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NBEO Part 2 > Lids/ Lashes > Flashcards

Lids/ Lashes Flashcards

1
Q

RTC for phthiriasis palpebrarum?

A

1 day

Because eggs may be hard to see and missed, eggs hatch daily, therefore need to monitor daily to ensure complete removal of eggs and lice

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2
Q

Tx of angioedema

A

Oral antihistamine and cold compress 4-6x/ day

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3
Q

RTC for angioedema

A

2-3 days to ensure resolution

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4
Q

Symmetrical bilateral ptosis onset around 20 years old is seen in which condition?

A

CPEO
Chronic progressive external ophthalmoplegia

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5
Q

Chloasma

A

Increased pigmentation around eyes and cheeks in pregnant women
*”mask of pregnancy”

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6
Q

What is Epiblepharon?

A

A congenital condition characterized by the absence of a lower lid crease, causing eyelashes to be oriented vertically.

Commonly observed in individuals of Asian descent and those with a high body mass index.

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7
Q

What are potential causes for Epiblepharon?

A

It may occur secondarily to:
* Surgical procedure
* Trauma
* Graves’ disease (leads to hyperthyroidism)

It can also be congenital.

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8
Q

What symptoms are associated with Epiblepharon?

A
  • Foreign body sensation
  • Ocular irritation
  • Reflexive tearing
  • Patients may be asymptomatic

Symptoms can vary in severity.

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9
Q

What are the clinical signs of Epiblepharon?

A
  • Vertical misdirection of lashes towards the globe
  • Mild corneal scratches
  • Superficial punctate keratitis (SPK)
  • Associated scarring of the cornea

The upper eyelid is rarely involved.

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10
Q

At what age may Epiblepharon spontaneously resolve in children?

A

By the age of 6 to 7 years

This resolution is secondary to facial elongation.

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11
Q

True or False: Epiblepharon can lead to decreased vision.

A

True

Decreased vision is exacerbated by down gaze due to corneal irritation.

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12
Q

Fill in the blank: Epiblepharon is characterized by the absence of a _______.

A

lower lid crease

This absence causes the eyelashes to misdirect vertically.

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13
Q

What are some treatment options for Epiblepharon?

A
  • Rotating the lid margin and taping it away from the globe
  • Application of a soft contact lens to protect the cornea
  • Epilation of the offending lashes (if there is only a small number)
  • Full-thickness suturing of the eyelid to create a normal eyelid crease (oculoplastics)

These options vary based on the severity and specific circumstances of the condition.

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14
Q

What should be prescribed in the presence of superficial punctate keratitis (SPK)?

A

Prescription of an age-appropriate topical antibiotic to ensure corneal health

This is important to prevent further complications associated with corneal involvement.

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15
Q

What type of artificial tears are recommended for patients with Epiblepharon?

A

Preservative-free artificial tears

These are preferred to avoid any irritation or adverse reactions that preservatives may cause.

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16
Q

When is surgery warranted for Epiblepharon?

A

If there is a significant degree of corneal involvement

Surgical intervention may be necessary to prevent further damage to the cornea.

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17
Q

Under what condition does epiblepharon not require urgent attention?

A

If the cornea is clear and there is no potential for lash misdirection onto the corneal surface

In such cases, patients may simply be monitored intermittently.

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18
Q

What is the primary approach to managing Epiblepharon if there is no corneal involvement?

A

The patient may simply be monitored intermittently to safeguard against future corneal involvement

This approach focuses on observation rather than immediate intervention.

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19
Q

What causes phthiriasis?

A

Phthiriasis is caused by pubic lice, also known as crab lice.

The scientific name for the organism is Phthirus pubis.

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20
Q

What is the size and body structure of Phthirus pubis?

A

Phthirus pubis measures roughly 2 mm in length and possesses a broad, flat body.

This small organism is specifically adapted to live in pubic hair.

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21
Q

How does pediculosis differ from phthiriasis?

