Lids, lashes, and adnexa Flashcards
1
Q
what is the function of the lids
A
- 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
2
Q
what are the muscles involved w/ the lids (ant to post)
A
orbicularis oculi
levator muscles
mueller’s muscles
3
Q
what is the vascular supply to the lids
A
opthalmic branch of the internal carotid and facial artery (branch of external carotid)
4
Q
what is the orbicularis oculi innervated by
A
7th cranial nerve
5
Q
which muscle is involved in involuntary blinking and forcible closure
A
orbicularis oculi
6
Q
what nerve is damaged in bell’s palsy
A
7th CN
7
Q
what is the levator muscle innervated by
A
3rd CN
8
Q
which muscle supports and elevates the supper lids
A
levator
9
Q
what is mueller’s muscle innervated by
A
sympathetic NS
10
Q
which muscle allows tonic eyelid elevation (slight elevation to uppper lid)
A
mueller’s muscle
11
Q
what prevents the spread of pre-septal cellulitis
A
orbital septum
-restricts fluid from ant to post
12
Q
where are the meibomian orifices located at
-what do they allow
A
tarsal plate
-allow secretion from mb to get to surface
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
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
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
16
Q
what are meibomian glands and what role do they play
A
modified sebaceous glands that provides importnat tear constituents
-superficial lipid layer
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)
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
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
20
Q
how are epicanthal folds inherited
A
autosomal dominant
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
22
Q
what can distichiasis may be seen with
A
chronic ocular infl
23
Q
what are the ocular complications of distichiasis
A
- 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)
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)
25
what are some risk factors of blepharophimosis if acquired
bilateral ptosis
| epicanthal folds
26
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
27
what are the congenital abnormalities of the eyelid
lid coloboma
epicanthal folds
distichiasis
blepharophimosis
28
what is ectropion
outward eversion of lower lid away from globe
| -poor apposition of the lid to the conj
29
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)
30
what are the objectiving findings of ectropion
-tearing
-hyperemia of bulbar conj
-conj drying: keratinization
-exposure keratitis
poor lid apposition (lower lid eversion)
31
what is the management/treatment of extropion
- horizontal shortening of the lids
| - artificial tear lubrication: tears/ointment
32
what are the classifications of ectropion
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
33
what is the treatment of ectropion
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)
34
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)
35
what is entropion
an in-turning of the upper or lower lid margin potentially causing lashes to touch and irritate the cornea
36
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)
37
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)
38
what is the managetment of entropion
1. epilation
2. electrolysis
3. cauterization
4. bandaged cl
5. artificial lubricant support
39
what are the classifications of entropion
```
congenital
spastic
involutional (aging)
cicatricial (chemical turn)
mechanical
chronic infection (trachoma)
-conjunctivitis, affects upper lid
```
40
what is trichiasis
misdirected lashes from upper and lower lid
41
what are the causes of trichiasis
1. secondary from entropion
2. chronic lid infections (bacterial conjunctivitis)
3. secondary to lid scarring from trauma or repeated infl conditions
42
what are the associated symptoms of trichiasis
1. tearing
2. irritation
3 redness (hyperemia around conj area)
4. fb sensation
43
what are the objective findings of trichiasis
1. eye lashes abrading conj and cornea
| 2. staining on cornea
44
what is the management/treatment of trichiasis
1. epilation
2. electrolysis
3. cauterization
4. bandaged cl
5. artificial lubricant support
45
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
46
what is the management/treatment of blepharochalsis
lid surgery, after disease process is quiet
47
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
48
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)
49
what is the treatment of dermatochalasis
blepharoplasty
- common lid surgery
- remove redundant tissue for cosmetic and VA
50
what is ptosis
damage or developmental failure to the levator muscle, dystrophy of superior rectus, 3rd nerve
51
what are the types of ptosis
congenital
| acquired
52
what are symptoms and associated findings to ptosis
upper lid drooping
| may have decrease vision depending on extent of ptosis
53
where is normal lid position
2mm below the limbus
| 2mm above pupil margin
54
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%)
55
what are the findings in congenital ptosis
- primary gaze ptosis
- impaired movement of lids in upgaze and downgaze
- absence of tarsal fold
56
in acquired ptosis what are the associated findings
brown aches
presence of tarsal fold
history
57
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
58
what is the treatment for acquired ptosis
take steps to prevent amblyopia
surgery
lid crutch
59
what is the staining pattern in trichiasis
fb track staining
60
what is poliosis
whitening of eye lashes
| -from skin disorder or depigmentation
61
what is madarosis
partial loss of lashes
| -lid injury, scarring, w/ chronic lid infections
62
what is alopecia
complete loss of hair/lashes
63
what is distichiasis
abnormal rows of lashes/misdirected lashes
64
what is tyalosis
thicking of lid margins
- chronic lid infections
- see more on lower lid area
65
what does nevus look like
usually flat and uniform
uniform pigmentation (focal)
congenital
8-10mm in size
66
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
67
what is the management/treatment
document, monitor
| excision or chemical cauterization
68
what is xanthalasma
multiple soft yellow deposists under the skin on the inner aspect of the lower and upper lids
69
what is the underlying cause of xanthalaasma
- maybe associated w/ elevated serum cholesterol
| - medical evaluation indicated
70
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
71
what is the treatment of xanthalasma
excision
laser treatment
bichloroacetic
72
what is the underlying cause of pseudoriferous cyst
involves plugged sweat glands (gland of moll)
73
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)
74
what is the management/treatment in pseudoriferous cyst
excision with drainage
| -need to lance bc when you poke it can reform
75
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
76
what is the management of sebaceous cyst
excision w/ drainage
77
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
78
what is the most commone eye lid malignancy
basal cell carcinoma
79
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
80
what are the risk factos for basal cell carcinoma
- age: > 60 years
- vocatoin: outdoors during sunlight
- exposure: UV radiation
- caucasian: fair skinned
81
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
82
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)
83
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
84
what does the multi-centric form of basal cell carcinoma look like
- less common
- multi-lobulated tumor
- found more on trunkal area
85
what are the features of basal cell carcinoma
- non metastasizing
- caues extensive localized destructin
- can recur
- begins insidiously
- progresses more rapidly laterally than posteriourly
86
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
