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Ocular Disease > Lid Anatomy > Flashcards

Lid Anatomy Flashcards

1
Q

What nerve controls orbicularis muscle?

A

CN 7

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2
Q

What nerve controls levator palpebrae superioris?

A

CN III

Mueller is controlled by sympathetic

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3
Q

What glands are on tarsal plates?

A

Zeiss and approx 30

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4
Q

How many lashes on upper and lower lid?

A

150 lashes on upper and 100 on lower

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5
Q

What are the 2 sebaceous glands

A

zeiss and meibomian

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6
Q

What are the sweat glands?

A

moll

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7
Q

What is blepharospasm?

A

involuntary bilateral spasm orbicularis
(where eyes shut and can’t open them)
females develop in 60’s
has 3:1 ratio

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8
Q

What is Tx for blepharospasm?

A

botox every few weeks to decrease muscle response. This is because lids can close while driving

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9
Q

What is blepharoclonus?

A

where patients blink a lot.

secondary to inflammation

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10
Q

What is Tx for blepharoclonus?

A

treat inflammation

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11
Q

What is myokymia? (think of David when muslce twitches)

A

eye lid twitches (fasiculation of orbicularis)
refractory period is messed up
jumping eyelid

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12
Q

What is etiology of myokymia?

A

lack of sleep, stress, medication, excessive alcohol consumption

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13
Q

What is Tx for mykymia?

A

want to prolong refractory period, cool compress, topical anti-histamine, take quinine.
Quinine found in tonic water

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14
Q

What is Pseudograefe?

A

aberrant regeneration of CN III
follows CN III palsy
elevates eye and it goes in because of MR and LFP fibers
eye will elevate when it is adducted.

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15
Q

What is Entropion?

A

Lower lids turns inward
congenital
can be confused with epiblepharon

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16
Q

What is most common age related involutional disorder?

A

entropion

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17
Q

treatment for entropion?

A

surgery, epilation, glue

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18
Q

What is ectropion?

A

outward rolling of lid where cornea and conjunctiva exposed

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19
Q

What are the causes for ectropion?

A

cicatricial or mechanical

mechanical = burns, dermatoses, tumor, trauma

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20
Q

What is Tx for cicatricial/mechanical ectropion?

A

steroids , surgery

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21
Q

what causes paralytic ectropion?

A

bells palsy. Can be induced by botox

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22
Q

What is etiology of congenital ectropion?

A

associated with other lid problems

Tx: taping, lubrication, surgery

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23
Q

What is nocturnal lagophthalamos?

A

incomplete lid closure
can be diagnosed from NaFl from tonometry
patients have inferior morning SPK

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24
Q

Who has lagophthalmos more kids or adults?

A

adults because of decreased tear production

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25
Q

What are the 4 types of lagophthalmos?

A

nocturnal, orbital, mechanical, paralytic?

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26
Q

What is orbital lagophthalmos?

A

caused by graves ophthalmopathy

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27
Q

what is mechanical lagophthalmos?

A

occurs because of facial or ocular scarring?

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28
Q

What is paralytic lagopthalmos?

A

caused because of paralysis of CN 7 because of Bell’s Palsy
cannot close lids properly
vascular association
you must rule out stroke for Bell’s Palsy
the flat side is the diseased side

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29
Q

What is Tx for paralytic lagophthalmos?

A

lubrication, taping, tarsorrhaphy ( where you stitch the lid shut)

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30
Q

what is congenital ptosis?

A

autosomal dominant

in down gaze the lid is higher than normal

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31
Q

what is blepharophimosis?

A 
autosomal dominant
characterized by severe bilateral ptosis
lateral ectropion
telecanthus (wide bridge)
normally the epicanthal folds in asian children cause a slight entropian but with this condition, the epicanthus is inverted and fold the opposite way.
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32
Q

what is horners?

A

ptosis, miosis, anhydrosis

congenital or aquired

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33
Q

What is congenital horners?

A

associated with heterochromia

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34
Q

what is acquired horners?

A

no heterochromia

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35
Q

what is pre-ganglionic horners?

A

associated with chest trauma and tumors

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36
Q

what is post-ganglionic horners?

A

will be benign and NOT have a loss of sweating

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37
Q

What are 3 tests for horners?

A

cocaine 10% solution, hydroxyamphetamine, PE (phenylephrine)

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38
Q

How do you use cocaine?

A

will dilate normal eye but not horners

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39
Q

how do you use hydroxyamphetamine?

A

will not dilate post ganlionic because not enough norepinephrine

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40
Q

how do you use phenylephrine?

