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Ocular Disease > Midterm 1 > Flashcards

Midterm 1 Flashcards

1
Q

qhs

A

every bed time

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2
Q

epicanthus plan

A

No treatment is required

Parents must be reassured that their child will most likely outgrow the condition

Infants should be observed and reevaluated every 6 months
-It is possible that true esotropia, particularly accommodative esotropia, may develop

If epicanthus is limiting the pt’s visual field (VF), then surgery can be performed

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3
Q

Coloboma facts

A
  • rare anomoly
  • Primarily congenital, but may be 2’ to trauma
  • Upper lid coloboma is often associated with cryptophthalmos – failure of eyelid formation
  • The eyelid skin grows continuously from the forehead to the cheek, covering the underlying globe
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4
Q

Blepharospasm secondary to

A

FB
Trichiasis
Keratitis

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5
Q

Ectropion subjective

A
  • Tearing
  • Eye or eyelid irritation
  • Constantly wiping eyes (exacerbates problem)
  • History of burns, surgery or trauma around lids
  • Concurrent Bell’s Palsy
  • Asymptomatic
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6
Q

myokymia treatment- meds

A

Botulinum toxin type A (Botox)

  • Injected into affected area
  • 2.5-5U IM q3mo

Antihistamines

Quinine 200-300mg PO qd-bid
Tonic Water!!!!!

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7
Q

Comorbid diagnoses include:

w/ blepharospasm

A

Dry eyes (49%)

Other neurologic disease (8%)

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8
Q

Conditions relieving blepharospasm included:

A

Sleep (75%)

Relaxation (55%)

Inferior gaze (27%)

Artificial tears (24%)

Traction on eyelids (22%)

Talking (22%)

Singing (20%)

Humming (19%)

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9
Q

Trichiasis Surgical Care: repositioning

A

Lash and follicle repositioning

Directed toward the anatomical cause of the problem

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10
Q

ectropin

A

Abnormal eversion of the lower lid margin away from the globe
-usually lower lid

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11
Q

Dermatochalasis plan

A
  • Can assess impact with a Visual Field
  • Patients with blepharitis may benefit from lid hygiene and topical antibiotics
  • Patients with dermatitis may benefit from topical steroid ointment
  • In general, the treatment is surgical
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12
Q

Horner’s syndrome

A
  • Ipsilateral findings of mild ptosis, miosis, and anhidrosis
  • The inferior eyelid may be elevated
  • Because of the lack of sympathetic innervation to the iris melanocyte development, a difference in the iris color between the eyes may result (heterochromia)
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13
Q

coloboma + eyelids

A

Trichiasis

Dermoid tumors

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14
Q

blinking

A
  • Average about 15-20 blinks / minute
  • One blink takes about 0.25 seconds
  • Disease may alter rates (ex. Pakinson’s, Hyperthyroid)
  • Partial blinks
  • Aggravated by keratoconjunctivitis sicca (dry eye)
  • -Remember contact lens wearers
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15
Q

ptosis treatement- things to check for during exam

A

Head posture should be carefully examined
-If the patient acquires a chin-up posture due to the worsening of ptosis, surgery may be indicated

-The patient should be checked for astigmatism due to the compression of the droopy eyelid

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16
Q

Staphylococcus aureus on lid margin

A

S. aureus is normally present on the lid margins of a small number of individuals

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17
Q

primary goal of coloboma treatment

A

Corneal protection is the primary goal in the medical treatment of eyelid colobomas

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18
Q

Angular Blepharitis

A

-Localized eczematoid inflammation of the lid at the outer canthus and sometimes medial canthal region

Staphylococcal form
Dry and scaly

Moraxella form
Wet

  • macerated lid with whitish, frothy discharge
  • Angular blepharitis may also involve the conjunctiva
  • All forms of angular blepharitis call for treatment with an antibiotic ointment
  • May need to try different antibiotics based on bacteria type
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19
Q

Hypersensitivity to staphylococcal toxins Ag-Ab-Complement triggered

A

Ag (staph product) +
Ab (produced in conjunctiva) +
complement components (from limbal blood vessels) –>
C3a and C5a (chemotactic factors for white cells from the limbal blood vessels)
White spot in cornea of an accumulation of white cells

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20
Q

entropion subjective

A
  • Ocular irritation
  • Foreign-Body sensation (FB sensation)
  • Pain or no pain
  • Tearing
  • Red-eye
  • Light sensitivity (photophobia)
  • Possible decreased vision
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21
Q

treatment for mild ectropion

A

Lubrication and moisture shields are helpful if significant corneal exposure exists

