Lids, Lacrimal, Orbit

Question 1

Ectropion

Answer 1

Eyelid is turned away downwards away from eyeball as a result of age-related laxity

Question 2

Entropion

Answer 2

eyelid is rolled inward against the eyeball,

Question 3

Causes of entropion

Answer 3

Eyelid laxity, trichiasis (introversion of eyelashes), eyelid inverta, orbicularis muscle over-rides tarsal plate

Question 4

Chalazion (meibomian cyst)

Answer 4

Small lump or cyst develops in your eyelid due to a blocked oil gland

Question 5

Cause of Chalazion

Answer 5

blockage of meibomian gland within tarsal plate, trapped sebaceous secretions, chronic granulomatous inflammation

Question 6

Treating Chalazion

Answer 6

May resolve spontaneously, hot compress and massage, surgical drainage

Question 7

Blepharitis

Answer 7

Meibomian Gland Dysfunction, eyes present red and sticky/ discharge

Question 8

Causes of Blepharitis

Answer 8

• Abnormally thick meibomian secretions
• Inflammation of lid margins
• Colonisation by Staph aureus

Question 9

Treating Blepharitis

Answer 9

• Hot compress to help drain meibomian glands
• Lid hygiene e.g. cleaning
• Oral tetracyclines

Question 10

Trichiasis

Answer 10

Misdirected lashes. Due to scarring of lid margin or corneal ulceration

Question 11

Treatment for Trichiasis

Answer 11

Epilation or permanent lash removal

Question 12

Causes of Ptosis (drooping)

Answer 12

age-related degeneration of levator muscle aponeurosis, Scar tissue or mass, cranial nerve palsy, Horner’s Syndrome, Myasthenia gravis, myotnic dystrophy

Question 13

Lacrimal System

Answer 13

Keeps the eye moist
Maintain smooth optical surface of cornea
Conveys oxygen to the avascular cornea
Defence against infection e.g. IgA, lysozyme

Question 14

Bell’s Palsy

Answer 14

Bell’s palsy is a condition that causes a temporary weakness or paralysis of face muscles

Question 15

Cause of dry eyes

Answer 15

Sjogren’s syndrome, rheumatoid arthritis, side effects of antihistamines

Question 16

Congenital nasolacrimal obstruction

Answer 16

Caused by delayed canalization of the lower end of the nasolacrimal duct. Often a sign of congenital glaucoma in abbies

Question 17

Treatment of congenital nasolacrimal obstruction

Answer 17

• Most will resolve by 1 year

- If persistent, may need surgical probing

Question 18

Acute dacryocystitis

Answer 18

Infection of the lacrimal sac caused by staphlococcus aureus or streptococcus pneumoniae. Secondary to nasolacrimal duct obstruction. May cause preseptal cellulitis

Question 19

Treating Acute Dacryocystitis

Answer 19

Oral antibiotics e.g. flucloxacillin
Warm compresses to aid drainage
Surgical drainage

Question 20

Orbits

Answer 20

Cavity or bony sockets that contain and protect the eyes. Roughly pyramidal with 4 walls

Question 21

Orbital cellulitis

Answer 21

inflammation of eye tissues behind the orbital septum. Caused by infection within the orbit.

Question 22

Features which distinguish orbital cellulitis from preseptal cellulitis

Answer 22

Restricted eye movements, proptosis, loss of vision, red/swollen conjunctiva. Check visual acuity, colour vision and pupil reactions. Urgent treatment required to prevent loss of sight.

Question 23

Fatal complications of Orbital Cellulitis

Answer 23

Cavernous Sinus thrombosis, Meningitis, cerebral abscess

Question 24

Treating Orbital Cellulitis

Answer 24

IV antibiotics

CT scan to check for orbital abscess or sinusitis

Question 25

Orbital floor blowout fracture with entrapment

Answer 25

Sudden increase in orbital pressure
Fractures at the weak points
Muscle, fat or connective tissue can be caught int the fracture

Question 26

Causes of thyroid eye disease

Answer 26

Hyperthyroidsim 
IgG-mediated inflammation
Proptosis and lid retraction
Limitation of movement
Optic nerve compression

Question 27

Treating Thyroid Eye Disease

Answer 27

Treat underlying thyroid problem, avoid smoking- makes TED worse, lubricants, eyelid taping, reduce swelling, surgery to correct diplopia