A

Pediculosis is caused by a different form of louse that has greater mobility and is typically found on the scalp, while phthiriasis is caused by P. pubis, which is slow-moving and rarely found on the scalp.

Pediculosis is more easily transmitted between individuals.

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22
Q

What indicates the transmission of phthiriasis?

A

Phthiriasis transmission requires close contact between individuals.

This is often associated with overcrowding or inferior hygiene.

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23
Q

What are common symptoms of phthiriasis?

A

Patients may report ocular itching and potentially conjunctival injection.

These symptoms are indicative of an infestation affecting the eye area.

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24
Q

What clinical signs may be observed during a slit lamp exam for phthiriasis?

A

Clinical signs may include:
* Lice clinging to the base of the eyelashes
* Small brown deposits on the lid margin (feces)
* Dried blood along the base of the eyelashes
* Small circular translucent nits (eggs)
* Conjunctival injection and follicles
* Potential preauricular lymphadenopathy
* Marginal keratitis in extreme cases
* Dermal blue spots (maculae caeruleae) from lice saliva

These signs help in diagnosing phthiriasis.

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25
Q

What is the first step in the treatment of phthiriasis?

A

Mechanical removal of all nits and lice with jeweler’s forceps.

The lice should be placed onto an alcohol wipe for immediate disposal.

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26
Q

What topical treatments may be beneficial after lice removal?

A

A bland ophthalmic ointment such as bacitracin or erythromycin applied tid for 10 days after removal is beneficial.

This helps in managing any residual infection or irritation.

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27
Q

What is a potential prescription option for phthiriasis treatment?

A

1% mercuric oxide qid for 14 days may be prescribed.

However, patient compliance can affect the treatment’s effectiveness.

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28
Q

What side effects are associated with mercuric ointment?

A

Ocular irritation, lens discoloration, and other side effects.

These can discourage patients from using the treatment as directed.

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29
Q

What alternative treatment involves physostigmine?

A

Two applications of 0.25% physostigmine applied 7 days apart may be prescribed.

This medication is also associated with ocular side effects.

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30
Q

Are anti-lice shampoos approved for ocular use?

A

No, anti-lice shampoos are not approved for ocular use.

Patients should wash their hair with anti-lice shampoo but avoid applying it to the eyes.

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31
Q

What additional hygiene measures should patients take if they have phthiriasis?

A

Patients should wash all bedding and towels that they may have used and consider cutting the lashes to the base to remove possible lice adhesion sites.

This helps prevent re-infestation.

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32
Q

What follow-up care is recommended for patients with phthiriasis?

A

Patients should be monitored every day because the eggs may be difficult to observe and any missed nits will hatch daily.

Regular follow-up is crucial for effective treatment.

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33
Q

What must be evaluated in a child diagnosed with phthiriasis?

A

A child diagnosed with phthiriasis must be evaluated for possible sexual abuse.

This is due to the nature of transmission and potential risk factors.

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34
Q

What is Meibomian gland dysfunction (MGD)?

A

A condition resulting from dysfunctional sebaceous glands

Also known as posterior blepharitis.

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35
Q

What conditions commonly occur alongside Meibomian gland dysfunction?

A

Anterior blepharitis and seborrheic dermatitis

These conditions can exacerbate MGD.

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36
Q

Which bacteria are believed to aggravate Meibomian gland dysfunction?

A

S. aureus and S. epidermidis

These are gram-positive bacteria that release lipases affecting lipid production.

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37
Q

What is the effect of lipases released by bacteria on the ocular surface?

A

They hydrolyze lipids, producing free fatty acids that irritate the ocular surface

This leads to dry eye symptoms.

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38
Q

List some common symptoms of Meibomian gland dysfunction.

A
  • Stinging
  • Dryness
  • Itching
  • Excessive tearing
  • Burning
  • Photophobia
  • Foreign body sensation
  • Decreased visual acuity
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39
Q

What clinical signs may be observed in a patient with Meibomian gland dysfunction?

A
  • Excessively oily and frothy tear film
  • Inspissated secretions
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40
Q

What are some long-term complications of Meibomian gland dysfunction?