Mild dryness - RTC 1-2 wks to evaluate the efficacy of therapy

If conjunctiva is markedly keratinized, a lubricating ointment should be used several days or weeks prior to ectropion repair

  • taping lids
  • wipe eyelids ip and in (towards the nose)
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22
Q

myogenic ptosis

A

Myasthenia Gravis
-Abnormality at the neuromuscular junction

  • Fatigability of voluntary muscle
  • Ptosis: bilateral but asymmetrical
  • Pt may have a history of fluctuating ptosis and strabismus
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23
Q

entropion treatment- botox

A

botulinum toxin (BOTOX®)

  • small amounts are quite effective for the treatment of spastic entropion
  • Weakens the pretarsal orbicularis oculi muscle
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24
Q

Dermatochalasis objective

A

The eyelid skin should be evaluated carefully
-Amount of skin redundancy, thickness of the skin, skin inflammation, and skin lesions

Presence of an upper eyelid crease should be noted and measured
-Normal upper eyelid crease falls 8-12 mm above the lid margin; generally higher in women

-Levator muscle function is usually intact

Eyelid margin position also should be noted

Normal upper eyelid margin position should fall ~1 mm below the superior limbus

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25
Q

s. epidermidis etiology

A

overgrowth– usual present on the lid margins (normal flora)

- inflammatory response of the body

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26
Q

coloboma + Sclera

A

Epibulbar Dermoid Tumor

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27
Q

Trichiasis plan

A

Lubricants may decrease the irritant effect of lash rubbing

If a more serious disease is the cause - medical therapy should be geared toward that disease

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28
Q

ectropion causes: cicatricial

congenital

A

Cicatricial (scarring)
-Due to chemical burn, surgery, trauma, chronic dermatitis, surgery, fractures, and other causes of scars

congenital is rarely an isolated anomaly

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29
Q

Electrocautery for ectropion

A

at the junction of conjunctiva and lower margin of the tarsus

vertical lines are placed inside the eyelid- poke holes– scarring pulls up lid

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30
Q

treatment for cicatricial ectropion

A

Cicatricial ectropion following trauma or lid surgery,
-digital massage may help stretch the scar

Skin grafts are another option

  • May be obtained from the upper lid if dermatochalasis (discussed later) is present
  • Preauricular or postauricular skin is another alternative
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31
Q

Associated Marginal Infiltrate

A
  • wbc infiltrate cornea between the epithelium and stroma (subepithelial)
  • white spot on cornea periphery with a clear area between it and limbus
  • does not stain with fluorscein
  • wbc die + release enzymes that damage the epithelium above infiltrate
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32
Q

coloboma + Lens

A

Cataract (anterior)

Subluxation

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33
Q

Meibomian Seborrheic Blepharitis

etiology

A

Excessive oil production

Quality of oil is abnormal

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34
Q

surgical treatment ectropion

Tarsorrhaphy

A

lids partially sewn together

-if cornea is exposed

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35
Q

Meibomian Seborrheic Blepharitis

objective

A
  • Frothing of tears
  • “Oil slick” in tear film
  • TBUT may be reduced
  • Conjunctival injection
  • Lid tissue appears normal
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36
Q

Trichiasis causes trauma

A

Postsurgical

  • Floor fracture repair or blepharoplasty
  • After enucleation
  • After ectropion repair

Chemical

  • Alkali burns to the eye
  • Medical drops (eg, glaucoma drops)

Thermal burns to face/lids

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37
Q

what is seb bleph associated with

A

stpah super infection

- plan = same for staph bleph

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38
Q

Distichiasis

A

lashes that are growing out of the meibomian glands (2nd row of lashes)

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39
Q

ectropion diagnosis

A

The lid distraction test
-how far the lid margin can be pulled away from the globe
> 8mm = lid margin laxity

The snap test
-How quickly the lid margin snaps back against the globe after it has been pulled away from it
> 1-2 seconds indicates lid margin laxity

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40
Q

Blepharospasm therapy

A

Reassurance!

