Lids, lashes, and adnexa Flashcards
what is the function of the lids
- prevention of ocular desiccation (dryness)
- protection of the globe
- glandular secretion from the eyelids, helps maintain pre-ocular tear film
- spontaneous blinking
- reflex blinking-response to irritant/foreign bodies
- eyelids close during sleep
what are the muscles involved w/ the lids (ant to post)
orbicularis oculi
levator muscles
mueller’s muscles
what is the vascular supply to the lids
opthalmic branch of the internal carotid and facial artery (branch of external carotid)
what is the orbicularis oculi innervated by
7th cranial nerve
which muscle is involved in involuntary blinking and forcible closure
orbicularis oculi
what nerve is damaged in bell’s palsy
7th CN
what is the levator muscle innervated by
3rd CN
which muscle supports and elevates the supper lids
levator
what is mueller’s muscle innervated by
sympathetic NS
which muscle allows tonic eyelid elevation (slight elevation to uppper lid)
mueller’s muscle
what prevents the spread of pre-septal cellulitis
orbital septum
-restricts fluid from ant to post
where are the meibomian orifices located at
-what do they allow
tarsal plate
-allow secretion from mb to get to surface
what is the grey line
a diving landmark on the lid margin separating lids into ant and post layers
-btwn orifices and lashes
what is the gland of mall and what does it secrete
-where is it located
modified sweat gland
secretes fatty material and sweat into hair follicle
-clear secretions
-close to lid margin
what is the gland of zeiss
where is it found
what does it secrete
modified sebaceous gland
found along hair follicle
secretes lipid material into hair follicle
-lipid (yellow) secretions
what are meibomian glands and what role do they play
modified sebaceous glands that provides importnat tear constituents
-superficial lipid layer
where are the accessory lacrimal glands of krautz and wolfring
-what kind of tears do they provide
under palpebral conj
watery-like teras (aqueous tears)
what is a lid coloboma?
what are secondary problems that can form?
what is treatment?
gaps/notches in the lids
- incomplete structural formation
- can be unilateral (more common) and bilateral
secondary prob: exposure of tear film and cornea (prone to infections), ocular desiccation, risk of infections
treatment: oculoplastic surgery
what are epicanthal folds
what is the management
what can be found in ct
what may it be associated w/
redundant folds of skin extening from the upper lid across to the inner anthus
- pseudostrabismus (eso)
- may be associated w/ down
management: optional-surgery
how are epicanthal folds inherited
autosomal dominant
what is distichiasis
-what is the management
meibomian glands replaced by abnormal row of lashes
- misdirected cilia, abnormal size
- lashes frequently irritate the cornea
manage: bandaged cl, epilation, electrolysis, cryotherapy
what can distichiasis may be seen with
chronic ocular infl
what are the ocular complications of distichiasis
- irritate bulbar conj
- secondary dry eye=> meib secretions replaced hair growth
- lashes irritate cnoj and cornea surface (fb sensation)
- inc reflex tearing
- inc likelihood infection (no lubrication, exposure to environ)
what is blepharophimosis
narrowing of lid fissure horizontally and vertically
- common in fetal alcohol syndrome
- autosomal dominant trait
- congenital (5% of all ptosis cases)
what are some risk factors of blepharophimosis if acquired
bilateral ptosis
epicanthal folds
what are some facial findings of people w/ blepharophimosis
- forehead bridge flatter and wider
- tip of ears lower down, pinned down
- btwn nose and mouth much shorter
- nostril flares turned out more, wider
what are the congenital abnormalities of the eyelid
lid coloboma
epicanthal folds
distichiasis
blepharophimosis
what is ectropion
outward eversion of lower lid away from globe
-poor apposition of the lid to the conj
what are the associated sympotoms with ectropion
- excessive tearing (pulling at lower lid margin)
- fb sensation secondary to exposure of cornea
- varied sympt depending on degree of ectropion
- red eye: hyperemia of conj (bulbar)
what are the objectiving findings of ectropion
-tearing
-hyperemia of bulbar conj
-conj drying: keratinization
-exposure keratitis
poor lid apposition (lower lid eversion)
what is the management/treatment of extropion