A
  • Chalazion
  • Trichiasis
  • Madarosis (missing lashes)
  • Thickening and notching of eyelid margins
  • Telangiectasia
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41
Q

What are the primary treatments for Meibomian gland dysfunction?

A
  • Warm compresses
  • Eyelid massage
  • Eyelid scrubs
  • Antibiotic ointments
  • Transient topical steroid use
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42
Q

How often should warm compresses and massage be performed initially for MGD?

A

Twice a day

This should continue until the condition stabilizes.

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43
Q

When might oral antibiotics be required in the treatment of Meibomian gland dysfunction?

A

When MGD is unresponsive to other treatments, severe, or if there is poor compliance

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44
Q

Fill in the blank: The tear film in Meibomian gland dysfunction may appear excessively _______.

A

[oily and frothy]

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45
Q

What is Meibomian Gland Dysfunction (MGD)?

A

A disorder affecting the meibomian glands, leading to dry eye symptoms.

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46
Q

What is the first step in treating anterior blepharitis?

A

Complete lid scrubs to remove bacteria.

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47
Q

What is the recommended treatment order for posterior blepharitis?

A

Perform massage first, then lid scrubs.

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48
Q

What advanced treatments may be required for severe cases of MGD?

A

In-office gland expression using technologies like LipiFlow® or iLux®.

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49
Q

What types of topical ointments may be prescribed for MGD?

A

Bacitracin, tetracycline, or erythromycin.

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50
Q

What is AzaSite® and why is it beneficial?

A

A topical azithromycin that is lipophilic and gel-forming, providing longer ocular retention.

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51
Q

What is the typical dosage for tetracycline in MGD treatment?

A

250 mg q.i.d.

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52
Q

What is the modified dosage for doxycycline that maintains efficacy?

A

20-50 mg.

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53
Q

What is included in the Alodox® Convenience Kit?

A
  • Low dose doxycycline (20 mg)
  • OcuSoft® lid hygiene pads
  • Tranquileyes® moist heat therapy goggles
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54
Q

What OTC supplement is suggested to improve dry eye associated with MGD?

A

Omega-3 fatty acids at a dosage of 2-3 g per day.

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55
Q

How has Restasis® proven beneficial for MGD patients?

A

It reduces lid margin inflammation in patients with MGD and/or rosacea.

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56
Q

True or False: The usage of Restasis® for MGD is considered on-label.

A

False.

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57
Q

RTC for MGD dx

A

3-4 weeks
* pt should be educated about how MGD is chronic, likely will need to continue eyelid scrubs and massage indefinitely

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58
Q

Adverse side effects of Kenalog eyelid injection (tx resistant chalazia and expedite resolution)

A
  • de pigmentation at injection spot
  • elevated IOP
  • retinal and/or choroidal vascular occlusion
  • pain on injection
  • temporary skin atrophy
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59
Q

Which conditions can cause a false appearance of a ptosis?

A
  • contralateral eyelid retraction (proptosis)
  • ipsilateral hypotropia
  • brow ptosis
  • dermatochilasis
  • lack of lid support by the globe
  • blepharospasm
  • Duane syndrome
60
Q

What ocular condition may cause a false appearance of ptosis?

A

Contralateral eyelid retraction

Other conditions include proptosis, ipsilateral hypotropia, brow ptosis, dermatochalasis, enophthalmos, phthisis bulbi, blepharospasm, and Duane syndrome.

61
Q

How does ipsilateral hypotropia contribute to pseudoptosis?

A

The upper eyelid naturally follows the globe downward

The appearance of pseudoptosis disappears when the fellow eye is covered.

62
Q

What measurements are important for evaluating suspected ptosis?

A

Marginal-reflex distance (MRD), palpebral fissure height, positioning of the upper and lower eyelids

MRD should be 4-4.5 mm, palpebral fissure height should be 7-10 mm in males and 8-12 mm in females.

63
Q

What is the normal positioning of the upper and lower eyelids?