Oral meds are not too effective

Botulinum toxin type A (Botox)
Injected along upper and lower eyelid
20-25U per eye IM q3mo
Most require re-injection in 3-4 months

Surgical

  • Last choice in therapy
  • Involves removal of the orbicularis
  • Reserved for those who are unresponsive to botulinum toxin
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41
Q

Antibiotics ointment applied to lid margin

  • bacitracin
  • erythromycin
  • gentamicin
  • tobramycin
  • reginmen
A

Bacitracin
-Cell wall inhibitor

Erythromycin
-Macrolide

Gentamicin
-Aminoglycoside

Tobramycin
-Aminoglycoside

Regimen
Moderate: qhs or bid
Severe: tid or qid

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42
Q

Dermatochalasis plan: surgical plan

A

Upper eyelid blepharoplasty should always be performed following a careful history and examination prior to the surgery

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43
Q

Associated Phlyctenule

A

-Hypersensitivity reaction to staph toxins

  • Raised white lesion on conjunctiva, limbus, or cornea
  • Can move over cornea, pulling blood vessels and scarring as it goes
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44
Q

Blepharospasm symptoms

A

Increased blink rate (77%)

Eyelid spasms (66%)

Eye irritation (55%)

Midfacial or lower facial spasm (59%)

Brow spasm (24%)

Eyelid tic (22%)

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45
Q

do marginal infiltrates stain?

A

no

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46
Q

3rd nerve palsy

A

defective adduction, depression and elevation

normal abduction

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47
Q

entropion medical therapy

A

May be warranted for pts who decline surgery

Ocular lubrication and tear preparations

  • Helpful for protecting the ocular surface
  • May break the cycle in pts with spastic entropion 2’ to dry eye syndrome
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48
Q

Cicatricial entropion surgery

A
  • Depends on the degree and etiology of scarring
  • Mild cases - removal of scar
  • More extensive scarring may require grafts

Cautery is another option (temporary) – Poor aesthetics
-vertical lines on exterior lid

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49
Q

coloboma why?

A

May result from the defective fusion of temporal and nasal waves of mesodermal tissue

Ischemia
Could cause problems in part of the lid that is farthest from the principal blood supply

Colobomas can effect many different structures (ex. iris, retina, ONH, etc)

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50
Q

Ectropion objective

A
  • Outward turning of the eyelid margin
  • Exposure keratopathy: Inflammation of the cornea caused by irritation
  • Conjunctival injection: Dilated blood vessels, which give a red appearance to the conjunctiva/sclera
  • Keratinization (2’ to conj drying)
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51
Q

what do tetracyclines inhibit

A

lipase synthesis by the bacteria

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52
Q

Epiblepharon

A

The pretarsal orbicularis muscle and the skin covering the eyelid push the eyelashes vertically or inwards

  • The eyelid margin is in a normal position
  • Usually resolves spontaneously as the face matures
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53
Q

staph bleph treatment- lid hygiene

A
  • remove crusts
  • remove bacteria
  • increase blood circ to lid margin
  • two step- warm compress + lid scrubs
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54
Q

Goblet cells

A

-In conjunctival epithelium
Secrete mucin
-Abundant at plica semilunaris (caruncle)
-None on limbus or mucocutaneous junction

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55
Q

pseudoptosis

A
  • dermatochalasis- excessive skin
  • prosthetic eye
  • contralateral lid retraction
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56
Q

ectropion causes

A

Acquired

  • Involutional (lid laxity age)
  • Paralytic (nerve issues)
  • Cicatricial (due to scarring)
  • Mechanical (Something is pushing or causing it)
  • Allergy (swelling)

Congenital (born that way)

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57
Q

Neurogenic ptosis

A

Horner’s syndrome

Deficient innervation of CNII to the levator

  • Diabetes Mellitus ( DM)
  • Aneurysms of the internal carotid artery
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58
Q

-Thyroid eye disease

A

frequently can be associated with dermatochalasis

-Associated with infiltration of the orbital fat and extraocular muscles with immunoglobulin complexes

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59
Q

Myokymia

A

Fasciculation of the orbicularis

“An annoying twitch”

Etiology:
Stress, tension, lack of sleep, caffeine, etc.
OPTOMETRY SCHOOL!

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60
Q

entropion causes

A

Involutional
Acute Spastic
Cicatricial
Congenital

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61
Q

ectropion objective- may also note

A

Punctate Epithelial Erosions (PEE)

  • Corneal epithelium loss
  • Caused by a variety of conditions
  • ex. tear abnormalities, exposure, etc
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62
Q

Phlyctenule

Treatment

A

Treat the staphylococcal blepharitis and add:

Topical steroid q2h to qid 
Prednisolone acetate
Dexamethasone
Loteprednol
Or…
Topical antibiotic/steroid combination such as tobramycin with dexamethasone, or tobramycin with loteprednol q2h to qid
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63
Q

orbicularis muscle (palpebral portion)

