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Disease 1 > Lecture 5/6- Eyelids Part 1: A and B > Flashcards

Lecture 5/6- Eyelids Part 1: A and B Flashcards

1
Q

which muscle is the main eyelid protractor, with the primary function of narrowing the palpebral fissure and closing the eye lids. ‘it contracts medially to pump tears toward the ducts. Innervated by CN VII, orbital portion is largest part - wink, preseptal portion is for winking and blinking

A

Orbicularis Oculi

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2
Q

What part of the orbicularis oculi is resposible for horizontal movement of eyelid in order to spread tear film and pump tears toward the duct?

A

Pretarsal portion

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3
Q

size range of the palpebral fissure

A

12-30 mm

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4
Q

name for the crease of the upper lid that represents the cutaneous insertion of fibers of the levator anoneurosis into the preseptal orbicularis oculi, 8-10 mm above lashes

A

Superior palpebral crease

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5
Q

What does it mean if there is no superior palpebral crease, here the fibers of the levator palpebrae aponeurosis insert into the preseptal orbicularis oculi

A

No crease = no LP superioris function - as in blepharoptosis

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6
Q

name for the crease below the lower lid, 4-5 mm below lower lashes

A

inferior palpebral crease

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7
Q

Thin, fibrous, multilayer sheath that separates the eyelids from the orbit - functions as an anatomical barrier to protect orbit from infection, heme, edema

A

orbital septum

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8
Q

What is unique to asian populations in terms of crease position and orbital septum anatomy of upper lid

A

Creases in lower position than caucasians
Upper lid orbital septum can be fused to the anoneurosis as it inserts into the tarsus - as high as the superior border of the tarsus, or as low as the lashes line = lower or absent UL crease

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9
Q

Term for upper eyelid sin laxity that increases with age, causing a hooding effect - not the same as ptosis, can be severe, causing mechanical ptosis with or without superior visual field defect or entropion

A

Dermatochalasis - can interfere with visual fields if hood droops over the pupil, and entropion i the hood causes the lashes to turn inward against the globe

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10
Q

prominent lower lids from orbital fat, malar bags, hypertrophy, or overriding orbicularis oculi, only can be treated by blepharoplasty

A

“Bags” under the eye

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11
Q

What could be a secondary condition developed after an elderly person has surgery to remove the excess skin present in dermatochalasis?

A

eye lid could not be able to close - lagophthalmos

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12
Q

Retractors of the upper eyelid

A

Levator palpebrae superior and superior tarsal muscle of Muller

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13
Q

Lower eye lid retractors

A

capsulopalpebral fascia and inferior tarsal

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14
Q

disease with weakness of tarsus elastin fibers

A

Floppy Eyelid syndrome

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15
Q

Arteries supplying upper eyelid that branch from the ophthalmic artery, which branches from ICA

A

Lacrimal, Supraorbital, Supratrochlear, Dorsal nasal

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16
Q

What artery supplies the superficial arterial system (facial and angular arteries) that supplies the lower lid

A

External Carotid artery

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17
Q

Artery supplying lacrimal gland, conjunctiva, lateral upper eyelid, terminates as lateral palpebral artery

A

Lacrimal artery

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18
Q

Artery supplying upper eyelid, scalp, forehead, levator muscle, periorbita, diploe of frontal lobe

A

Supraorbital artery

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19
Q

Artery supplying skin of superior medial aspect of the orbit, forehead, and scalp

A

Supratrochlear artery

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20
Q

Artery supplying nose bridge skin, lacrimal sac, terminates as medial palpebral artery

A

Dorsal nasal artery

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21
Q

Eye lid venous drainage review

A

drains through tributaries of ophth vein, and superficially through superficial temporal and angular (superficial frontal and supraorbital and supratrochlear)

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22
Q

Vein with dual drainage - deep by superior opth, and superficial by anterior facial vein

A

Angular vein

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23
Q

Vein that empties into common facial vein, that empties into external jugular

A

Angular vein

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24
Q

Which lymphatic system drains the skin and orbicularis oculi

A

superficial system

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25
Q

which lynphatic system drains that tarsi and conjunctiva, upper lid, later half of LL and lateral canthus

A

Deep system - into the preauricular and deep parotid nodes

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26
Q

Nerves of the eyelids

A

3, 5, 7

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27
Q

Viral infections causing skin lesions along a V1 dermatome, and a lesion on the tip of the nose - Hutchison’s sighn - with associated kerato uveitis. Typically, involvement of nasociliary nerve is seen.

