LIDS, LASHES, AND ADNEXA Flashcards
1
Q
Lid coloboma
- Gap/notch in lid, not hereditary
- Unilateral more common than bilateral
- Upper lid: usually at jct of inner/middle third of lid
- Lower lid: usually at jct of middle/lateral third of lid
Symptoms
- Consistrent with dry eye
A
Signs
- Less irrigation of tear film, more exposure, faster evaporation
- More prone to secondary infection
- Lysozymes/lactoferrin unable to break down bacteria
Management
- Oculoplastic surgery
2
Q
DISTICHIASIS
- Meibomian orifices replaced by abnormal row of lashes
- Rare, autosomal dominant
- Usually bilateral
- Hair is misdirected twd cornea
Symptoms
- Foreign body sensation
- Redness, tearing, dryness
A
Signs
- Fluorescein track stains
- Lack of lipid layer (Meibomian orifices occluded, xs evaporation
Management
- Bandage contact lens
- Epilation
- Electrolysis
- Cryo Treatment
- Artificial Tears
3
Q
BLEPHAROPHIMOSIS
- Narrowing of lid fissure horizontally or vertically
- Lid structures are normal
- Autosomal dominant
- Associated with epicanthal folds or ptosis
Symptoms
- Decreased quality of vision
- Dry eye symptoms
A
Signs
- Reduced VA
- Amblyopia (deprivation)
Management
- Oculoplastic surgery
NOTES
- FAS: causes
- blepharophimosis,
- abnormal RE,
- absent philtrum,
- elongated upper lip,
- flared ala,
- flat midface,
- underdeveloped jaw,
- ear abnormalities
4
Q
ECTROPION
- Outward eversion of lower lid
- Congenital: rare
- Paralytic: secondary to bell’s palsy/CNVII paralysis
- Spastic: secondary to lid trauma, mostly seen in younger pts
- Orbicularis contracts, pulls lid down
- Cicatricial: secondary to facial burns, due to skin contraction
- Allergic: secondary to tyalosis
- Mostly chronic allergies
- Mechanical: secondary to growth
Symptoms
- Xs tearing
- Redness
- Foreign body sensation
A
Signs
- Tyalosis
- Exposure keratitis
- Poor lid apposition
Management
- Horizontal shortening of lids
- Artificial tears
- Bandage contact lens: water drawn
out of lens due to gradient – NOT
COMMON
5
Q
ENTROPION
- Inward turning of lid margin
- Involutional: age-related
- Cicatricial: secondary to burns
- Mechanical: due to growth
- Spastic: trauma related, transient
- Can also be secondary to trachoma
Symptoms
- Tearing
- Redness
- Irritation
- Foreign body sensation
A
Signs
- Secondary trichiasis
- Xs tering
- Hyperemia
- Track staining
Management
- • Epilation
• Electrolysis
• Cauterization
• Bandage contact lens
• Artificial tears
6
Q
BLEPHAROCHALASIS
- Repeated idiopathic episodes of acute lid swelling
- Fluid accumulates, stretches skin
Symptoms
- Decreased vision
- Brow ache
A
Signs
- Redundant lid skin with wrinkled appearance
- Decreased VA
- Pseudoptosis
Management
- Blepharoplasty
7
Q
DERMATOCHALASIS
- Loosened/redundant skin on lid
- Related to age, elasticity decreases
- Common
- Usually bilateral
Symptoms
- Decreased VA
- Brow ache
A
Signs
- Decreased VA
- Pseudoptosis
- Redundant lid skin
Management
- Blepharoplasty
8
Q
PAPILLOMA
- Benign epithelial growth
- Non-infectious
- Can be pigmented or non-pigmented, singular or multiple
- Pedunculated: smaller, stalk-like base
- Sessile: flat base, dome-shaped
- Texture similar to surrounding skin
- Space between them
- Well – defined, avascular
A
Management
- document,
- monitor,
- excise,
- cauterize w/bichloroacetic
acid
9
Q
XANTHELASMA
- Multiple soft yellow deposits under skin on
inner aspect of upper/lower lids - Associated with elevated cholesterol
A
Management
- excision,
- laser,
- cauterize (uncommon)
10
Q
BASAL CELL CARCINOMA
- Most common lid malignancy – 90% prevalence
- Derived from epithelial cells
- Non-metastatic – will get bigger, but won’t migrate
- Initially grows laterally, then deeper, creates
central indentation. Grows slowly. - Can recur
- Begins insidiously
- Progresses more rapidly laterally than posteriorly
- Extensive local destruction
A
Risk Factors
- Age over 60
- UV exposure
- Outdoor vocation
11
Q
BASAL CELL CARCINOMA
NODULAR TYPE
A
- Localized, raised
- Most common
- Center is depressed, houses visible, fine, telangetic blood vessels
- Edges appear pearly/translucent
- 5-10 mm in size
12
Q
BASAL CELL CARCINOMA
ULCERATIVE TYPE
A
- Skin loses its fine lines
- Center is ulcerated
- Distinct borders
- Telangetic vessels
visible
13
Q
BASAL CELL CARCINOMA
SCLEROSING TYPE
A
- Pale yellow
- Flatter
- Firm texture
- Indistinct borders
- Could be a bit red from vascularization, but
usually yellow - Less common
14
Q
BASAL CELL CARCINOMA
MULTI-CENTRIC TYPE
A
- Multi-lobulated tumor
- Found more on truncal area
- Less common
15
Q
Management of basal cell carcinoma
A
- Refer for removal
- Biopsy for confirmation
- Moh’s technique
- Surgeries:
- Excision
- Frozen section
- Radiotherapy
- Cryo-surgery