A
  • Striated
  • Eyelid closing muscle - used in blinking and voluntary winking
  • Keeps lid tight to globe
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64
Q

baby shampoo for lid scrub

A
  • The baby shampoo is first diluted one-to-one with water in a ‘cup’ in the palm of the hand.
  • This is then mixed by rubbing with the clean fingertips and then applied in a gentle oval scrubbing motion to the margin and eyelash base of the closed eyelid for 1 minute, followed by a fresh water facial rinse.
  • The baby shampoo can alternatively be diluted in a container (e.g. plastic cup) and scrubbing performed using a washcloth wrapped around a finger (after dipping it in the diluted shampoo). A cotton tip applicator may be used alternatively.
  • NOT recommended anymore due to drying effects
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65
Q

Blepharoclonus

A

Increased frequency of blinking

Increased closure phase

Caused by

  • Irritation
  • Inflammation

Most frequently seen in children

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66
Q

Trichiasis objective

A
  • Physical examination helps to elucidate the cause of lash misdirection
  • Treatment based on cause of misdirection
  • Examine both the upper and the lower lids
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67
Q

Levator aponeurosis

A

-Striated
-Lid opening muscle
-Innervated by CN III
-Fibers pass through the
orbicularis to attach to the skin

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68
Q

Trichiasis subjective

A 
FB sensation
Red eyes
Pain
Photophobia
Tearing
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69
Q

Trichiasis causes autoimmune

A

Ocular cicatricial pemphigoid

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70
Q

ectropion assessment

A

Take careful history

Slit-lamp exam – check for P.E.E., exposure keratopathy, etc.

Treatment is based on cause and severity

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71
Q

treatment for mild ptosis

A

Observation is required if no signs of amblyopia, strabismus, and abnormal head posture

Follow-up every 3-4 months for signs of amblyopia due to congenital ptosis

External photographs can be helpful in monitoring patients.

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72
Q

Blepharospasm subjective

A

essential blepharospasm - increased blink rate and intermittent eyelid spasms

Blepharospasm commonly is associated with dystonic movements of other facial muscles

Changes associated with long-standing blepharospasm include:

  • eyelid and brow ptosis
  • Dermatochalasis
  • Entropion
  • canthal tendon abnormalities
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73
Q

Marcus Gunn “jaw-winking” syndrome

A
  • Anomalous innervation pattern

- Lid elevation occurs with mastication or with movement of the jaw to the opposite side

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74
Q

Dermatochalasis subjective

A

A functional (obstructs superior field) and / or a cosmetic problem

In addition, patients may note:

  • ocular irritation
  • Entropion of the upper eyelid
  • Ectropion of the lower eyelid
  • Blepharitis
  • Dermatitis
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75
Q

Wolfring

A
  • near tarsus; basal aqueous secretion
  • Both assist lacrimal gland in aqueous secretion
  • Only lacrimal gland has reflex secretion (tearing)
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76
Q

Epicanthus

A

a crescent fold of skin that extends from the side of the nose to the lower lid and partially covers the inner canthus

Invariably bilateral
Although it may be asymmetrical

Normally, asymptomatic

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77
Q

permanent fixes for ectropion

Involutional ectropion

A

Most surgeons elect to shorten and tighten the lower lid – called a Tarsal Strip

Usually only a few stitches that are often removed 7 to 14 days later

Almost immediate resolution of the condition

blepharoplasty

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78
Q

Seborrheic Blepharitis etiology

A

allergic bleph
Unknown
-Often associated with seborrheic dermatitis
-Chronic disorder of the skin/head areas where sebaceous glands are abundant
-Dandruff (AKA scurf) - excessive shedding of dead skin cells of the scalp - is often a symptom of seborrheic dermatitis

79
Q

Congenital entropion

A
  • Very rare
  • Usually in the lower eyelid
  • It may arise due to a number of underlying developmental abnormalities
80
Q

staph bleph follow up

A

1-3 weeks depending on severity and medications prescribed

-if cornea involved then follow up within days

81
Q

Patient education

A
  • Chronic condition - Usually exacerbations and remissions
  • Goal: to control not cure
  • Importance of daily lid hygiene
  • Medication for acute flare-ups
82
Q

what does pus indicate?

A

bacterial infection

83
Q

Trichiasis plan surgical

A

Lash and follicle destruction surgery
Preferred for segmental or focal trichiasis.