A

elevates side affected by muellers

IMPORTANT TO RULE OUT MALIGNANCY

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41
Q

what is myotonic dystrophy?

A

characterized by muscle wasting
patient has mournful expression
will have difficulty relaxing muscle once contracted

Ptosis, Cataract, Retinal changes: retinopathy, near light reflex dissociation, low IOPs, similar to bells, but it is bilateral.

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42
Q

what is myastenia gravis?

A

loss of receptors giving rise to muscle fatigability and weakness
90% will present with ocular signs

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43
Q

what is the DX for myastenia gravis?

A

tensilon test

use edrophonium will improve ptosis

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44
Q

what is the Tx for myastenia gravis?

A

steroids, immunosuppresives, anticholinesterases, thymectomy

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45
Q

What is floppy eyelid syndrome?

A

obese middle age men get this where lids are easily everted and cornea drys
associated with sleep anea and keratoconus

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46
Q

What is Tx for floppy eyelid syndrome?

A

lid taping or surgery

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47
Q

What is Dermatochalasis?

A

bilateral conditions in elderly patients

redundancy of the skin

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48
Q

What is the Tx for dermatochalasis?

A

can send for blepharoplasty

affects visual fields

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49
Q

What is a lid coloboma?

A

deals with children and the embryonic tissue that didn’t close
can get a cleft lid

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50
Q

What is the Tx for lid coloboma?

A

surgical repair for 3 - 6 months of age

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51
Q

What is cryptophtalmia?

A

skin is over the eyelids (fusion)

no Tx

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52
Q

what is the Tx for ablephara and Micorblephron?

A

Ablepharon = absence of the eyelid
Microblepharon = shortening of the eyelid
Tx: surgery

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53
Q

What is a contusion?

A

ecchymosis = black eye

can cause a hemorrhage that can cause IOP rise that can damage sight

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54
Q

What are the 3 common types of thermal burns?

A

flame, flash and scalding

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55
Q

What happens if you get a chemical burn from acid?

A

it is self limited and you will get a very red eye

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56
Q

What if you get alkali in your eye?

A

can cause greater destruction due to capillary closure.

IF EYE TURNS WHITE = BAD!!!

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57
Q

What is the Tx for burns?

A

irrigation for 1 - 2 mins with neutral irrigation
5 - 10 minutes of non-neutral
then you place anti-biotic and cycloplege the pt

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58
Q

What is an adhesive lid trauma?

A

This is crazy glue in your eye.

59
Q

What is the Tx for adhesive lid trauma?

A

mineral oil soaks and a pressure patch with forceps later

60
Q

What is Molluscum contagiosum?

A

viral skin infection

Sx: yellow nodules with follicular conjuctivitis and SPK

61
Q

What is the Tx of Molluscum contagiosum ?

A

excision by cautery

62
Q

What is a xanthelasma?

A

plaque like lesions occurring in the middle-age pts
occurs in younger pts with hyperlipidemia
this is higher in females than males

63
Q

What is the Tx for xanthelasma?

A

excision by cosmesis

64
Q

What is seborrheic keratoses?

A

a papilloma that looks like a mole growth

65
Q

What is actinic keratoses?

A

a pre-cancerous skin lesion
found in elderly fair skinned people with h/o skin exposure
will see it on tips of ears

66
Q

What is treatment of actinic keratoses?

A

biopsy with cryo

67
Q

What is a sudoriferous cyst?

A

form from gland of moll

typically asymptomatic but can lead to trichasis (inward turning of eye lashes)

68
Q

What is the Tx for sudoriferous cyst?

A

excision because lancing will increase recurrences

69
Q

What is a sebaceous cyst?

A

occurs from hair follicles or sebaceous glands

pts are asymptomatic

70
Q

What is a Tx for a sebaceous cyst?

A

superficial - lance

subcuteneous - let it drain

71
Q

What is verrucae vulgaris or plana?

A

HPV viral wart
most common benign tumor of lids
Vulgaris - crusted on a stalk
plana - flat pitted appearance

72
Q

what is the Tx for verrucae vulgaris or plana?

A

chemical cautery

do not want to lance or drain because can lead to conjunctivitis

73
Q

what is a basal cell carcinoma?

A

most common malignant tumor
slow growing and eats away
it requires excision with biopsy followed by radiation

74
Q

what is the Tx for a basal cell carcinoma?

A

requires excision with biopsy followed by radiation

75
Q

What is a squamous cell carcinoma?

A

5 to 10% malignancies
more aggresive
occurs in elderly people with fair skin

76
Q

what is a sebaceous gland carcinoma?

