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OD2-PPO > Lids, lashes, and adnexa > Flashcards

Lids, lashes, and adnexa Flashcards

1
Q

what is the function of the lids

A
  1. prevention of ocular desiccation (dryness)
  2. protection of the globe
  3. glandular secretion from the eyelids, helps maintain pre-ocular tear film
  4. spontaneous blinking
  5. reflex blinking-response to irritant/foreign bodies
  6. eyelids close during sleep
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2
Q

what are the muscles involved w/ the lids (ant to post)

A

orbicularis oculi
levator muscles
mueller’s muscles

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3
Q

what is the vascular supply to the lids

A

opthalmic branch of the internal carotid and facial artery (branch of external carotid)

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4
Q

what is the orbicularis oculi innervated by

A

7th cranial nerve

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5
Q

which muscle is involved in involuntary blinking and forcible closure

A

orbicularis oculi

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6
Q

what nerve is damaged in bell’s palsy

A

7th CN

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7
Q

what is the levator muscle innervated by

A

3rd CN

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8
Q

which muscle supports and elevates the supper lids

A

levator

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9
Q

what is mueller’s muscle innervated by

A

sympathetic NS

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10
Q

which muscle allows tonic eyelid elevation (slight elevation to uppper lid)

A

mueller’s muscle

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11
Q

what prevents the spread of pre-septal cellulitis

A

orbital septum

-restricts fluid from ant to post

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12
Q

where are the meibomian orifices located at

-what do they allow

A

tarsal plate

-allow secretion from mb to get to surface

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13
Q

what is the grey line

A

a diving landmark on the lid margin separating lids into ant and post layers
-btwn orifices and lashes

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14
Q

what is the gland of mall and what does it secrete

-where is it located

A

modified sweat gland
secretes fatty material and sweat into hair follicle
-clear secretions
-close to lid margin

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15
Q

what is the gland of zeiss
where is it found
what does it secrete

A

modified sebaceous gland
found along hair follicle
secretes lipid material into hair follicle
-lipid (yellow) secretions

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16
Q

what are meibomian glands and what role do they play

A

modified sebaceous glands that provides importnat tear constituents
-superficial lipid layer

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17
Q

where are the accessory lacrimal glands of krautz and wolfring
-what kind of tears do they provide

A

under palpebral conj

watery-like teras (aqueous tears)

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18
Q

what is a lid coloboma?
what are secondary problems that can form?
what is treatment?

A

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

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19
Q

what are epicanthal folds
what is the management
what can be found in ct
what may it be associated w/

A

redundant folds of skin extening from the upper lid across to the inner anthus

  • pseudostrabismus (eso)
  • may be associated w/ down

management: optional-surgery

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20
Q

how are epicanthal folds inherited

A

autosomal dominant

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21
Q

what is distichiasis

-what is the management

A

meibomian glands replaced by abnormal row of lashes

  • misdirected cilia, abnormal size
  • lashes frequently irritate the cornea
    manage: bandaged cl, epilation, electrolysis, cryotherapy
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22
Q

what can distichiasis may be seen with

A

chronic ocular infl

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23
Q

what are the ocular complications of distichiasis

A
  1. irritate bulbar conj
  2. secondary dry eye=> meib secretions replaced hair growth
  3. lashes irritate cnoj and cornea surface (fb sensation)
  4. inc reflex tearing
  5. inc likelihood infection (no lubrication, exposure to environ)
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24
Q

what is blepharophimosis

A

narrowing of lid fissure horizontally and vertically

  • common in fetal alcohol syndrome
  • autosomal dominant trait
  • congenital (5% of all ptosis cases)
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25
Q

what are some risk factors of blepharophimosis if acquired

A

bilateral ptosis

epicanthal folds

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26
Q

what are some facial findings of people w/ blepharophimosis

A
  • forehead bridge flatter and wider
  • tip of ears lower down, pinned down
  • btwn nose and mouth much shorter
  • nostril flares turned out more, wider
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27
Q

what are the congenital abnormalities of the eyelid

A

lid coloboma
epicanthal folds
distichiasis
blepharophimosis

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28
Q

what is ectropion

A

outward eversion of lower lid away from globe

-poor apposition of the lid to the conj

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29
Q

what are the associated sympotoms with ectropion

A
  • 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)
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30
Q

what are the objectiving findings of ectropion

A

-tearing
-hyperemia of bulbar conj
-conj drying: keratinization
-exposure keratitis
poor lid apposition (lower lid eversion)