A

Upper lids about 2 mm below the superior limbus, lower lids approximately 1 mm above the inferior limbus.

64
Q

What is Marcus Gunn jaw-winking syndrome characterized by?

A

An abnormally positioned upper eyelid considered a true ptosis

The ptosis improves by stimulating the ipsilateral pterygoid muscles via chewing, sucking, or opening the mouth.

65
Q

What is Blepharophimosis syndrome?

A

A rare autosomal dominant condition with moderate to severe symmetrical ptosis, short horizontal palpebral aperture, telecanthus, and epicanthus inversus

Other features include lateral ectropion of lower lids and poorly developed nasal bridge with hypoplasia of the superior orbital rims.

66
Q

What condition is associated with variable true ptosis that increases with fatigue?

A

Myasthenia gravis

67
Q

What is the proper technique for evaluating the levator muscle?

A

Firmly place your thumb against the patient’s brow, ask the patient to look down, zero the ruler at the upper lid margin, then ask the patient to look up and measure the upper eyelid margin on the ruler.

68
Q

What characterizes good levator function?

A

12 mm or more

69
Q

What characterizes fair levator function?

A

5-11 mm of upper eyelid excursion

70
Q

What characterizes poor levator function?

A

4 mm or less

71
Q

What is the main function of the orbicularis oculi muscle?

A

To close the eyelids

72
Q

What is the common name for the corrugator supercilii muscle?

A

Frowning muscle

73
Q

What is the action of the corrugator supercilii muscle?

A

Draws the eyebrows downward and medially

74
Q

What is the main action of the procerus muscle?

A

Depression of the skin between the eyebrows

75
Q

What does the orbicularis oris muscle do?

A

Closes the mouth and puckers the lips

76
Q

Fill in the blank: The main function of the orbicularis oculi muscle is to _______.

A

close the eyelids

77
Q

How is the upper eyelid crease measured?

A

As the vertical distance between the upper eyelid margin on downgaze and the upper eyelid crease

78
Q

What is the typical measurement of the upper eyelid crease in females?

A

10 mm

79
Q

What is the typical measurement of the upper eyelid crease in males?

A

8 mm

80
Q

What does the absence of the eyelid crease suggest?

A

Congenital ptosis with poor levator function

81
Q

What is commonly observed in patients with a high eyelid crease?

A

An aponeurotic defect

82
Q

Fill in the blank: The eyelid crease is typically larger in _______.

A

females

83
Q

True or False: The upper eyelid crease measurement is the same for males and females.

A

False

84
Q

What is eyelid ptosis?

A

An abnormally low positioning of the upper eyelid that may be congenital or acquired

85
Q

What are the four anatomical classifications of eyelid ptosis?

A
  • Myogenic
  • Neurogenic
  • Aponeurotic
  • Mechanical
86
Q

What characterizes myogenic ptosis?

A

Decreased levator function due to myopathy or impaired nerve impulse transmission

87
Q

What causes simple congenital ptosis?

A

Failure of neuronal migration and development during fetal growth

88
Q

What conditions can lead to acquired myogenic ptosis?

A
  • Myasthenia gravis
  • Myotonic dystrophy
  • Chronic progressive external ophthalmoplegia
89
Q

What is a classic sign of myogenic ptosis?

A

A weak or absent eyelid crease

90
Q

What is neurogenic ptosis caused by?

A

An innervational defect to the levator muscle

91
Q

Which cranial nerve palsy is most commonly associated with neurogenic ptosis?

A

Third cranial nerve palsy

92
Q

What is Horner syndrome?

A

Oculosympathetic palsy that presents with subtle upper and lower eyelid ptosis

93
Q

What is a characteristic of Marcus Gunn jaw-winking syndrome?

A

A ptotic eyelid elevates with jaw movement

94
Q

What causes aponeurotic ptosis?

A

A defect in the levator aponeurosis due to dehiscence, dis-insertion, or stretching

95
Q

What are common signs of aponeurotic ptosis?

A
  • High eyelid crease
  • Good levator function
  • Moderate degree of ptosis (3 to 4mm)
96
Q

What is mechanical ptosis?

