Lids/Lashes/Lacrimal System Flashcards
What are the general lids/lashes/lacrimal system disease?
- Dermatochalasis
- Blepharochalasis
- Blepharitis
- Hordeolum –> Chalazion
- Ectropion
- Entropion
- Floppy Eyelid Syndrome
- Benign Essential Blepharospasm
- Meige syndrome
- Myokia
- Keratoacanthoma
What is a rare lid disease that affects young pts and causes repeated episodes of acute eyelid swelling?
Blepharochalasis
What are the signs of Staph Blepharitis?
- Collarettes
- Impale cilia
- Crusts
- Fibrinous impaled cornflakes
NOTE: Staph epidermidis > S. aureus
What are the signs of Seborrheic Blepharitis?
- Oily greasy scales
- Sleeves
- Madarosis
What is an acute infection (staph) of MGs called?
Internal hordeolum
What is an acute infection of the Zeiss/Moll?
External Hordeolum
Benign essential blepharospasm is spasms of which muscles?
- Orbicularis oculi
- Procerus
- Corrugator musculature
NOTE: may cause TMJ. Tx: Botox*
What is Meige’s syndrome characterized by?
BEB & lower facial abnormalities (i.e. difficulty chewing & opening the mouth, jaw spams, jaw pain, etc)
~50% pts w BEB have Meige’s syndrome
Describe Keratoacanthoma.
- Middle aged
- Males
- UV exposure
- Fast growth (~8 weeks)
- Shrinks & resolves on own
What are examples of eyelid cysts?
- Epidermal inclusion cyst (EIC)
- Milia
- Sebaceous cyst
- Sudoriferous cysts
NOTE: these are typically benign lesions that develop from the epithelium, often associated w the meibomian, sebaceous, and sweat glands of the eyelids
What is an acquired lesion found on the lid and surrounding adnexal tissue that may appear WHITE & is due to occlusion of sweat pores OR pilosebaceous follicles?
Milia
“small buried grains of white rice”
What is characterized by retention of fluid in the glands of Zeiss or retention of debris in the Meibomian glands?
Sebaceous Gland Cysts
Solitary, smooth lesions that are YELLOW or OPAQUE
Which eyelid cysts are elevated round lesions caused by blockage of the gland of MOLL?
Sudoriferous cysts
What are examples of infections of the lids/lashes?
- Pthiriasis palpebrum
2. Demodicosis
Hx of crab louse
Can be seen on eyelashes uni or bilaterally + blood-tinged debris
What do you think?
Phthiriasis palpebrum
Demodex on lashes
Eye pain in the morning*
See sleeving of the base of the lashes.
What do you think?
Demodicosis
Lice live in the follicles, come out to hatch eggs at night
What are the malignant growths of the lids/lashes?
- Basal cell carcinoma
- Squamous cell carcinoma
- Sebaceous gland carcinoma
- Malignant melanoma
Which malignant growth of the lid is the most common skin cancer in the US?
BCC
NOTE: also most common eyelid cancer
Profile of BCC?
- Males
- Fair skin
- UV
- Malignancy of basal cells=shiny pearly nodule w surface TELANGIECTASIA –> rodent ulcer
What is the 2nd most common eyelid malignancy?
Squamous cell carcinoma
NOTE: malignancy of the spinosum layer of epidermis AND MORE AGGRESSIVE than BCC
Name the progression toward Squamous Cell Carcinoma.
ACTINIC KERATOSIS (pre-cancer) –> CIN (carcinoma in situ) –> SCC (malignany) = erythematous plaque, rough/scaly
(-) surface telangiectasia
Which malignant growth of the lids is rare, seen in ELDERLY females, Hx of chalazia, highly infiltrative + inflammatory, with a HIGH MORTALITY rate?
Sebaceous Gland Carcinoma
NOTE: malignancy of sebaceous glands (Meibomian/Zeis). Can mimic BCC
Which malignancy of the lids is the MOST lethal Primary Skin Cancer?
Malignant melanoma
NOTE: malignancy of the melanocytes
Prognosis of Malignant melanoma depends on?
DEPTH of invasion
Progression of Malignant Melanoma?
LENTIGO maligna (pre-cancer) + Primary Aquired Melanosis (PAM) –> MM
- Children/young adults
- Hx bacterial/viral infection (vs sarcoid/grave’s vs idiopathic orbital inflamm)
- Swelling of outer 1/3 temporal upper lid
- Acute S shaped ptosis (chronic > acute episodes)
- (+) PAL
- Redness
Dacryoadenitis
Relevant Lacrimal System Disorders?
- Dacryoadenitis
- Dacryocystitis
- Canaliculitis
- Nasolacrimal duct obstruction
- Punctal Stenosis
- Ear/nose/throat infection
- Lacrimal drainage obstructed
- ACUTE PAIN»_space;
- Kids
Dacryocystitis
Chronic cases of Dacryocystitis should raise suspicion for what?
Epithelial carcinomas and malignant lymphomas
NOTE: carcinomas can express blood in the tear film w palpation of the lacrimal sac
- Viral/fungal
- Actinomyces israelii (canals + yellow rocks)
- Swollen pounting puncta
- Unresponsive to Ab Tx, mis-Dx as conjunctivitis
Canaliculitis!
- Congenital (membranous block of valve of Hasner)
- Acquired (involutional)
- Unilateral epiphora
- Reopens 1-2 months after birth
- Can cause secondary dacryocystitis
Nasolacrimal Duct Obstruction
NOTE: 5-30% new borns
- Narrowing or occlusion of puncta of upper and/or lower lid
- Older age
- Epiphora
Punctal Stenosis
Which Jones I or II is a Patent System?
Jones 1
Meaning if you blow nose into tissue –> NaFl will follow
If don’t see NaFl –> (-) –> Obstruction –> Move on to Jones II
What does Reflex Fluid mean in Jones 2?
Upper/lower canaliculus blockage (proximal to common canaliculus)
What does retrograde flow through opposite canaliculus mean?
Nasolacrimal blockage
What does it mean if they taste saline/recover in nose during Jones 2?
Cleared
