytic - 2° CN VII palsy causing orbicularis weakness
  2. Mechanical - 2° visible/palpable mass i.e. tumour/cyst/oedema
  3. Cicatricial – scarring vertically shortens the anterior lamella
  4. Involutional - age-related lid laxity
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14
Q

What systemic diseases can capillary haemangiomas cause?

A

Kasahach-Merrit Syndrome (platelet consuption); High output CCF; Laryngeal obstruction

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15
Q

List three organisms that can cause preseptal cellulitis.

A
  • Staphylococcus aureus
  • Streptococcus spp (Strep. pyogenes, Strep pneumoniae)
  • Haemophilus influenzae type b
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16
Q

What are the treatment options for lid capillary haemangiomas?

A
  1. Systemic steroids; 2. propanolol 2mg/kg; 3. interferon-alpha; 4. vincristine; 5. injected steroids;
17
Q

How do you manage preseptal cellulitis?

A

MILD:
• Amoxycillin/Clavulante 875/125mg o BD
SEVERE:
• Flucloxacillin 50mg/kg to 2g iv QID (Gm+ve) & cefotaxime 50mg/kg to 2g iv QID (Gm-ve)

18
Q

How do you manage dacrocystitis?

A

(1) Establish diagnosis
(2) Mild: Amoxycillin/Clavulante 875/125mg o BD
(3) Severe : Flucloxacillin 2g iv QID & ceftriaxone 2g iv D +/- incision if pouting (risk of fistula)

19
Q

What are some ddx of dacryocystitis?

A

Dacryocoele, encephalocoele if above medial canthus, dermoid, TCC, nasopharyngeal SCC for adults

20
Q

Outline your management of Thyroid Eye Disease.

A

ALL
1. Smoking cessation
2. Education regarding symptoms of exposure & ON compromise
3. Endocrine review
4. Rx Glc
5. Rx Exposure keratopathy
6. Cold compress for eyelid oedema,
ACUTE
1. Prednisolone o 40-100mg tapered over 6/52
2. Orbital irradiation does not improve proptosis – OK for active vertical diplopia
3. Orbital decompression if ON compression; severe exposure; globe luxation; uncontrolled IOP; cosmesis
CHRONIC
1. Stepwise Surgical Rx – Orbital Decompression → strabismus surgery → eyelid surgery (if stable TED/TFTs)
2. Decompression – not within 3cm of ant lacrimal crest + 1cm of optic canal; release periorbita (med;lat;floor)
3. Strabismus – prisms; recess fibrotic muscle; NEVER resect; adjustable (Kraus TransASOpht 1993)
4. Lids
• UL retraction: If severe - LPS recession; if mild-Mullerectomy
• LL retractor: recess ± spacer (ear/hardpalate cartilage)

21
Q

How do you surgically manage paralytic ectropion?

A

Acute:
• Medial canthus – Lee Medial Canthotoplasty
• LTS or lateral tarsorrhaphy
• (remember gold weight & botox for UL)
Chronic:
• FTSG due to frequent cicatricial component

22
Q

How do you surgically manage cicatricial entropion?

A

Lower lid - Mild – Retractor surgery
- Severe – Tarsal facture; Mucosal graft (to lengthen post lamellar); Excise lashes
Upper lid - Mild – Anterior lamellar repositioning
- Severe – Terminal tarsal rotation

23
Q

Outline the risk factors for and management of involutional entropion?

A 
1.	Horizontal laxity 		
•	LTS / Wedge excision (AND below)
2.	Lower lid retractor dehiscence (tarsal plate destabilisation)
•	Jones inferior retractor repair or
•	Everting/Quickert suture
3.	AP lamellar override (orbicularis preseptal overrides pretarsal) 
4.	Relative enophthalmos
•	Weiss full thickness lid split
•	Temporary tape
24
Q

What do you tell patients considering LPS resection for ptosis surgery?

A

Good Outcome: a) symmetry in 1o gaze b) will have ptosis when looking up c) will have lag when looking down
Complications: a) under>over correction b) contour irregular c) entropion d) lash ptosis e) lagophthalmos f) conjunctival prolapse

25
Q

How do you treat canaliculitis?

A

(1) canaliculotomy; canalicular marsupalisation + irrigation (moxifloxacin/penicillin G/iodine 1%)
(2) postop - warm compress; moxifloxacin QID; doxycycline 100mg BD

Oculoplastics (1 decks)

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