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31
Q

what is the management/treatment of extropion

A
  • horizontal shortening of the lids

- artificial tear lubrication: tears/ointment

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32
Q

what are the classifications of ectropion

A
  1. congenital (rare)
  2. involutional (aging)
    - more common, horizontal taxity secondary to aging
  3. paralytic: secondary to 7th nerve palsy (temp or perm)
  4. spastic (lid trauma)
    - seen in younger indiv secondary to lid trauma
    - orbicularis muscle contracting lid to evert
  5. cicatricial (chemical or burns)
    - skin contractoin (scarring) secondary to burns or chem injury
  6. allergic (chronic allergies)
    - may produce thickened skin, w/ a tendencey to pull lid margins away from the globe
    - bilateral
  7. mechanical
    - growth causing lid margin to evert
    - usually unilateral
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33
Q

what is the treatment of ectropion

A
  1. artificial tear lubricants
    - for spk and hyperemia
    - 20-40min (4-6x a day)
  2. taping of lids
  3. bandaged cl
    - keep cornea less exposed to outside and protect conj and prevent drying
  4. surgical intervention
    - make lateral fissure smaller, sew corners of eyes together (tarsorrhaphy)
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34
Q

what treatment to use when it is ectropion from bell’s palsy

A

artificial tears, solution, or gel at night
surgical tape to shut lids
-lagging ophthalmus (can’t shut eyes completely)

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35
Q

what is entropion

A

an in-turning of the upper or lower lid margin potentially causing lashes to touch and irritate the cornea

36
Q

wha tare the sympotoms of entropion

A
  • excessive tearing in lower lid margin
  • irritation/fb sensation to conj tissue
  • hyperemia (red eye) to conj tissue
  • trichiasis (inward turn of lashes)
37
Q

what are the objective findings of entropion

A
  • lids turned inward
  • abrasion of lashes on conj and cornea
  • staining on cornea (+ w/ fl dye, fb tracks)
38
Q

what is the managetment of entropion

A
  1. epilation
  2. electrolysis
  3. cauterization
  4. bandaged cl
  5. artificial lubricant support
39
Q

what are the classifications of entropion

A 
congenital
spastic
involutional (aging)
cicatricial (chemical turn) 
mechanical 
chronic infection (trachoma)
-conjunctivitis, affects upper lid
40
Q

what is trichiasis

A

misdirected lashes from upper and lower lid

41
Q

what are the causes of trichiasis

A
  1. secondary from entropion
  2. chronic lid infections (bacterial conjunctivitis)
  3. secondary to lid scarring from trauma or repeated infl conditions
42
Q

what are the associated symptoms of trichiasis

A
  1. tearing
  2. irritation
    3 redness (hyperemia around conj area)
  3. fb sensation
43
Q

what are the objective findings of trichiasis

A
  1. eye lashes abrading conj and cornea

2. staining on cornea

44
Q

what is the management/treatment of trichiasis

A
  1. epilation
  2. electrolysis
  3. cauterization
  4. bandaged cl
  5. artificial lubricant support
45
Q

what is blepharochalasis

A

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
46
Q

what is the management/treatment of blepharochalsis

A

lid surgery, after disease process is quiet

47
Q

what is dermatochalasis

A

looseneed or redundancy of skin on the eyelid

  • pseduo-ptosis: upper lid drop
  • caused by aging
  • common
  • seen in middle to older aged pt
48
Q

what are the associated symptoms and findings of dermatochalasis

A

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)

49
Q

what is the treatment of dermatochalasis

A

blepharoplasty

  • common lid surgery
  • remove redundant tissue for cosmetic and VA
50
Q

what is ptosis

A

damage or developmental failure to the levator muscle, dystrophy of superior rectus, 3rd nerve

