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Abnormal Ocular conditions > Lids > Flashcards

Lids Flashcards

1
Q

Xanthelasma

A

soft, yellowish plaques,
variable sizes,
often bilateral, upper and lower eyelid,
lipid and cholesterol deposits,

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2
Q

Squamous Cell Papilloma

A

Also known as viral wart
* Common in adults
* Sessile or pedunculated
* Histopathology: excessive convoluted
epithelium with central fibrovascular core

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3
Q

Basal Cell Papilloma

A

Seborrheic keratosis
* Very common (90% > 60 yrs)
* Smooth, waxy or warty surface
* Slow growing, not painful or tender
* Flat or raised plaque
* Skin coloured, yellow, grey, light brown,
dark brown or mixed colours
* Cosmetic removal

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4
Q

Dermatitis Papulosa Nigra (DPN)

A
  • Multiple small diameter black or
    dark brown papules - face and
    neck
  • Dark skin colour
  • Incidence and number increase
    with age
  • Papules are identical to small
    seborrheic keratoses
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5
Q

Skin Tags

A
  • Very (most) common
  • Small, soft, skin coloured growth
  • Variable size, shape, colour and number
  • Cause unclear - clusters of collagen and
    blood vessels surrounded by skin
  • Harmless
    Skin tags
    SIO2001 Kate Doorduyn
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6
Q

Capillary Haemangioma

A
  • Strawberry naevus: evident in
    neonatal period
  • Grows in first year then usually
    regresses by 5yrs
  • May be cutaneous, orbital or
    mixed
  • Systemic associations
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7
Q

Vascular Malformation

A
  • Port-wine stain
  • Present at birth - may become
    more prominent with time
  • Sturge-Weber syndrome (5%)
  • 30% glaucoma
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8
Q

Retention Cysts

A
  • Small, round, non-tender cysts
  • Cyst of Zeis
  • White cheesy (sebaceous)
    material
  • Sebaceous cyst
  • Similar to a cyst of Zeis
  • Cyst of Moll
  • Clear, fluid filled
  • Cosmetic excision
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9
Q

Milia

A
  • Tiny superficial white/yellow dome-
    shaped cysts
  • Usually multiple - nose, chin & cheeks
  • Any age - common in new born babies
    (40%)
  • Trapped keratin
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10
Q

Naevi

A
  • Congenital or acquired
  • Pigmented or non-pigmented
  • Flat or slightly raised
  • +/- hairs, warty surface
  • Malignant transformation is rare
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11
Q

Actinic Solar Keratosis

A
  • Flat scaly lesions, rough skin
  • Red, pink, brown or skin coloured
  • Older age, h/o sun exposure
  • May give rise to squamous cell
    carcinoma
  • Occasionally papillomatous or
    cutaneous horn
    Actinic Keratosis
    SIO2001 Kate Doorduyn
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12
Q

Cutaneous Horn

A
  • Keratin projection
  • Arise from benign, premalignant and
    malignant lesions
  • 10% associated with squamous cell
    carcinoma
  • Base is the point of interest
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13
Q

Keratacanthoma

A
  • Rapidly enlarges (months)
  • Regresses or evolves into squamous cell
    carcinoma
  • Volcano shaped with keratin plug
  • Visually, often difficult to distinguish
    from BBC or SCC
  • Histopathology - arises from hair follicle
    skin cells
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14
Q

Basal Cell Carcinoma (BCC)

A
  • Most common periocular malignancy
  • Slow growing, painless, often ulcerated
  • Do not metastasise but invade locally
  • Change in lid contour/lash redirection
    Types
  • Nodular
  • Ulcerative
  • Sclerosing
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15
Q

Squamous Cell Carcinoma (SCC)

A
  • May evoke inflammatory response
  • Symptomatic - patient concern about lesion,
    may irritate or itch, may bleed
  • Can look similar to BCC but more aggressive
  • More likely to metastasise than BCC
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16
Q

Malignant Melanoma

A
  • Very rare (of the eyelid)
  • Can arise de novo or as a malignant
    transformation of a naevus
  • Signs include itching, bleeding,
    pigmentary changes, increase in size
  • 50% are non-pigmented
17
Q

Ectropian

A

Outward rotation (eversion) of the
eyelid margin (usually lower)
* Occurs in ~4% of >50 yr olds
* 70% bilateral
Aetiology (causes)
* Age-related (involutional)
* most common cause
* Horizontal lid laxity
* Weakness of the orbicularis oculi and/or
canthal tendons
* Cicatricial: scarring +/- contracture of skin
and underlying tissue
* Paralytic (VII nerve palsy)
* Mechanical/Inflammatory
* Congenital

18
Q

Entropian

A

Inward turning (inversion) of the tarsus
and lid margin
* Causes lashes to come into contact
with the ocular surface
* Affects ~2% of the elderly population

  • Age-related (involutional)
  • Commonest cause
  • Degenerative changes result in horizontal
    lid laxity
  • Cicatricial
  • Scar tissue pulls the lid inwards
  • Burns, surgery, rheumatoid arthritis
  • Muscle Spasm
  • Congenital (rare)
19
Q

Ptosis

A
  • Greek word ‘to fall’
  • Drooping or abnormally low
    position of the upper lid
  • Associated reduction in the
    palpebral fissure height
20
Q