A

Ptosis caused by a gravitational effect of an eyelid mass or eyelid scarring

97
Q

What potential causes can lead to mechanical ptosis?

A
  • Retained contact lenses
  • Eyelid inflammation (chalazion)
  • Giant papillary conjunctivitis
  • Neoplasm/tumor
98
Q

What is traumatic ptosis?

A

Ptosis resulting from eyelid laceration, contusion injury, or orbital roof fracture

99
Q

Fill in the blank: Myogenic ptosis can be _______ or acquired.

A

congenital

100
Q

True or False: Aponeurotic ptosis often presents with a high eyelid crease.

A

True

101
Q

Dacryocystitis

A

Inflammation of lacrimal sac secondary to obstruction within the nasolacrimal duct, leading to back up and stagnation of tears within nasolacrimal duct
* can be acute, chronic, or congenital

102
Q

Symptoms of acute Dacryocystitis

A
  • unilateral pain, radiates to cheek, teeth, face
  • swelling and erythema of tissue surrounding lacrimal sac
  • mucopurulent discharge from punctum
  • concurrent fever and malaise
  • can lead to preseptal cellulitis if not treated
103
Q

Symptoms of canaliculitis

A
  • excessive tearing
  • mucopurulent discharge
104
Q

True or false
There is swelling on the lacrimal sac in canaliculitis

A

False
* there is no swelling of lacrimal sac
* inflammation of the canaliculus

105
Q

Most effective tx for canaliculitits?

A

Canaliculotomy

106
Q

Most effective tx for canaliculitits?

A

Canaliculotomy

107
Q

Tx for acute Dacryocystitis

A

Augmentin 500 mg po TID for 14 days
* if patient does not report fever

But if pt does become ill then pt should be hospitalized and treated with IV antibiotics (cedazolin)

If chronic, surgery (dacryocystorhinstomy)

108
Q

RTC for acute Dacryocystitis

A

1 day
* monitor for improvement daily.
If worsens, intervention can occur in a timely manner

109
Q

What is a hordeolum?

A

An acute infection of the eyelid, commonly known as a stye

Hordeola can be classified as internal or external based on their location and are typically associated with pain.

110
Q

What are the most common pathogens causing hordeola?

A

Staphylococcus

Hordeola often occur concurrently with blepharitis.

111
Q

How are chalazia different from hordeola?

A

Chalazia are not infections and are caused by lipogranulomatous material

Chalazia typically cause little to no pain and can grow large, lasting a significant amount of time.

112
Q

What is the primary treatment for chalazia?

A

Frequent warm compresses and digital massage

Some doctors may prescribe oral antibiotics to treat concurrent meibomitis rather than the chalazion itself.

113
Q

What is dacryocystitis?

A

An inflammation of the lacrimal sac, which can be acute, chronic, or congenital

It can present with various symptoms depending on its type.

114
Q

What are the symptoms of chronic dacryocystitis?

A

Unilateral tearing, a mass in the nasal canthal region, intermittent discharge

The mass is typically not tender to the touch and may follow a history of acute dacryocystitis.

115
Q

What are the symptoms of acute dacryocystitis?

A

Unilateral pain, swelling, erythema of the tissue, mucopurulent discharge

Pain may radiate to the cheek, teeth, or face, and patients may also report fever or malaise.

116
Q

What causes acute dacryocystitis?

A

Obstruction of the nasolacrimal duct leading to stagnant fluid and infection

This condition can result in a mucopurulent discharge from the punctum if pressure is applied.

117
Q

Fill in the blank: A hordeolum is generally associated with some degree of _______.

A

pain

118
Q

True or False: Chalazia are typically acute in nature.

A

False

Chalazia are not acute and usually cause little to no pain.

119
Q

What are the three types of dacryocystitis?

A

Acute, chronic, congenital

120
Q

What are the symptoms of chronic dacryocystitis?