A

Herpes Zoster Ophthalmicos

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28
Q

glands at the coruncula and within eyebrow hars, associated with periocular skin vellus - thin hairs

A

Sebaceous - holocrine glands

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29
Q

modified sebaceous glands at tarsal plate, each has a central duct with multiple acini to synthesize lipids for outer layer of tear film

A

Meibomian glands

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30
Q

modified apocrine sweat glands - open into a lash follicle, are more in lower lid

A

Moll Glands

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31
Q

Modified sebaceous glands associated with Lash follicles

A

Zeiss glands

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32
Q

glands at eyelid skin, not confined to lid margin, unlike apocrine glands

A

Eccrine sweat glands

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33
Q

units that comprise hair follicles together with their sebaceous glands

A

Pilosebaceous units

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34
Q

Thickening of the keratin layer appearing as white flaky skin, can be a feature of benign and malignant epithelial tumors

A

Hyperkeratosis

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35
Q

thickening of the squamous cell layer

A

acanthosis

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36
Q

Alteration of the size, morphology, and organization of cellular components of a tissue. increased cell growth and change in histological features

A

Dysplasia

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37
Q

Keratinization other than on the surface

A

Dyskeratosis

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38
Q

Retention of nuclei into the keratin layer

A

Parakeratosis

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39
Q

dysplastic changes throughout the thickness of the epidermis and marked hyperkeratosis

A

Carcinoma in Situ

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40
Q

Epicanthal folds that are symmetrically distributed between upper and lower lids, most common type in caucasions

A

Palebralis

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41
Q

epicanthal folds that originate in the medial aspect of the upper lids and extends medially, most common in orientals

A

Tarsalis

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42
Q

epicanthal folds that start in lower lids and extends upwards to the medial canthal areas, associated with blepharophimosis

A

Inversus

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43
Q

Epicanthal fold that arise above the brow and extends downwards to the lateral aspect of the nose

A

Superciliaris

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44
Q

Wide distance between the medial canthi due to long medial canthus tendons - not hypertelorism which is wide separation of orbits

A

Telecanthus- associated with Waadenburg, Mobious, Treacher-Collens, Rubinstein - Taybi, Turner Syndromes

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45
Q

A patient comes in with epicanthal folds starting at the lower lids and extending to medial canthus, and long medial canthus tendons, short palpebral aperture, barely any nasal bridge, poor levator function, and lateral extropion of LL. Patient also has Amblyopia. Diagnose, Treat, How does it occur?

A
  1. Blepharophimosis Syndrome
  2. Surgery for epicanthus inversus and telecanthus, then bilateral frontalis suspensions
  3. Rare Autosomal Dominant, caused by mutations in FOXL2 gene on chromosome 3
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46
Q

Extra horizontal fold of skin that stretches across the anterior lid margin, vertically directed lashes. not a congenital entropion, and common in orientals. Diagnose and Treat

A

Epiblepharon

No treatment, spontaneous resolution with age

47
Q

A patient with microphthalmos is having an eyelid turn inward and the lashes are touching the cornea. What does he have?

A

Upper lid entropion - secondary to echanical effects of micro, causing upper lid inversion

48
Q

A patient with improper development of the inferior retractor aponeurosis is having an eyelid turn inward and the lashes are touching the cornea. What does he have?

A

Lower Lid Entropion

49
Q

How do you treat congenital (or any other ) entropions

A

Surgery

50
Q

Symmetrical enlargement of the palpebral fissure with malposition of lateral canthus and ectropion. If severe, lagophthalmos and exposure keratopathy are present. Associated to lateral displacement of lacrimal drainage system, double row of meibomian orifices, telechanthus, strabismus. Diagnose and Treat

A

Euryblepharon

Tarsorrhaphy - lateral canthal tightening

51
Q

SMall eyelids, vertical shortening of eyelids, opften associated with anophthalmos

A

Microblepharon

52
Q

Deficiency of the anterior lamellae of eye lids, systemic anomalie syndrome characteried by fish like mouth, ear and genital anomalies, and redundant skin. Diagnose and treat

A

Ablepharon - Ablepharon-macrostomia syndrome

Reconstructive skin grafting

53
Q

Uncommon, unilateral/bilateral, partial/full thickness eyelid defect on upper or lower lid. occurs when eyelid development is incomplete due to failure of lid ectoderm to fuse with lid folds, or to mechanical forces like amniotic bands