Epilation – usually temporary

  • When lash grows back - often short and irritating
  • Often leaves the lash follicle

Electrolysis

  • Can be effective
  • Often painful for the pt and tedious for the surgeon

Wedge resection of the lid
-Requires a full-thickness resection of the lid margin

Radiofrequency ablation
-Extremely effective

Cryosurgery - effective, but many potential complications

84
Q

treatment: surgery ptosis

A

Done by:
Shortening of the levator
Must have some levator function

Frontalis suspension procedure

  • Levator function must be poor
  • The lids are linked to the frontalis movement
85
Q

lid position in downgaze ptosis

A

congenital: the ptotic lid appears higher in downgaze
acquired: ptotic lid is equal to the non-ptotic lid

86
Q

A large lid coloboma plan

A

immediate surgical closure is usually needed to prevent corneal compromise

A 2-stage reconstruction may be required
Consists of a tarsal –
-reconstruction w/ skin graft

87
Q

coloboma + Cornea

A

Exposure keratopathy

Corneal scarring

88
Q

Eyelid Coloboma

A
  • full-thickness defect of the eyelid

Triangular defect
-Base of the notch primarily at the margin

It primarily affects upper lid
-Usually between the inner and middle third of the lid

If in the lower lid
-Usually between the middle and outer third of the lid

89
Q

amount of ptosis

A

different between fissures

mild 1-2mm
moderate 2-3mm
severe > 4 mm

90
Q

BlephEx

A
  • Rysurg
  • Medical grade disposable micro-sponge spins along edge of eyelids and lashes
  • Removes scurf/debris and exfoliates eyelids
  • Proparacaine usually instilled prior to treatment
  • Eyes rinsed afterwards
  • 6 -8 minute procedure
91
Q

orbicularis muscle (orbital portion)

A
  • Striated

- Eyelid closing muscle - used in forced closure

92
Q

what innervates the facial nerve?

A

CN VII - facial

93
Q

Hypochlorous acid 0.02%

A
  • Ocusoft HypoChlor™
  • Spray or gel
  • Used as needed or daily
  • Can be used with lid wipes
  • Spray form often used AM
  • Gel form often used PM
  • Generic versions as well
94
Q

Cicatricial entropion

A

Result of scaring of the palpebral conjunctiva
-A consequent inward rotation of the lid margin

Digital eversion of the eyelid margin is difficult in cases of cicatricial entropion

95
Q

Mechanical ptosis

A

Excessive weight

  • Edema
  • Tumors

Traumatic
-Lacerations effecting nerves or muscles

96
Q

ptosis objective

A

One lid appears lower

Can look at old family picture to assess for any changes in ptosis

97
Q

entropion objective

A
  • The eyelid is turned in!
  • P.E.E. (from exposure)
  • Foreign body tracking
  • Conj injection
  • Corneal ulcer
  • Decreased corneal sensation
  • Corneal scarring if long-term
98
Q

Dermatochalasis Differential Diagnoses

A
  • Entropion
  • Floppy Eyelid Syndrome
  • Steatoblepharon
  • ptosis
99
Q

staph bleph

Secondary mechanism of inflammation

A

Production by the bacteria of lipase

  • -> breaks down the lipids in the tears
  • -> free fatty acids (FFAs)
  • -> trigger inflammatory and irritative response
100
Q

staph bleph subjective

A
  • depends on severity
  • chronic irritation and burning
  • FB
  • tender lids (hordeola/chalazia)
  • crusts on lashes
  • lids stick together in morn
  • complaint of red irritated lids
101
Q

what do docycycline inhibit

A

staph exotoxin- induced cytokines and chemokines

- helpful even if the bacteria are resistant to the antibiotic effect

102
Q

Dermatochalasis causes

A

The most common cause is a normal aging phenomenon

Trauma

Pts with severe periorbital edema may develop redundancy of the eyelid skin

  • This can be severe enough to cause a functional visual field defect
  • Chronic renal insufficiency can be associated with periorbital edema
  • Chronic dermatitis
103
Q

Meibomian Seborrheic Blepharitis

treatment

A
  • lid margin cleaning

- lubricants

104
Q

Blepharospasm affected

A

Patients over 50

F>M

There are at least 50,000 cases of blepharospasm in the United States

Up to 2000 new cases diagnosed annually
The prevalence is approximately 5 in 100,000

105
Q

Muller’s muscle

A
  • Originates from the underside of the levator
  • Smooth
  • Lid opening muscle
  • Innervated by the sympathetic system
  • Inserts into superior tarsus
106
Q

Orbital septum

A
  • Attaches peripherally at the periosteum at the orbital margin
  • Centrally, it fuses with levator aponeurosis (upper lid) and the tarsal plate (lower lid)
  • Acts as diaphragm to separate orbital structures from lid structures
107
Q

seb bleph subjective

A
  • wet bleph
  • Frequently asymptomatic
  • Possible morning “mattering”
  • Dry eye complaints (poor tear film)
  • Symptoms may depend on other concurrent processes
108
Q