A

VERY RARE
usually a meibomian gland
may be present as a chalazion

77
Q

What is a melonoma?

A

RARE

78
Q

What is Karposi’s sarcoma?

A

vacular tumor associated with AIDS

rapid growing

79
Q

What is the Tx for Karposi’s sarcoma?

A

radiation

80
Q

What is the episclera?

A

dense vascular connective tissue

provides nutrition cornea

81
Q

What is the vasculature for the episclera?

A

superficial episcleral plexus with Tenon’s capsule

82
Q

What is episcleritis?

A

benign and sudden onset

involves 3 layers!!

83
Q

what 3 layers does episcleritis involve?

A

conjunctival vessels
deep episcleral plexus
superficial scleral plexus (tenon’s vessels)
there are no scleral or muculature involvement

84
Q

What are the symptoms for episcleritis?

A

MILD pain in 1 or both eyes but NOT painful

acute onset of redness

85
Q

What are the clinical signs of episcleritis?

A

vision normal
mild tenderness
nodule that can be moved slightly
70 to 75% NO associated systemic disease

86
Q

Does episcleritis affect males or females more?

A

occurs in females 20 to 40 years old

87
Q

How to differentiate episcleritis from scleritis?

A

scleritis pain is deep, severe, and occurs on ipsilateral side of head/face

88
Q

how to differentiate episleritis from iritis?

A

cells and flare in anterior chamber

89
Q

how to differentiate episleritis from conjunctivitis?

A

discharge

need to differentiate from contact lens over wear

90
Q

what is the cause of episcleritis?

A

it is idiopathic

if not it is a connective tissue disease

91
Q

What is the history for someone with episcleritis?

A

someone with a rash, venereal disease, arthritis, recent viral illness

92
Q

What is the work up for episcleritis?

A

you would look for bluish hue externally

You would drop phenylephrine 2.5% in each eye and examine the vascular pattern

93
Q

Most people have simple or nodular episcleritis?

A

simple! and can have sectorial or diffuse

94
Q

What is simple episcleritis?

A

has greyish infiltrates
generalized and moderate swelling
resolves quickly

95
Q

What is nodular episcleritis?

A

nodule of localized edema
takes longer to resolve than simple
has a moveable nodule

96
Q

what is the Tx for episcleritis?

A

none
Mild: iced artificial tears, topical decongestants
Moderate to Severe: steroid drops
or oral NSAIDS

97
Q

what is the follow up for scleritis?

A

if on steroids check IOP weekly

check in 2 to 3 weeks if on artificial tears

98
Q

what is chronic (stubborn) episcleritis?

A

RARE
NO necrosis
bluish color
never develops to scleritis

99
Q

tell me about the anatomy of the sclera?

A

rich nerve supply
avascular
low metabolism

100
Q

What is scleritis?

A

inflammatory disease that affects the sclera

101
Q

What is anterior scleritis?

A

patient has redness in the eye

severe eye pain

102
Q

what is posterior scleritis?

A

patient will NOT present redness and MAY NOT present eye pain

103
Q

Tell me about scleritis?

A

uncommon, chronic
can lead to blindness and eye loss
tissue destruction
50% is due to systemic cause

104
Q

Who does scleritis mostly affect?

A

females more than males from 40 to 60 years old

105
Q

What happens in scleritis?

A

inflammation of deep episcleral plexus
its dark red with a bluish tint
affects choroidal vasculature

106
Q

what are the symptoms for scleritis?

A

severe ocular pain, may wake up from sleep, recurrent episodes common, decreased VA leading to blindness

107
Q

what are the signs of scleritis?

A

inflammation of scleral, episcleral, and conjunctival vessels,
sclera will have bluish hue

108
Q

how to tell difference from episcleritis?

A

episleritis does NOT have the sclera involved. Episleritis is more acute, patients are younger with episcleritis and with milder symptoms

109
Q

what are conditions that cause scleritis?

A 
collagen disease
metabolic disease
granulmatous disease
infectious disease
ocular condition
110
Q

What systemic disease is scleritis associated with?

A

connective tissue diseases and others

111
Q

what is anterior scleritis?

A

most people have this one
non-necrotizing and vision is maintained
is diffuse and nodular

112
Q

what is the Tx for anterior scleritis?

A

take oral NSAIDS
oral prednisone
immunosuppressive therapy

113
Q

what is anterior scleritis necrotizing?

A

most severe form, vision threating complications, pain is extreme, collagen vasculature problems occur
THIS IS AN OPHTHALMIC EMERGENCY!!

114
Q

Can secondary complications occur with anterior necrotizing with inflamation scleritis?