A

Unilateral tearing, mass in the nasal canthal region, intermittent discharge

Typically not tender to touch and often has a history of acute dacryocystitis

121
Q

What symptoms characterize acute dacryocystitis?

A

Unilateral pain, swelling, erythema, mucopurulent discharge

Pain may radiate to the cheek, teeth, or face

122
Q

What is the most common cause of acute dacryocystitis?

A

Obstruction of the nasolacrimal duct

123
Q

What infection is most frequently associated with acute dacryocystitis?

A

Staphylococcal origin

124
Q

What may acute dacryocystitis lead to if not treated timely?

A

Preseptal cellulitis

125
Q

What are the symptoms of preseptal cellulitis?

A

Diffuse swelling of the eyelid, tenderness, erythema

Extraocular motility is normal, pain on eye movement is absent, no proptosis

126
Q

What common history do patients with preseptal cellulitis report?

A

Insect bite, local skin abrasion, concurrent sinusitis

127
Q

What is the most common malignant eyelid lesion?

A

Basal cell carcinoma (BCC)

128
Q

How does basal cell carcinoma typically present?

A

Waxy, translucent nodule that eventually ulcerates

129
Q

What do patients often report about their basal cell carcinoma lesion?

A

It has been there for years and does not seem to heal

130
Q

What should be done if basal cell carcinoma is suspected?

A

Refer for a biopsy of the tissue

131
Q

Does basal cell carcinoma typically metastasize?

A

Very rarely

132
Q

Fill in the blank: Preseptal cellulitis causes _______ swelling of the eyelid.

A

Diffuse

133
Q

What is often prescribed alongside warm compresses and lid massage for MGD?

A

An oral antibiotic

This is especially common in advanced cases where the patient is symptomatic.

134
Q

What is the initial dosage and duration for tetracycline in treating MGD?

A

250 mg qi.d. for 1 week then b.i.d. for 6-12 weeks

‘qi.d.’ means four times a day and ‘b.i.d.’ means twice a day.

135
Q

What is the initial dosage and duration for doxycycline in treating MGD?

A

100 mg b.i.d. for 1 week then q.d. for 6-12 weeks

‘q.d.’ means once a day.

136
Q

What is the dosage and duration for minocycline in treating MGD?

A

100 mg daily for 6-12 weeks

137
Q

What recent findings have been shown regarding doxycycline dosage?

A

Decreasing the dosage from 100 mg to 20-50 mg offers the same efficacy

This change also reduces the potential for unwanted side effects.

138
Q

What properties do the oral medications for MGD provide?

A

Antimicrobial and anti-inflammatory effects

These effects are beneficial for treating eyelid symptoms.

139
Q

What serious pathology should be considered in patients with unilateral, intractable, or asymmetrical blepharitis?

A

Sebaceous gland carcinoma

Further testing should be performed to rule out this serious pathology.

140
Q

Floppy eyelid syndrome is typically observed in which demographic?

A

Older, obese males

These patients often complain of foreign body sensation or excessive ocular irritation.

141
Q

What symptoms do patients with floppy eyelid syndrome commonly experience?

A

Foreign body sensation or excessive ocular irritation

Symptoms are particularly noticeable upon awakening.

142
Q

What is a key characteristic of the eyelids in patients with floppy eyelid syndrome?

A

Increased laxity that can evert while sleeping

This leads to discomfort and irritation.

143
Q

What skin condition is characterized by persistent scaly, dry skin?

A

Actinic keratosis

This condition is not exhibited by the patient in the case.

144
Q

Who is most at risk for developing actinic keratosis?

A

People with lighter pigmentation and history of excessive ultraviolet light exposure

This demographic tends to be most vulnerable.

145
Q

What ocular manifestations are characteristic of systemic amyloidosis?

A

Yellow, waxy nodules in the inferior fornix and small conjunctival hemorrhages

These findings are significant indicators of the condition.

146
Q

How does an amelanotic nevus typically appear?

A

As a vascularized mass with little (to no) pigmentation

This distinguishes it from pigmented nevi.

NBEO Part 2 (20 decks)

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