Trichiasis causes

A

Stevens-Johnson syndrome

Vernal keratoconjunctivitis

109
Q

congenital ptosis

A
  • 90% of ptosis cases
  • Present at birth
  • 70% of cases are unilateral
110
Q

what type of hypersensitivity reaction is phlyctenule

A

Type IV reaction

111
Q

entropion Surgical Therapy

A
  • Multiple surgical procedures have been described
  • The most common procedures utilized in the management are as follows:
  • Repair of involutional entropion
  • Repair of the horizontal laxity
112
Q

types of acquired ptosis

A

Neurogenic

Myogenic

Aponeurotic
-Where the levator aponeurosis has undergone structural changes which reduces its ability to lift the eyelid

Mechanical

113
Q

angular bleph etiology

A

-Chronic lid irritation
-Skin drying, scaling, cracking in outer canthi
Cause
-Moraxella lacunata
-Staphylococcus epidermidis
-Staphylococcus aureus

114
Q

floppy eyelid syndrome

A

Disorder of the eyelids that is associated with severely redundant and lax eyelids
Skin and muscles are affected
Tarsal plate develops a rubbery consistency
When chronic, this leads to markedly redundant and lax eyelid skin and orbicularis muscle

115
Q

Associated Marginal Infiltrate

treatment

A

treat bleph + add

Topical steroid q2h to qid 
Prednisolone acetate
Dexamethasone
Loteprednol
Or…

Topical antibiotic/steroid combination such as tobramycin with dexamethasone (Tobradex), or tobramycin with loteprednol (Zylet) q2h to qid
(every 2 hours)

116
Q

medial ectropoim
lateral
tarsal

A

Medial
-Can see an everted medial aspect of the lid

Lateral
-Can see an everted lateral aspect of the lid

Tarsal (complete)
-Can see the entire lower lid everted

117
Q

trichiasis Objective

Look for

A

Conjunctival scarring

FB tracking on cornea (linear defects)

Entropion

Distichiasis

Symblepharon formation

118
Q

Staphylococcal Blepharitis etiology

A

Infection of the lash follicles and lid margins with s. aureus or s. epidermidis

119
Q

seb bleph interpalpebral pee

A

spreads toxicity around cornea

120
Q

lid scrubs

A
  • diluted baby shampoo + water or commercially available cleansers
  • scrub lid margin
  • bid to qid after warm compress
121
Q

seb bleph treatment

A
  • plain jane
  • lid hygiene
  • lubricants
  • follow 2-4 weeks
  • pt education on chronicity
122
Q

seborrheic bleph objective

A

-Greasy, waxy scales at the base of the lashes that flake off easily (dandruff-like)(AKA scurf)
-Skin of the lid a little greasy
- not infecive =>
inflam + allergic

123
Q

ziess gland

A
  • around hair follicle
  • Unilobular gland
  • Produce oils for the lash follicles
124
Q

clinical evaluation for congenital ptosis

A

If congenital ptosis obscures any part of the pediatric pt’s visual field, surgery must be performed to correct the problem early in life

  • Otherwise, a permanent loss of vision may occur as a result of amblyopia
  • Occlusion amblyopia
  • Astigmatism from the compression of the droopy eyelid
125
Q

coloboma + Conjunctiva

A

Injection
Symblepharon
Malformation of the caruncle

126
Q

what does CN VII cause?

A
  • eyelids to close
  • mouth and cheeks to ‘smile’
  • forehead to ‘furrow’
127
Q

most common form of ectropion

A

involutional

  • Horizontal lid laxity
  • Usually due to age-related weakness
  • Most patients are elderly
  • Laxity-related ectropion typically begins medially
  • With time, the central lid margin and the lateral lid may evert
128
Q

Steatoblepharon

A

Herniation of the orbital fat in the upper or lower eyelids.

129
Q

staph bleph objective

A
  • crusts along lash line at the base of lashes
  • dried pus
  • encircles crust= collarette
  • crust at lash base can appear oily
  • infected follicles and madarosis
  • ulcers at base of lashes
  • trichiasis
  • tylosis- red thickened hardened lid margin
  • secondary conjuctivities
130
Q

ectopion

In pts with suspected facial nerve palsy:

A

Orbicularis dysfunction can be tested by

  • Asking pt to show their teeth rather than smile
  • Compare elevation of the angles of the lips
  • Inferior scleral show should be distinguished from ectropion
131
Q

angular bleph treatment

A

moraxella- zinc sulfate 0.25% solution

staph- bacitracin or erythromycin

132
Q

Cicatricial entropion scar tissue

A

Scar tissue of the conjunctiva is usually a result of:

