L6 Lids, Orbits and Ocular Trauma Flashcards
Causes of Ptosis?
Ptosis (Drooping of the Upper Eyelid) can be caused by:
1. Neurogenic
- CN III palsy
- Horner’s syndrome
2. Myogenic
- Myasthenia gravis
- Myotonic dystrophy
- Myopathy of levator
3. Aponeurotic: Defect in levator aponeurosis (eg. senile ptosis, or post-surgery/trauma)
4. Mechanical: Gravitational effect of an eyelid mass:
- Chalazion (eyelid cyst formed by blocked oil gland)
- Tumour
5. Congenital: Levator dysgenesis
Triad of Horner’s Syndrome?
Diagnosis?
Triad of Horner’s Syndrome (Lesion of the Sympathetic Pathway):
- Ptosis: drooping eyelids
- Miosis: Small constricted pupils
- Anhidrosis: Loss of sweating on the face
Diagnosis:
- IMAGING – isolate site of lesion (urgent vs non-urgent)
- Topical Apraclonidine – dilates horner miotic pupil
Causes/Signs/Symptoms of CN III (Oculomotor) Nerve Palsy?
Causes:
- Vascular
- Trauma
- Compression (aneurysm)
- Infiltrative (Ca)
Signs:
- Ptosis
- Down and Out Gaze
- Mydriasis: Mid-Dialated Pupil
Symptoms:
- Ptosis
- Diplopia
What does CNIII (Occulomotor Nerve) Innevate?
Innervates: x6 EOM:
- Medial, Inferior, Superior recti
- Inferior Oblique
- Levator Palpebral Superioris
Innervates: Iris Sphincter & Ciliary Muscle
Weakening of____________________ muscle due to a systemic disorder that causes muscle weakness => Fatigable Ptosis?
Myasthenia Gravis: weakening of Levator Palpebral Superiois (LPS) => Fatigable Ptosis
Cause/Signs/Diagnosis/Treatment of Myasthenia Gravis?
Cause: Weakening of Levator Palpebral Superiois (LPS) muscle due to a systemic disorder that causes muscle weakness (Problem at Neuromuscular Junction)= > Fatigable Ptosis
Diagnosis:
- Serology: Ach Receptor Ab, anti-MuSK Ab, TFT
- Ice Pack Test: Ice pack is then applied for 2–5 min and the eyelid is re-measured. positive if improvement of 2 mm or more
- Edrophonium test: positive for myasthenia gravis if their muscles get stronger after being injected with Tensilon
- EMG
Treatment:
- Acetylcholinesterase inhibitor
- Steroids
- Inspiratory Muscle Training
Most common form of acquired ptosis?
Aponeurotic (Senile) Ptosis
Cause/Signs/Diagnosis/Treatment of Aponeurotic (Senile) Ptosis
Most common form of acquired ptosis:
- Due to disinsertion of Levator aponeurosis
- Usually bilateral
Clinically Diagnosed:
- high lid crease
- frontalis overaction
- facial soft-tissue laxity
- Good levator function
Treatment: Eye Lid Surgery
Causes of Mechanical Ptosis?
Casues/Diagnosis/Considerations of Congenital Ptosis?
What is Marcus Gunn Jaw and which condition is it associated with?
Marcus Gunn Jaw Winking Syndrome – Congenital Ptosis (Levator Palpebrae Mal-Development) improves with jaw opening
____________: Outward Malposition of the Lower Eyelid.
Types/Causes/Treatments?
Ectropion: Outward Malposition of the Lower Eyelid
- Involutional:
- Due to lid laxity
- Correct by lid tightening procedure (eg lateral tarsal strip, wedge resection)
- Cicatricial:
- Due to scarring / skin contracture
- Correct with skin flaps / grafts
- Paralytic: Due to facial nerve (CN7) palsy eg Bell’s Palsy
______________ : Inward turning of eyelid margin toward cornea and ocular surface
Types/Causes?
Entropion: Inward turning of eyelid margin toward cornea and ocular surface
Periorbital Cellulitis vs Orbital Cellulitis?
- Location of Infection?
- Risk of Progression to?
Name of this Condition?
Clinical Presentation?
Management?
Orbital (Postseptal) Cellulitis
Etiology: Usually Sinusitis
Clinical features: SYSTEMICALLY UNWELL child, fever, signs of optic nerve dysfunction
Management: urgent CT or MRI orbits and IV antibiotics