A

Eyelid Coloboma

54
Q

Upper lid colobomas at middle and inner thirds are associated with what syndrome causing unlateral face deformities of ear, chin, corner of mouth, and benign dermoid cysts, and possible a missing eye

A

Goldenhar Syndrome

55
Q

lower lid colobomas at middle and outer thirds are associated with what syndrome causing underdeveloped cheek bones, small jaw/ chin, cleft palate, hearing loss, eyes slant downwards

A

Treacher Collins - lower lid colobomas can also be associated with amniotic band syndrome

56
Q

Rare congenital anomaly where skin is continuous over eyeball with absence of eyelids - lids are completely replaced by a layer of skin that is fused with a microphthalmos

A

Cryptophthalmos - complete when lids completely replaced by layer of skin

57
Q

What syndrome is associated with incomplete cryptophthalmos with microphthalmos, rudimentary lids, syndactyly, urogenital anomalies, malformed upper airway, craniofacial structures, mental handicap

A

Fraser syndrome - AD, caused by mutations in FRAS-1 and FRAS-2 genes on chromosome 13

58
Q

Rare condition more frequently seen in black infants with down syndrome and collodion skin disease, bilateral and symmetrical, may resolve spontaneously with conservative tx or require surgery

A

Congenital upper lid eversion

59
Q

common acquired condition, posterior midirection of lashes from normal origin sites, cause trauma to cornealcan be due to scarring of lid margin from chronic blepharitis, herpes zoster, or others.

A

Trichiasis

60
Q

Ways to treat Trichiasis - remove, shock, freeze, laser, surgery

A
  1. Epilation every 4 to 6 weeks
  2. electrolysis with needle electrocutes root
  3. cryotherapy but lots of complications, removes many at once
  4. Argon laser ablation - cures after 1 or 2 sessions
  5. surgery with full-thickness wedge resection or anterior lamellar excision
61
Q

Partial or complete second row of lashes emerging at or behind meibomian gland orifices, aberrant lashes tend to be thinner and shorter and directed posteriorly

A

Distichiasis

62
Q

Downward sagging of upper eyelid lashes, idiopathic or associated with floppy eyelid syndrome, dermatochalasis with anterior lamellar slip or long- standing facial palsy

A

Eyelash Ptosis

63
Q

Curling and increased growth with lengthening and rigidity of eyelashes, can be caused by prostaglandis, ciclosporins, phenytoin, AIDS, hypothyroid, malnutrition, lots of syndromes

A

Trichomegalia

64
Q

loss of eyelashes, local : blepharitis, Skin disorder: alopecia or psoriasis, systemic disease: lupus, syphilis, leprosy, After removal: trichiasis treatment, trichotilomania - pt pulls them out

A

Madarosis

65
Q

Premature localized whitening of hair, which may involve lashes and eyebrows, caused by blepharitis, vitiligo, marfan, waardenburg, tuberous sclerosis etc

A

Poliosis

66
Q

congenital or acquired low position of the upper eyelid, associated with HA, neck pain, motility changes, diplopia, anisocoria, benign etiologies - Rule out Horner, 3rd nerve palsy, Myasthenia gravis, malignancy

A

Ptosis

67
Q

Type of ptosis due to an innervation defect - Horner, 3rd nerve palsy, marcus gunn jaw winking syndrome, ophthalmoplegic migraine, multiple sclerosis

A

Neurogenic Ptosis

68
Q

Type of ptosis with levator muscle myopathy, impairment of impulses transmission to the muscle - Myasthenia Gravis, mytonic dystrophy, progressive ophthalmoplegia

A

Myogenic Ptosis

69
Q

Type of ptosis with defect in the levator palpebra aponeurosis

A

Anoneurotic Ptosis

70
Q

Type of ptosis due to gravity caused by a mass or scarring

A

Mechanical Ptosis

71
Q

congenital causes of ptosis

A

blepharophimosis, incomplete lavator differentiation, thiamine deficiency

72
Q

“Ptosis” caused by Lack of support: orbital volume deficit

Contralateral lid retraction, Isilateral hyoptropia, Brow Ptosis, dermatochalasis

