LIDS

Question 1

List the three types of entropion (include cause)

Answer 1

1. involutional - age related
2. cicatricial - due to contraction of conjunctiva following a chemical injury or inflammation
3. spastic - due to a secondary blepharospasm

Question 2

what is entropion?

Answer 2

A common malposition of the eyelid which causes he lid to turn toward the eye

Question 3

list the management of involutional entropion

Answer 3

medical - use of ocular lubricants, antibiotic ointments, taping of the lid and Botox
surgical - commonly stitching on the lower lid

Question 4

what may be used to manage spastic entropion?

Answer 4

Botox

Question 5

what are the 4 types of ectropion?

Answer 5

1. involutional - age related
2. paralytic - bells palsy
3. mechanical - due to tumour, lesion etc
4. cicatricial - due to scarring

Question 6

what is ectropion?

Answer 6

a common eyelid malposition which causes the lower lid to droop or hang

Question 7

what may be seen in a px with ectropion?

Answer 7

some may be asymptomatic, watery eyes, very irritated conjunctiva, skin changes to the lid (red and scaly)

Question 8

how would you manage px with ectropion?

Answer 8

lubricants
refer for surgery - dependant on cause
antibiotics if recurrent infection

Question 9

what is ptosis?

Answer 9

an abnormally low lying upper lid

Question 10

list the types of ptosis

Answer 10

1. senile
2. myogenic
3. neurogenic
4. mechanical
   5 pseudoptosis

Question 11

how would you classify senile ptosis?

Answer 11

a main characteristic is an absent or high skin crease on the upper lid, the drooping of the lid tends to get worse later in the day

Question 12

how would you classify myogenic ptosis?

Answer 12

often seen in younger px, is seen secondary to a generalised muscular disease such as myasthenia gravis, chronic external ophthalmoplegia and myotonic dystrophy

Question 13

what is the cause of mechanical ptosis?

Answer 13

swelling or tumour

Question 14

what is the cause of neurogenic ptosis?

Answer 14

3rd nerve palsy, Horners syndrome. will often be accompanied with a fixed dilated pupil and paralysis of the medial rectus, superior rectus, inferior rectus and inferior oblique

Question 15

what is pseudoptosis?

Answer 15

what may first appear to be a ptosis but may actually be:
loss of volume (artificial eye)
lid retraction of the opposite eye
brow ptosis
hypotropia etc

Question 16

what tests would you perform to evaluate entropion

Answer 16

horizontal laxity test

Question 17

what test would you perform to evaluate ectropion

Answer 17

horizontal laxity test

Question 18

what tests would you perform to evaluate ptosis

Answer 18

cover test/ motility
pupil evaluation
observe for jaw winking
if there is lavatory fatigue - may indicate myasthenia gravis

Question 19

how is ptosis corrected?

Answer 19

dependant on strength of levator muscle
if strong then levator resection surgery
is weak then a brow suspension procedure

Question 20

state what is in image above.
entry level management of px
risk factors

Answer 20

Hordeolum/ Stye
advise it will most likely resolve on its own warm compress and stress good lid hygiene , affected lash epilation
more common in those who experience bleph/ poor lid hygiene

Question 21

what is shown in the image above
entry level management
when should concerns be raised?

Answer 21

Chalazion
advise may take up to 6 months to resolve, advise warm compress and lid hygiene.
refer if large or affecting vision.
concern should be raised if recurrent as may be sebaceous cell carcinoma

Question 22

how to differentiate between benign and malignant lid bumps

Answer 22

benign are usually well defined, skin is well preserved on and around bump, surface ulceration is uncommon
malignant often have indistinct margins, gradual destruction of affected skin and surround, surface ulceration present, LOSS OF LASHES

Question 23

benign or malignant?

Answer 23

benign
- Naevus

Question 24

benign or malignant?

Answer 24

malignant
- basal cell carcinoma

Question 25

benign or malignant?

Answer 25

malignant
squamous cell carcinoma

Question 26

benign or malignant?

Answer 26

benign
- dermoid cyst

Question 27

list characteristics of basal cell carcinoma

Answer 27

painless, slow growth, pearly white edges, nodular, central ulceration.
once removed will be gone. most common in Caucasians > 50 and those with AIDS

Question 28

list characteristics of squamous cell carcinoma

Answer 28

painless, slightly raised far more aggressive and rapid growing than BCC. more common in Caucasians >70

Question 29

list characteristics of sebaceous cell carcinoma

Answer 29

arises from meibomian gland or sebaceous glands. note lash loss as can be present as recurrent bleph or chalazion. IMPORTANT TO NOTE UNILATERAL BLEPH

Question 30

list characteristics of malignant melanoma

Answer 30

most aggressive. pigmented tumours which grow rapidly with distant spread common

Question 31

what is lash ptosis?

Answer 31

downward sagging of top lashes

Question 32

what is Trichiasis

Answer 32

misdirection of lash growth

Question 33

what is Distichiasis

Answer 33

can be acquired or congenital. a second full or partial row of lashes grow behind the mb glands, the lashes are typically finer and grow posteriorly

Question 34

what is Trichomegaly

Answer 34

excessive lash growth due to prostaglandin use, aids, hypothyroidism etc

Question 35

what is Madarosis

Answer 35

loss of lashes

Question 36

what is Poliosis

Answer 36

premature whitening of the hair may be of lashes as well as hair and brows

Question 37

describe anterior Blepheritis

Answer 37

Staphylococcal - hard crusty scales around the base of the lashes, mild papillary conjunctivitis and chronic conjunctival hyperaemia. long standing cases may cause scarring, poliosis, madarosis and trichiasis
seborrheic - greasy lid margins, soft scales and adherence of the lashes with eachother

Question 38

list characteristics of posterior blepheritits

Answer 38

MGD
excessive secretion, capping of glands. toothpaste like expression from glands. foamy tear film