Lid Retraction

A
  • Suspected when eyelid margin is
    above or level with the superior
    limbus
    Aetiology
  • TED – thyroid eye disease
  • auto immune condition where
    the eyes appear to bulge
  • Neurogenic
  • e.g. Marcus Gunn Jaw Winking
  • Mechanical
  • e.g. surgical overcorrection of
    a ptosis
  • Congenital
  • e.g. Duane’s syndrome * Risk of exposure keratitis
21
Q

Lagopthalmos

A

Inadequate eyelid closure
* Tear film disturbance
* Corneal desiccation
Symptoms
* Grittiness
* Burning
* Increased lacrimation
Associations
* CN VII (facial nerve) palsy
* Proptosis e.g. TED
* Night time (while sleeping)
incomplete eyelid closure
Lagophthalmos
Treatment of lagophthalmos
* Ocular lubricants
* Eyelid taping (esp. nocturnal)
* Surgery - depending on cause

21
Q

Floppy Eyelid Syndrome

A
  • Generalised laxity of eyelid tissues
  • Can be unilateral or bilateral
  • Lids spontaneous evert during sleep
  • Symptoms - non-specific ocular irritation, redness
  • Signs - SPK, easy distraction of lid from globe, easy upper lid eversion,
    lower lid ectropion, ptosis, chronic papillary conjunctivitis, whitish
    mucous discharge
  • Treatment - lubricants, eye shield for sleep, wedge excision, canthal
    tendon repair
  • Associated with sleep apnoea (life threatening)
22
Q

Facial Nerve Palsy (Bell’s palsy)

A

Partial or complete paralysis of the facial nerve (VII
cranial nerve)
* Facial nerve: Sensory, motor and
parasympathetic functions
* Bell’s palsy – idiopathic lower motor neurone
facial nerve dysfunction
Aetiology:
* Idiopathic
* Latent virus infection (HSV, herpes zoster)
* Others (infection, trauma, tumour)
Risk Factors:
* Pregnancy
* Diabetes
* HIV

23
Q

Blepharospasm

A

Involuntary tonic, spasmodic, bilateral eyelid closure
* F>M
* More common in older individuals (60+ yrs)
* Causes - idiopathic, Parkinson’s disease, psychogenic drugs e.g.
psychotropics
* Treatment - botulinum toxin injections into orbicularis oculi

24
Q

Obicularis Myokymia

A

*Involuntary contraction producing an annoying twitching
sensation
*Very common presentation in optometric practice
*Related to fatigue, stress and caffeine
*Rarely other associations:
* Hemifacial spasm
* Multiple sclerosis
*Treatment: rest and relaxation, warm compress and lid massage

25
Q

Trichiasis

A
  • Inward misdirection of eyelashes towards
    the cornea
    Aetiology
  • Chronic blepharitis = scarred lids
  • Scar tissue from trauma, HZO
  • CF: Distichiasis & Epiblepharon
    Signs & Symptoms
  • Ocular discomfort, irritation and foreign
    body sensation
  • Watering & red eye
  • Corneal erosion
  • Corneal ulcer/infective keratitis
26
Q

Madorosis
Poliosis

A

Loss of lashes
Whitening of lashes

27
Q

Blepharitis

A
  • Inflammation of eyelid margins
  • Extremely common
  • Chronic/relapsing
  • Typically bilateral
    Predisposing/Risk factors
  • Seborrheic dermatitis (dandruff)
  • Ocular rosacea
  • Long term contact lens wear
  • Topical eye medication (glaucoma)
  • Demodex
28
Q

Anterior Blepharitis

A
  • Bacterial (Staphylococcal)
  • Crusting/collarettes/scales
    at base of lashes
  • Telangiectasia (dilated
    blood vessels)
  • Lash misdirection/loss
  • Seborrheic (gland of Zeis):
  • Greasy deposits at base of lashes
  • Demodex:
  • Cylindrical deposits extending up lashes
  • lash misdirection/loss, general redness
  • itching
29
Q

Posterior Blepharitis

A
  • Thickened meibomian secretions
  • Microliths
  • Meibomianitis - passive retention of
    secretions (chalazion, styes)
  • Foam in tear meniscus
  • Unstable tear film - evaporative tear
    deficiency
30
Q

Hordeolum

A
  • Acute bacterial infection (Staphylococcal) of an
    eyelid gland
  • 24-48 hours red swelling
  • Tender eyelid lump
  • May spontaneously express itself with a
    purulent material
  • Often associated with blepharitis
    Two types
  • External hordeolum (stye)
  • Lash follicle and associated gland of Zeis or
    Moll - base of eyelash
  • Internal hordeolum
  • Meibomian gland - tarsal plate
    Treat as per blepharitis
31
Q

Chalazion

A
  • Common, chronic lid lump
    Aetiology
  • Blockage of Meibomian gland duct
  • Inflammatory response - stagnate
    secretions and inflammatory cells
  • Spontaneous or follow hordeolum
  • Typically less acute and occurs over a
    period of weeks
    Symptoms
  • Usually painless lid lump
  • Single or multiple, may be recurrent

Abnormal Ocular conditions (1 decks)

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