- horizontal shortening of the lids
- artificial tear lubrication: tears/ointment
what are the classifications of ectropion
- congenital (rare)
- involutional (aging)
- more common, horizontal taxity secondary to aging - paralytic: secondary to 7th nerve palsy (temp or perm)
- spastic (lid trauma)
- seen in younger indiv secondary to lid trauma
- orbicularis muscle contracting lid to evert - cicatricial (chemical or burns)
- skin contractoin (scarring) secondary to burns or chem injury - allergic (chronic allergies)
- may produce thickened skin, w/ a tendencey to pull lid margins away from the globe
- bilateral - mechanical
- growth causing lid margin to evert
- usually unilateral
what is the treatment of ectropion
- artificial tear lubricants
- for spk and hyperemia
- 20-40min (4-6x a day) - taping of lids
- bandaged cl
- keep cornea less exposed to outside and protect conj and prevent drying - surgical intervention
- make lateral fissure smaller, sew corners of eyes together (tarsorrhaphy)
what treatment to use when it is ectropion from bell’s palsy
artificial tears, solution, or gel at night
surgical tape to shut lids
-lagging ophthalmus (can’t shut eyes completely)
what is entropion
an in-turning of the upper or lower lid margin potentially causing lashes to touch and irritate the cornea
wha tare the sympotoms of entropion
- excessive tearing in lower lid margin
- irritation/fb sensation to conj tissue
- hyperemia (red eye) to conj tissue
- trichiasis (inward turn of lashes)
what are the objective findings of entropion
- lids turned inward
- abrasion of lashes on conj and cornea
- staining on cornea (+ w/ fl dye, fb tracks)
what is the managetment of entropion
- epilation
- electrolysis
- cauterization
- bandaged cl
- artificial lubricant support
what are the classifications of entropion
congenital spastic involutional (aging) cicatricial (chemical turn) mechanical chronic infection (trachoma) -conjunctivitis, affects upper lid
what is trichiasis
misdirected lashes from upper and lower lid
what are the causes of trichiasis
- secondary from entropion
- chronic lid infections (bacterial conjunctivitis)
- secondary to lid scarring from trauma or repeated infl conditions
what are the associated symptoms of trichiasis
- tearing
- irritation
3 redness (hyperemia around conj area) - fb sensation
what are the objective findings of trichiasis
- eye lashes abrading conj and cornea
2. staining on cornea
what is the management/treatment of trichiasis
- epilation
- electrolysis
- cauterization
- bandaged cl
- artificial lubricant support
what is blepharochalasis
repeated idiopathic episodes of acute eyelids swelling => due to fluid accumulating btwn skin and orbicularis muscle
- redundant skin w/ wrinkle appreance
- pre mature wrinkling of lid adnexa
- rare
- seen in young pt
what is the management/treatment of blepharochalsis
lid surgery, after disease process is quiet
what is dermatochalasis
looseneed or redundancy of skin on the eyelid
- pseduo-ptosis: upper lid drop
- caused by aging
- common
- seen in middle to older aged pt
what are the associated symptoms and findings of dermatochalasis
usually bilateral but asymmetric in appearance
may have reduced VA (push down on upper lid)
may have reduced peripheral visual fields (redundant skin in visual axis temporally)
pseduoptosis
induced trichiasis (upper lid)
brow ache (frontalis muscle)
what is the treatment of dermatochalasis
blepharoplasty
- common lid surgery
- remove redundant tissue for cosmetic and VA
what is ptosis
damage or developmental failure to the levator muscle, dystrophy of superior rectus, 3rd nerve
what are the types of ptosis
congenital
acquired
what are symptoms and associated findings to ptosis
upper lid drooping
may have decrease vision depending on extent of ptosis
where is normal lid position
2mm below the limbus
2mm above pupil margin
how does congenital ptosis occur
what are the assoicated causes
secondary to development of levator muscle or isolated dystrophy of the levator muscle
- marcus gunn jaw winking syndrom (5%)
- blepharophimosis (5%)
- superior rectus weakness (25%)
what are the findings in congenital ptosis
- primary gaze ptosis
- impaired movement of lids in upgaze and downgaze
- absence of tarsal fold
in acquired ptosis what are the associated findings
brown aches
presence of tarsal fold
history
