kk Flashcards
What is the definition of ptosis?
Drooping of the upper eyelid to cover more than 2mm (1/6) of the cornea while the patient is looking forward.
What are the different causes of acquired ptosis?
Aponeurotic (most common acquired cause)
Neurogenic (Horner’s syndrome and 3rd nerve palsy)
Myogenic (myasthenia gravis)
Mechanical (large chalazion)
How is the degree of ptosis assessed?
Judged by the lid margin-corneal distance (MRD), which decreases in ptosis. Normal MRD is 4-5mm.
What are the different types of ptosis and their respective causes?
-Congenital (simple): Due to dystrophy of the levator muscle, poor levator contraction, and poor relaxation. Associated with anomalies such as weak superior rectus muscle and Marcus Gunn phenomenon.
-Neurogenic: Associated with 3rd nerve palsy and Horner’s syndrome.
-Myogenic: Associated with myasthenia gravis.
-Trauma can cause aponeurotic, myogenic, or neurogenic ptosis.
What are the suitable surgical procedures for ptosis with good and poor levator action?
- Good levator action: Resection
- Poor levator action: Frontalis sling
What are the complications of unilateral severe ptosis?
Amblyopia and squint
Why can mild bilateral ptosis be managed conservatively until the age of school?
Full development of muscles can lead to spontaneous improvement.
How can trauma cause ptosis?
Trauma can cause aponeurotic, myogenic, or neurogenic ptosis.
What type of ptosis can be mistaken with myogenic (myasthenia gravis) ptosis?
Involutional (senile) ptosis, which worsens at the end of the day due to fatigue of Muller’s muscle.
What is the most important extraocular muscle to be examined during EOMs examination and why?
Superior rectus, because it shares a common embryological origin with the levator, they both share the same common sheath, and have the same nerve supply.
What is squamous blepharitis?
Chronic inflammation of the lid margin characterized by scales
What is ulcerative blepharitis?
Chronic inflammation of the lid margin characterized by ulcers.
Etiology
The cause or set of causes of a disease or condition.
Organism
The specific microorganism responsible for causing a disease.
Predisposing factors
Factors that make an individual more susceptible to a disease or condition.
Symptoms
Subjective evidence of a disease or condition as perceived by the patient
Signs
Objective evidence of a disease or condition as observed by a healthcare professional.
Complications
Additional medical conditions or adverse effects that arise from a primary disease or condition.
Why should we rub antibiotic ointment well into the lid margin?
Because the organism is hidden in the lash root.
Entropion
Rolling in of the lid margin
Ectropion
Rolling out of the lid margin
Which lid is more affected by all types of entropion & ectropion?
Lower eye lid
Congenital, Cicatricial (conjunctival fibrosis)
Causes of entropion
Causes of ectropion
Congenital
Cicatricial (fibrosis of skin)
Types of Cicatricial causes for entropion
Trachoma (most common)
Post-operative
Chemical injuries
Ocular cicatricial pemphigoid
Types of cicatricial causes for ectropion
Burns, Post-operative (blepharoplasty)
Causes of Involutional (senile) entropion
Horizontal laxity of lid tissue, vertical laxity
Causes of Involutional (senile) ectropion
Horizontal laxity of lid tissue
Causes of Mechanical ectropion
Large chalazion
Causes of 7th nerve palsy leading to ectropion
Paralysis of orbicularis oculi
Symptoms of entropion and ectropion
Foreign body sensation
Lacrimation
Photophobia
Blepharospasm
Disfigurement
Complications of entropion and ectropion in conjunctiva
Ulceration
Keratinization
Chronic conjunctivitis
Complications of entropion and ectropion in cornea
Corneal ulceration (most dangerous)
Vascularization and opacification
Conjunctival exposure
Corneal exposure»_space; ulceration in lower 1/3
Treatment for Cicatricial entropion
Replacing the shortened conjunctiva by a mucus membrane graft
Treatment for Cicatricial ectropion
Replacing the shortened skin by skin graft from behind the ear
What is a Hordeolum extremum?
A style
What is a Hordeolum Internum?
An infected chalazion
Hordeolum extremum def
Acute suppurative infection of zies gland
Hordeolum Internum def
Acute suppurative infection of meibomian gland
Complications of chalazion
Infection (hordeolum Internum)
ptosis (if large chalazion on upper lid)
ectropion (if large chalazion on lower lid)
astigmatism (if pressing on globe),
malignant transformation
Hordeolum
Acute suppurative infection of hair follicle or zies gland (extremum or style)
Chalazion
Chronic lipo-granulomatous infection of meibomian gland
Symptoms of Chalazion
Painful, red swelling at lid (for chalazion)
painless lid swelling (painful if infected),
cosmetic disfigurement
Treatment of Chalazion
Rarely surgical drainage is needed, oral and systemic antibiotics + hot foments, control of diabetes, rarely spontaneous resolution, incision and cottage from conjunctival side (vertical)
What are the predisposing factors for Hordeolum?
Malnutrition & hypo-vitaminosis
old age
diabetes mellitus
What are the local predisposing factors for Hordeolum?
Eye strain due to uncorrected errors of refraction, lack of sleep
What are the general treatment options for Hordeolum?
Systemic antibiotic
topical antibiotics
horizontal incision
What is the related organism to lash root?
Staph aureus
What are the signs of Chalazion?
Localized lid swelling, not tender, not attached to skin (firm, well defined)
What is the extra information about Chalazion?
Chalazion is better palpated than seen, less attached to skin, firm and well defined
What are the complications of Hordeolum?
Madarosis (loss of eyebrows or eyelashes)
cavernous sinus thrombosis
orbital cellulitis