A

yes like staphyloma and ectasia

115
Q

What is a staphyloma?

A

thinning of the sclera, bulging of the uvea,

116
Q

what is ectasia? (POSSIBLE TEST QUESTION)

A

bulging of the sclera without uveal lining

117
Q

what is anterior necrotizing without inflammation (scleromalacia perforans)?

A

occurs in patients with long standing rheumatoid arthritis, NO PAIN, older females

118
Q

What is the Tx for Necrotizing scleritis?

A

oral prednisone, immunosuppressive agents, eye surgery may need to be performed

119
Q

What is posterior scleritis?

A

can occur with anterior scleritis, restricted EOMS, proptosis, pain, tenderness, decreased vision (permanent), usually unrelated to systemic disease

120
Q

What is worse anterior or posterior scleritis? (Isaac made up this question)

A

probably posterior

121
Q

what are the ocular signs for posterior scleritis?

A

disc swelling, macular edema, choroidal folds or detachment

122
Q

what is the Tx for posterior scleritis?

A

asprin, NSAIDS, steroids, immunosuppressive therapy

123
Q

What is Tx for scleritis?

A

if infections then use anti-biotic
if foreign body the remove it
glasses or eye shield should be worn at all times
TOPICAL STEROIDS NOT EFFECTIVE
sub-conjunctival steroids are contraindicated

124
Q

what is the work up for scleritis?

A

examine sclera everywhere
do slit lamp with the green light
do a physical exam

125
Q

what do you use to diagnose scleritis?

A

10% phenylephrine test
will blanch conjunctival vessels and superficial episcleral vessels
WILL NOT blanch deep scleral plexus

126
Q

what are pigment cuffs?

A

very common
short anterior ciliary arteries
associated with axonfeld’s loop

127
Q

What is a blue sclera?

A

tissue color due to scleral thinning and exposed uvea

NORMAL for infants

128
Q

what is osteogenesis imperfecta?

A

inherited condition
permanent blue sclera
affects skeleton, joints, teeth, skin, and eyes

129
Q

what are the 3 signs for osteogenesis imperfecta?

A

blue sclera, deafness, and bone fractures

130
Q

What is melanosis oculi?

A

congenital bilateral hyperpigmentation of conjunctiva, episclera, sclera, uvea, and choroid
seen in darker colored patients (LIKE GANESH but that’s messed up but hey you are going to remember it now lol)

131
Q

what is the nevus of ota?

A

pigmentation of the periorbita skin

will distribute along ophthalmic and maxillary division of CN V

132
Q

What is senile hyaline plaque?

A

older patients over 50 will get this
it is localized non-inflammatory thinning
reassure patient it is not cancerous

133
Q

What is icterus/jaundice?

A

yellow pigmentation of the sclera or skin because of high concentrations of bilirubin in the blood
NEEDS A MEDICAL EXAM

134
Q

What is scleral perforations?

A 
can be due to high velocity projectiles
like BB gun, fireworks, metal hammerings
varying pain
sight may not be detectable
will have decreased IOP
NO MRI for patient
135
Q

What is the Tx for scleral perforations?

A 
immediate hospitalization
Fox shield (eye shield) given to patient
136
Q

What is a blue sclera?

A

tissue color due to scleral thinning and exposed uvea

NORMAL for infants

137
Q

what is osteogenesis imperfecta?

A

inherited condition
permanent blue sclera
affects skeleton, joints, teeth, skin, and eyes

138
Q

what are the 3 signs for osteogenesis imperfecta?

A

blue sclera, deafness, and bone fractures

139
Q

What is melanosis oculi?

A

congenital bilateral hyperpigmentation of conjunctiva, episclera, sclera, uvea, and choroid
seen in darker colored patients (LIKE GANESH but that’s messed up but hey you are going to remember it now lol)

140
Q

what is the nevus of ota?

A

pigmentation of the periorbita skin

will distribute along ophthalmic and maxillary division of CN V

141
Q

What is senile hyaline plaque?

A

older patients over 50 will get this
it is localized non-inflammatory thinning
reassure patient it is not cancerous

142
Q

What is icterus/jaundice?

A

yellow pigmentation of the sclera or skin because of high concentrations of bilirubin in the blood
NEEDS A MEDICAL EXAM

143
Q

What is scleral perforations?

A 
can be due to high velocity projectiles
like BB gun, fireworks, metal hammerings
varying pain
sight may not be detectable
will have decreased IOP
NO MRI for patient
144
Q

What is the Tx for scleral perforations?

A 
immediate hospitalization
Fox shield (eye shield) given to patient

Ocular Disease (1 decks)

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