A

Pseudoptosis

73
Q

Measurement for ptosis- distance between upper lid margin and corneal reflection in primary gaze ptosis - graded as mild - 2 mm, moderate - 3 mm, severe - 4 mm

A

Margin-reflex distance

74
Q

Distance between upper and lower lid margins - ptosis measurement

A

Palpebral fissure height

75
Q

pt looks down with your thumb against eyebrow, ask to look up as far as possible, excursion is measured with a ruler - normal 15 or less, good is 12 to 14, fair is 5 to 11, poor is 4 or less - ptosis measurement

A

Levator Function

76
Q

vertical distance between the lid margin and the lid crease looking downward - ptosis measurement, females 10 mm, males 8 mm

A

Upper lid crease

77
Q

distance between lid margin and skin fold with the eyes in primary gaze position

A

Pretarsal show

78
Q

associated sign of ptosis where the levator of the contralateral eye is over stimulated resulting in lid retraction

A

Increased innervation

79
Q

Associated sign of ptosis where pt looks up for 30 seconds, progressive drooping of one or both eyelids or inability to sustain upward gaze suggests myasthenia gravis

A

Fatigability

80
Q

Check superior rectus in patients with congenital ptosis, correction if ipsilateral hypotropia improves ptosis

A

Ocular motility defects

81
Q

Associated sign of ptosis involving winking with chewing, in 5% of congenital ptosis, mandibular branch of CN5 is midirected to LP, pt learn to mask it, surgery is option

A

Jaw winking phenomenon- marcus gunn jaw winking syndrome

82
Q

Globe rotation when eyes close - associated sign of ptosis

A

Bell Phenomenon

83
Q

Ptosis most likely due to failure of neuronal migration or failure of muscular development, minority is hereditary, ABSENT UPPER LID CREASE AND POOR LEVATOR function, lid lag while looking down, SR weakness

A

Simple Congenital ptosis

84
Q

syndrome that frequently follows an acquired CN 3 nerve palsy, or abberrant facial nerve regeneration, Bizarre movements of upper lid with eye movements - treat with brown suspensions and LP disinsertion

A

3rd CN misdirection syndrome

85
Q

Syndrom marked by Retraction of lid on R gaze - pseudo Von Graefe sign

A

Left Brown’s Syndrome

86
Q

Type of ptosis related to age and desinsertion or stretching of aponeurosis of LP, ptosis due to fatigue of muller muscle during the day, can be confused with MG, bilateral, Tx with LP resection, reinsertion and repair

A

Involutional Ptosis

87
Q

Type of ptosis, result of impaired mobility of the UL caused by dermatochalasis, tumors, heavy scar tissue, severe edema

A

Mechanical ptosis

88
Q

When working up a ptosis patient, give the reason for testing for EOMS, Pupils, History

A
  1. EOMs to rule out CN3 Palsy
  2. Pupilsto rule out Horners or parasypathetic denervation in CN3 palsy
  3. History to see if congenital, with lid lag, or if variable ptosis - MG suspect
89
Q

3 signs of Horners

A

Miosis, ptosis (enophthalmus from muller muscle paralysis can contribute to the appearance of ptosis), anhidrosis

90
Q

Effect of cocaine in a Horner Pupil

A

NO DILATION

91
Q

Effect of apraclonidine on a Horners pupil

A

SUPER DILATION

92
Q

Effect of hydroxyamphetamine in a Horners Pupil - Interpretation

A

Dilates - Pre-ganglionic

No Dilation- Post gangionic

93
Q

when is ptosis an indication for surgery in children?

A

amblyopia risk
abnormal head posture
furrowed eye brow

94
Q

test for assessing fatigue in ptosis patients with possible MG

A

Ice pack test - levator function test

95
Q

outward turning of the eyelid margin - tearing, irritation, corneal exposure, conjunctival injection, thickening. Due to laxity or dinsertion

A

Ectropion

96
Q

Patient with glaucoma is presenting sings of ectropion. you notice the presence of scarring on the inner lid. you ask the patient what medication he is taking, what would you suspect his answer might be, how would you treat it ?

A

Dorzolamide - trusopt or brimonidine - alphagan

Discontinue use of Glaucoma meds, try something else for glaucoma

97
Q

A patient with ectropion comes in, and upon evaluation of the frontalis muscle, you notice that the eyebrows cannot be raised and the corners of the mouth curl slope downward and cannot be lifted. Mom says he has been like this since birth, What is the likely diagnosis? what if it was acquired?