  • Trauma
  • Infections
  • Chemical burns
133
Q

punctal ectropion

A

If you can see the puncta without manipulation, this is punctal ectropion

134
Q

Blepharospasm

A

Any abnormal tic or twitch of the eyelid

Bilateral involuntary orbicularis contraction: results in eye closure

Spasmodic

Idiopathic

135
Q

Tarsal plate

A
  • Dense fibrous connective tissue
  • Responsible for structural integrity of the lids
  • Upper plate about 1 cm high x 2.5 cm wide
  • Lower tarsal plate smaller dimensions
136
Q

acquired ptosis causes

A

Affliction of the nerve supply to the lid musculature

Diseases of the muscles

Mechanical interferences in elevation

137
Q

Dermatochalasis

A

Redundant and lax eyelid skin overhanging the margin

Mainly seen in elderly
Age of onset most frequently is noted in the 40s and progresses with age

Some patients have a familial tendency and develop dermatochalasis in their 20s

138
Q

Acute spastic entropion

A

Usually occurs as a result of ocular irritation
May be due to an infectious, inflammatory, or traumatic (eg, surgical) processes

Orbicularis oculi muscle overwhelms the oppositional action of the lower eyelid retractors

Most of these patients often have an involutional component.

139
Q

Meibomian Seborrheic Blepharitis

subjective

A

dry eye complaints

140
Q

lubricants

A

if keratitis cornea
-dry eye secondary to lid condition
- Artificial tears qid or prn
(when necessary)

141
Q

Punctate epithelial erosions (PEE)

A
  • subjective for staph bleph
  • rxn to bacterial exotoxins
  • PEE in inferior third of the cornea
  • PEE stains with fluorescein
  • divits in the cornea epithelium that cause fluorescein to fluress
142
Q

what happens if inflam is caused by bacteria?

A

PMNs (polymorphonucleosides) move from the blood into the tissue to fight the infection through phagocytosis
dead PMNs + protein clot = pus

143
Q

ectropion causes: medical; allergic

A

Mechanical
Due to herniated orbital fat, eyelid tumor and others

Allergic
Contact dermatitis

144
Q

Dermatochalasis causes

A
  • Gravity
  • Loss of elastic tissue in the skin, and
  • Weakening of the connective tissues

-More common in the upper eyelids but can be seen in the lower eyelids

145
Q

oral antibiotics

A

Valuable when unusually severe

146
Q

entropion causes

involutional

A
  • May be due to numerous problems

- The patient may exhibit horizontal laxity of the medial and/or lateral canthal tendons.

147
Q

Aponeurotic ptosis

A

Loss of levator tone and / or degeneration of levator attachments

Usually bilateral

Most common acquired ptosis

148
Q

coloboma: Treatment of small defect

A

Treatment of small defects (or large defects awaiting surgery) include the following:

Artificial tears and ointment

Moist chamber optical bandages

Bedtime patching

149
Q

moll gland

A

sweat

oil production

150
Q

what happens during the inflammation response staph bleph

A
  • dilation of blood vessels (redness)
  • increased vasc permeability (edema + blood proteins)
  • ## Movement of PMNs from blood into tissue
151
Q

entropion treatment hygiene + CL

A

Eyelid hygiene, antibiotics, and steroids
-Useful for treating blepharitis, which may cause spastic entropion

-Bandage Contact Lens to protect cornea

152
Q

Trichiasis causes infectious

A

Blepharitis
Herpes zoster
Trachoma (chlamydia)

153
Q

what was the primary cause of phylctenules

A

TB
- pts who were immigrants from areas with tb or peeps who acquired it
now staph is primary cause again

154
Q

epicanthus objective

A

Pseudo-esotropia
-A condition in which the alignment of the eyes is straight; however, they appear to be crossed

More common in infants and toddlers, esp those of Asian decent

  • Normally present in fetal life from the 3rd to 6th month
  • If this normal fetal structure fails to regress, clinical epicanthus is seen

Common in those with autosomal dominant inheritance patterns (ex. trisomy 21)

155
Q

Krause

A

near fornix; basal aqueous secretion

156
Q

Meibomian gland

A
  • Sebaceous gland (oil)
  • Provides the oily layer of the tear film
  • Meibomian gland opening just behind the lashes
157
Q

warm compress

A

soak lids with warm wet compress (lids closed)
10-15 min bid-qid
(2xday, 4xday)

158
Q

-Blepharochalasis

A

separate and distinct from dermatochalasis
A rare disorder that typically affects the upper eyelids
Characterized by intermittent eyelid edema
Results in relaxation of the eyelid tissue and resultant atrophy
Unilateral in ~50%

