Lid & Lacrimal

Question 1

What are the 3 muscles of the eyelid?

Answer 1

1) Orbicularis oculi muscle
2) Levator palpebrae superior muscle
3) Superior tarsal muscle (Muller muscle)

Question 2

Levator palpebrae superior muscle function?

Answer 2

Main elevator of the upper lid

Question 3

Levator palpebrae superior muscle supplied by?

Answer 3

3rd CN (Oculomotor)

Question 4

Muller’s muscle function?

Answer 4

Weaker elevator of the upper lid

Question 5

Muller’s muscle supplied by?

Answer 5

Sympathetic system

Question 6

Orbicularis oculi muscle function?

Answer 6

Lid closure

Question 7

Orbicularis oculi muscle supplied by?

Answer 7

7th CN (Facial)

Question 8

The conjunctiva can be divided into:

Answer 8

1) The palpebral conjunctiva (covering the eyelids)
2) The bulbar conjunctiva (covering the globe with its sclera)
3) The conjunctival fornix

Question 9

What are the causes of ptosis?

Answer 9

1) Mechanical (anything preventing full eyelid opening)
2) Disinsertion of the aponeurosis of the levator muscle from its insertion on tarsus
3) Neurological
4) Myogenic

Question 10

What is the most common cause of acquired ptosis?

Answer 10

Disinsertion of the aponeurosis of the levator muscle from its insertion on tarsus

Question 11

What is the most common cause of congenital ptosis?

Answer 11

Malformation of the levator
palpebrae superioris muscle

Question 12

Ptosis signs?

Answer 12

1) Palpebral aperture size reduction
2) Lid creases are absent or in abnormal position.
3) Horner’s syndrome signs (small pupil, anhydrosis )
4) 3rd CN palsy (large pupil, Diplopia)
5) Myasthenia Gravis (fatigue after repeated movements)

Question 13

What is Involutional Entropion?

Answer 13

When the preseptal part of the orbicularis muscle overrides the pretarsal muscle

Question 14

Management of entropion?

Answer 14

1) Taping of the lower lid and Lubrication
2) Botulinum toxin into the orbicularis muscle (palpebral part)
3) Surgery

Question 15

Causes of ectropion?

Answer 15

1) Age related orbicularis laxity
2) 7th CN palsy
3) scarring of the periorbital skin

Question 16

What is a Chalazion?

Answer 16

Lipo-Granuloma within the tarsal plate due to meibomian gland obstruction

Question 17

Molluscum Contagiosum is caused by:

Answer 17

DNA Poxvirus

Question 18

What is the cyst of Moll?

Answer 18

Translucent cyst due to sweat gland obstruction

Question 19

What is the Cyst of Zeis?

Answer 19

Opaque cyst due to obstructed accessory sebaceous gland

Question 20

90% of eyelid tumors
are __.

Answer 20

Basal Cell Carcinoma

Question 21

Basal cell carcinoma has a ___ (good/bad) prognosis.

Answer 21

Good

Question 22

What is Trichiasis?

Answer 22

Eyelashes are directed towards the globe and the lid margin is normal

Question 23

What causes Trichiasis?

Answer 23

Chlamydia trachomatis

Question 24

Tears drains into (in order):

Answer 24

Upper and lower puncta -> Upper and lower canaliculi -> Common canaliculus -> Lacrimal sac -> Nasolacrimal duct -> Nose

Question 25

The tear film comprises three layers:

Answer 25

1) A thin mucin layer in contact with the ocular surface 2) Aqueous layer 3) A surface oil layer

Question 26

The thin mucin layer of the tear film is produced by:

Answer 26

Conjunctival goblet cells

Question 27

The Aqueous layer of the tear film is produced by:

Answer 27

Lacrimal gland

Question 28

The surface oil layer of the tear film is produced by __ and delivered to __.

Answer 28

The tarsal meibomian glands; the lid margins

Question 29

Sjogren’s syndrome's dry eyes is mainly caused by a deficit in which layer of the tear film?

Answer 29

Aqueous layer, due to deficient Lacrimal gland secretions

Question 30

Aqueous layer deficiency signs on fluorescein stain:

Answer 30

1) Early break up of the tear film after 5 seconds of blink suppression 2) Punctate staining will show small dots of fluorescein over the exposed corneal or conjunctival surface 3) Filamentary keratitis (tags of abnormal mucus)

Question 31

Evaporative dry eye can be caused by:

Answer 31

1) Inadequate Meibomian oil delivery (MGD) 2) Malposition of the globe or lid Margin

Question 32

Watery eyes will result from failure of __.

Answer 32

The distal end of the nasolacrimal duct to canalize

Question 33

Obstructed canaliculi may result in ___ or ___.

Answer 33

Mucocele; Dacryocystitis

Question 34

In infantile drainage obstruction, the conjunctiva __ (is/is not) inflamed

Answer 34

Is not

Question 35

Causes of adult drainage obstruction?

Answer 35

1) Infections 2) Direct Trauma, Fractures 3) Topically applied drugs

Question 36

How does adult drainage obstruction present?

Answer 36

1) Watery eyes 2) Stickiness 3) White eyes Worse in cold or windy weather

Question 37

What can be seen on slit lamp in adult drainage obstruction?

Answer 37

Stenosed punctum

Question 38

Patency of the Nasolacrimal system can be assessed by:

Answer 38

1) Syringing normal saline into the canaliculi 2) Fluorescein dye disapperance after 5 minutes 3) Dacryocystogram 4) Dacroyscintogram

Question 39

What is the management for adult drainage obstruction?

Answer 39

1) Exclude other ocular diseases causing watery eyes 2) Dacryocystorhinostomy (DCR)

Question 40

What are the nasolacrimal system infections?

Answer 40

1) Dacryocystitis 2) Mucocele

Question 41

Dacryocystitis is mostly due to:

Answer 41

Obstruction of the nasolacrimal system

Question 42

Dacryocystitis presents with:

Answer 42

Painful swelling on the medial side of the orbit

Question 43

How is Dacryocystitis treated?

Answer 43

Systemic antibiotics

Question 44

What is a Mucocele?

Answer 44

Collection of mucus in an obstructed sac, usually painless (not infected).