51
Q

what are the types of ptosis

A

congenital

acquired

52
Q

what are symptoms and associated findings to ptosis

A

upper lid drooping

may have decrease vision depending on extent of ptosis

53
Q

where is normal lid position

A

2mm below the limbus

2mm above pupil margin

54
Q

how does congenital ptosis occur

what are the assoicated causes

A

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%)
55
Q

what are the findings in congenital ptosis

A
  • primary gaze ptosis
  • impaired movement of lids in upgaze and downgaze
  • absence of tarsal fold
56
Q

in acquired ptosis what are the associated findings

A

brown aches
presence of tarsal fold
history

57
Q

what are the associated causes of acquired ptosis

A
  • 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
58
Q

what is the treatment for acquired ptosis

A

take steps to prevent amblyopia
surgery
lid crutch

59
Q

what is the staining pattern in trichiasis

A

fb track staining

60
Q

what is poliosis

A

whitening of eye lashes

-from skin disorder or depigmentation

61
Q

what is madarosis

A

partial loss of lashes

-lid injury, scarring, w/ chronic lid infections

62
Q

what is alopecia

A

complete loss of hair/lashes

63
Q

what is distichiasis

A

abnormal rows of lashes/misdirected lashes

64
Q

what is tyalosis

A

thicking of lid margins

  • chronic lid infections
  • see more on lower lid area
65
Q

what does nevus look like

A

usually flat and uniform
uniform pigmentation (focal)
congenital
8-10mm in size

66
Q

what is a papilloma

what does it look like

A
  • 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
67
Q

what is the management/treatment

A

document, monitor

excision or chemical cauterization

68
Q

what is xanthalasma

A

multiple soft yellow deposists under the skin on the inner aspect of the lower and upper lids

69
Q

what is the underlying cause of xanthalaasma

A
  • maybe associated w/ elevated serum cholesterol

- medical evaluation indicated

70
Q

what is the ocular appearance of xanthalasma

-where is it typically found

A
  • 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
71
Q

what is the treatment of xanthalasma

A

excision
laser treatment
bichloroacetic

72
Q

what is the underlying cause of pseudoriferous cyst

A

involves plugged sweat glands (gland of moll)

73
Q

what is the ocular appearance to the pseudoriferous cyst

A
  • along lid margin
  • focal elevation
  • taut surface
  • clear fluids (not lipid like, from gland of moll)
74
Q

what is the management/treatment in pseudoriferous cyst

A

excision with drainage

-need to lance bc when you poke it can reform

75
Q

what does a sebaceous cyst look like

A
  • along lid margin
  • focal elevation
  • taut surface: smooth tight surface
  • yellow/sebum
  • flat base, size of lesion can vary
76
Q

what is the management of sebaceous cyst

A

excision w/ drainage

77
Q

what are signs of malignancy

A

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
78
Q

what is the most commone eye lid malignancy

A

basal cell carcinoma

79
Q

what are the characteristics of basal cell carcinoma

A
  • 90% prevelence
  • slow growth potential, laterally then post
  • predominanctly derived from ep tissue
  • non metastatic
  • extensive loca destruction
80
Q

what are the risk factos for basal cell carcinoma

A
  • age: > 60 years
  • vocatoin: outdoors during sunlight
  • exposure: UV radiation
  • caucasian: fair skinned
81
Q

what does the nodular type of basal cell carcinoma look like

A

-most common presentation
-classic appearing lesion
raised
-approx 5-10mm in size
-pearly/translucent edges
-fine telangiectatic vessels

82
Q

what does the ulcerative form of basal cell carcinoma look like

A
  • most common
  • surface loses its fine skin lines
  • umbilication and erodes to create ulcerative center
  • raised(elevated lesion)
83
Q

what does the sclerosing form of basal cell carcinoma look like

A

less common

  • pale yellow
  • flatter and firm in texture
  • indistinct borders
  • difficult to distinguish
84
Q

what does the multi-centric form of basal cell carcinoma look like

A
  • less common
  • multi-lobulated tumor
  • found more on trunkal area
85
Q

what are the features of basal cell carcinoma

A
  • non metastasizing
  • caues extensive localized destructin
  • can recur
  • begins insidiously
  • progresses more rapidly laterally than posteriourly
86
Q

what is the management of basal cell carcinoma

A

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

OD2-PPO (8 decks)

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