what are the associated causes of acquired ptosis
- trauma
- surgical damage
- oculomotor palsy (pupils spared!! if not, tumor)
- horner’s syndrome (sympathic NS affected=> muellers muscle, pupils affected, anhydrosis, myosis, partial ptosis)
- diabetes
what is the treatment for acquired ptosis
take steps to prevent amblyopia
surgery
lid crutch
what is the staining pattern in trichiasis
fb track staining
what is poliosis
whitening of eye lashes
-from skin disorder or depigmentation
what is madarosis
partial loss of lashes
-lid injury, scarring, w/ chronic lid infections
what is alopecia
complete loss of hair/lashes
what is distichiasis
abnormal rows of lashes/misdirected lashes
what is tyalosis
thicking of lid margins
- chronic lid infections
- see more on lower lid area
what does nevus look like
usually flat and uniform
uniform pigmentation (focal)
congenital
8-10mm in size
what is a papilloma
what does it look like
- beningn epithelial growth (polyp of skin)
- found around lid adnexa area
- well defied/textured lesions
- non-infectious
- slow growing
- can be pigemented or not
- can be single or multiple
- can be sessile (broader elevevated) or pedunculated (narrow base and comes forward)
- avascular, raised surface
- upward elevation of cells
what is the management/treatment
document, monitor
excision or chemical cauterization
what is xanthalasma
multiple soft yellow deposists under the skin on the inner aspect of the lower and upper lids
what is the underlying cause of xanthalaasma
- maybe associated w/ elevated serum cholesterol
- medical evaluation indicated
what is the ocular appearance of xanthalasma
-where is it typically found
- multiple pale yellow deposits, size varies
- slightly elevated but flat
- usually bilateral
- more common in women
- typically found on inner aspect of the lower and upper lids
- not portruding like papilloma
what is the treatment of xanthalasma
excision
laser treatment
bichloroacetic
what is the underlying cause of pseudoriferous cyst
involves plugged sweat glands (gland of moll)
what is the ocular appearance to the pseudoriferous cyst
- along lid margin
- focal elevation
- taut surface
- clear fluids (not lipid like, from gland of moll)
what is the management/treatment in pseudoriferous cyst
excision with drainage
-need to lance bc when you poke it can reform
what does a sebaceous cyst look like
- along lid margin
- focal elevation
- taut surface: smooth tight surface
- yellow/sebum
- flat base, size of lesion can vary
what is the management of sebaceous cyst
excision w/ drainage
what are signs of malignancy
Asymmetry, Bleeding, Color
- history of growth
- change in color
- change in size
- shape-lack of symmetry
- vascularization
- history of bleeding
- skin surface changes
- loss of hair growth
what is the most commone eye lid malignancy
basal cell carcinoma
what are the characteristics of basal cell carcinoma
- 90% prevelence
- slow growth potential, laterally then post
- predominanctly derived from ep tissue
- non metastatic
- extensive loca destruction
what are the risk factos for basal cell carcinoma
- age: > 60 years
- vocatoin: outdoors during sunlight
- exposure: UV radiation
- caucasian: fair skinned
what does the nodular type of basal cell carcinoma look like
-most common presentation
-classic appearing lesion
raised
-approx 5-10mm in size
-pearly/translucent edges
-fine telangiectatic vessels
what does the ulcerative form of basal cell carcinoma look like
- most common
- surface loses its fine skin lines
- umbilication and erodes to create ulcerative center
- raised(elevated lesion)
what does the sclerosing form of basal cell carcinoma look like
less common
- pale yellow
- flatter and firm in texture
- indistinct borders
- difficult to distinguish
what does the multi-centric form of basal cell carcinoma look like
- less common
- multi-lobulated tumor
- found more on trunkal area
what are the features of basal cell carcinoma
- non metastasizing
- caues extensive localized destructin
- can recur
- begins insidiously
- progresses more rapidly laterally than posteriourly
what is the management of basal cell carcinoma
all must be referred for removal
- biopsy to confirm
- excision: mohr’s tech
- frozen section surgery
- radio-therapy
- cryo-surgery
- environmental considerations
- continued monitoring for potential re-development or newer lesions
