LIDS Flashcards
List the three types of entropion (include cause)
- involutional - age related
- cicatricial - due to contraction of conjunctiva following a chemical injury or inflammation
- spastic - due to a secondary blepharospasm
what is entropion?
A common malposition of the eyelid which causes he lid to turn toward the eye
list the management of involutional entropion
medical - use of ocular lubricants, antibiotic ointments, taping of the lid and Botox
surgical - commonly stitching on the lower lid
what may be used to manage spastic entropion?
Botox
what are the 4 types of ectropion?
- involutional - age related
- paralytic - bells palsy
- mechanical - due to tumour, lesion etc
- cicatricial - due to scarring
what is ectropion?
a common eyelid malposition which causes the lower lid to droop or hang
what may be seen in a px with ectropion?
some may be asymptomatic, watery eyes, very irritated conjunctiva, skin changes to the lid (red and scaly)
how would you manage px with ectropion?
lubricants
refer for surgery - dependant on cause
antibiotics if recurrent infection
what is ptosis?
an abnormally low lying upper lid
list the types of ptosis
- senile
- myogenic
- neurogenic
- mechanical
5 pseudoptosis
how would you classify senile ptosis?
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
how would you classify myogenic ptosis?
often seen in younger px, is seen secondary to a generalised muscular disease such as myasthenia gravis, chronic external ophthalmoplegia and myotonic dystrophy
what is the cause of mechanical ptosis?
swelling or tumour
what is the cause of neurogenic ptosis?
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
what is pseudoptosis?
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
what tests would you perform to evaluate entropion
horizontal laxity test
what test would you perform to evaluate ectropion
horizontal laxity test
what tests would you perform to evaluate ptosis
cover test/ motility
pupil evaluation
observe for jaw winking
if there is lavatory fatigue - may indicate myasthenia gravis
how is ptosis corrected?
dependant on strength of levator muscle
if strong then levator resection surgery
is weak then a brow suspension procedure
state what is in image above.
entry level management of px
risk factors
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
what is shown in the image above
entry level management
when should concerns be raised?
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
how to differentiate between benign and malignant lid bumps
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
benign or malignant?
benign
- Naevus
benign or malignant?
malignant
- basal cell carcinoma
benign or malignant?
malignant
squamous cell carcinoma
benign or malignant?
benign
- dermoid cyst
list characteristics of basal cell carcinoma
painless, slow growth, pearly white edges, nodular, central ulceration.
once removed will be gone. most common in Caucasians > 50 and those with AIDS
list characteristics of squamous cell carcinoma
painless, slightly raised far more aggressive and rapid growing than BCC. more common in Caucasians >70
list characteristics of sebaceous cell carcinoma
arises from meibomian gland or sebaceous glands. note lash loss as can be present as recurrent bleph or chalazion. IMPORTANT TO NOTE UNILATERAL BLEPH
list characteristics of malignant melanoma
most aggressive. pigmented tumours which grow rapidly with distant spread common
what is lash ptosis?
downward sagging of top lashes
what is Trichiasis
misdirection of lash growth
what is Distichiasis
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
what is Trichomegaly
excessive lash growth due to prostaglandin use, aids, hypothyroidism etc
what is Madarosis
loss of lashes
what is Poliosis
premature whitening of the hair may be of lashes as well as hair and brows
describe anterior Blepheritis
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
list characteristics of posterior blepheritits
MGD
excessive secretion, capping of glands. toothpaste like expression from glands. foamy tear film