A

congenital :Moebius syndrome, if acquired: bells palsy, vascular lesion, tumor, trauma

98
Q

Cause of facial nerve paralysis where the upper and lower facial muscles are equally affected in voluntary and emotional movements

A

Peripheral Lesions

99
Q

Cause of facial nerve paralysis where only voluntary movements of the forehead and orbicularis oculi are affected to a small degree because of bilateral cortical innervation, emotional movements are unimpaired

A

Supranuclear Lesions

100
Q

Flattening of the entire face with loss of forehead wrinkles, infraorbital fold, nasolabial fold, eyebrow drooping, elevated upper eyelid, ptosis, ectropion of lower lid, epiphora, lagophthalmos, exposure keratopathy

A

Paralytic Ectropion

101
Q

How to treat paralytic ectropion

A

topical lubrication - antibiotic if a lot of exposure
taping eyelids closed at bed time- mask
temporary suture or botulin toxin into LP

102
Q

Condition caused by seventh nerve palsy, cerebellopontine angle tumors, herpes zoster oticus, infiltration of tumors of parotid gland, bells, trauma, vascular lesions, moebius syndrome

A

Paralytic ectropion

103
Q

Test for ectropion - if mild, lid in normal position, but when pulled out it returns slowly, if advanced, lid is not in apposition with globe,

A

Snap-Back test: positive if no brisk return

104
Q

Inward turning of an eyelid caused by disinsertion of lower lid retractors or secondary to inflammation, trauma, scarring, or congenital malformation of lower lid retractors

A

Entropion

105
Q

How to treat entropion

A

epilation, lubricant, taping, BCL, antibiotics if severe

106
Q

Soft, rubbery easily everted lid, unilateral or bilateral, ovese middle aged men who sleep face down, lids get everted by pillow, leads to keratoconjunctivitis, loss of tarsal integrity, decrease in elastin in tatus, elongation of tarsal plate

A

Floppy Eyelid Syndrome

107
Q

problems associated with floppy eyelid syndrome

A

keratoconus, skin elasticity, joint hypermotility-people who can push their eyes outward, sleep apnea

108
Q

how to treat floppy eyelid syndrome

A

lid taping, night mask, not sleeping face down, lubricants, antibiotics, weight control

109
Q

Eyelids midirected, causing conj hyperemia, corneal staining, FB sensation, Irritation, due to age, disease, trauma. treated with epilation, lubricant, BCL, antibiotics, if severe - laser/cryo/electro tx

A

Trichiasis

110
Q

Uncommon condition characterized by cagarette paper skin from multiple episodes of edema, onset around puberty, orbital fat herniation/absorption, can result in ptosis, lacrimal gland can prolapse, Diagnose with drug induced urticaria, angioedema, TX blepharoplasty and ptosis correction

A

Blepharochalasis

111
Q

Disease characterized by eyelid twitching - spontaneous contractions of the orbicularis muscle, caused by hyper firing of nerve fibers - irritation - can be provoded by stress, caffeine, smoking, alcohol, eye strain

A

Orbicularis Myokemia

112
Q

Patient comes in with complains about their eye appearing to jump periodically. How do you treat?

  1. Education
  2. If persistent…
  3. If unresolved after topical tx
  4. if still unresolved
A

Orbicularis Myokemia

  1. discontinue caffeine, smoking, drinking, manage stress, sleep more, correct refractive error
  2. Topical antihistamines - Emadine
  3. Add Oral H1 blocker like phenergan or benadryl
  4. Refer for botox
113
Q

idiopathic, Involuntary Eyelid closure - hyper-contractions of orbicularis muscle, causing uncontrollable lid closure, corrugator, frontalis, procerus may be involved. More common in females in their 50’s - 60’s , abnormal levels of neurtotransmitters, What needs ruled out? how do you treat? If persists?

A

Essential Blepharospasm
Rule out Anti-dopamine and SSRI meds
Oral histamine - zyrtex, sedative at bedtime - benadryl or phenergan
If persists - botox

114
Q

incomplete lid closure - physiologic or nocturnal, can be orbital - protposis, paralytic- 7th nerve palsy, mechanical - lid scarring, or tumor - neuroma or parotid gland, How to treat?

A

Lagophthalmos
Mild - lubricant and artificial tears, lid taping
Moderate- Severe: antibiotic, sugery, implants

Disease 1 (8 decks)

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