159
Q

congenital ptosis causes

A

Irregularity of the levator muscle (myogenic)

  • Fibrous and adipose tissues are present in muscle belly, rather than normal muscle fibers
  • Diminishes ability of the levator to contract and relax1
  • Abnormality of CN III superior division (neurogenic)
  • nerve signals are not strong enough
160
Q

Hypothyroid

A

Body lacks sufficient amounts of thyroid hormone

161
Q

what are the two major causes of hypothryoid

A
  1. Inflammation
    Most common cause of inflammation is autoimmune thyroiditis (Hashimoto’s Disease)
  2. The broad category of “medical treatments”
    The treatment of many thyroid conditions warrants surgical removal of a portion or all of the thyroid gland
162
Q

Hyperthyroid

A

Condition caused by the effects of too much thyroid hormone

163
Q

what is the most common underlying cause of hyperthyroidism?

A

graves’ disease

  • An autoimmune disease
  • -Autoantibodies (Thyroid-stimulating immunoglobulins) attach to specific activating sites
  • -This causes the thyroid gland to grow and make more hormone
164
Q

TED mechanism

A
  • TED pts produce autoantibodies that bind to fibroblasts cells with in the eye socket
  • fibroblasts produce chemical signals
165
Q

what is the hallmark of active TED

A

accumulation of orbital glycoaminoglycans (hylauronic acid) –> leads to swelling + congenstion in and around the eye socket

166
Q

what is the main AB is produced by TED pts

A

TSI- thyroid stimulating immunoglobin

- amount of TSI correlates w/ TED severity – can be tested in blood

167
Q

what are the orbital changes with TED

A

Increase in orbital volume causes forward protrusion

-Results in proptosis, restricted eye muscle movement and, in some patients, optic neuropathy

168
Q

why/how does the proptosis occur

A
  • enlarged ocular muscles + soft tissue
  • glycoproteins accumulate
  • pushes eyes forward
  • presses on ON
  • reduced eye movements
  • strabismus
169
Q

what is the major risk factor of TED

A
  • smoking

- radioiodine

170
Q

TED overview

A

a multisystem autoimmune disorder

171
Q

euthryoid condition

A

eye signs of graves disease occur in pt who is not hyperthyroid
10%

172
Q

active phase TED

A

congestive inflam phase

  • red + painful eyes
  • thyroid therapy shortens active phase
173
Q

TED symptoms

A 
Dry Eyes
Puffy Eyelids
Angry-looking eyes
Bulging eyes
Diplopia
Visual loss
Field loss
Dyschrmoatopsia
Photopsia on upgaze
Ocular pressure or Pain
174
Q

what is the easiest way to classify TED by structure

A

LIDS

  • lid retraction
  • puffy lids
175
Q

lid lag

Von Graefe’s sign

A

Delay of upper lid in following globe movement in downward gaze (Von Graefe’s sign) *

176
Q

lid lag

Dalrymple sign

A

Lid retraction in primary gaze

177
Q

how to manage lid signs

A

lubrication

surgery after 6m-1y

178
Q

conjunctival chemosis

A

extrusion of orbital fat

179
Q

Conjunctiva and Corneal Signs

by structure

A

Injected, chemotic conjunctiva

Superior limbic keratoconjunctivitis

Signs of corneal exposure and ulceration

180
Q

conj cornea management

A

Management

Lubrication

-Elevate head during sleep

Tinted cosmetic lenses

Steroids (systemic and periocular)

181
Q

Orbital decompression

A

removal of one or more of the walls in the orbit- gives more space for ON

182
Q

EOM signs w/ TED

A

Apparent under-activity of extraocular muscles

-Most common is fibrosis of IR
Causing diplopia on up-gaze
-2nd most common is MR
-Then the SR and Levator
-Finally the LR

elevated IOP on upgaze

183
Q

EOM signs management

A

Lubrication

Eye patching or prisms

Meds
Steroids
botulinum toxin

Surgery - wait 6 months to 1 year

184
Q

Fundus Signs w/ TED

A

-optic neuropathy- compression of ON

185
Q

optic nerve signs management

A

Orbital decompression

IV then oral Steroids

186
Q

Nospecs

A 
class 0
No physical sign or symptoms
187
Q

nOspecs

A 
class 1
only signs, no symptoms (upper eyelid retraction, stare + eyelid lag
188
Q

noSpecs

A 
class 2
Soft tissue involvement (symptoms +signs
189
Q

nosPecs

A 
class 3
proptosis
190
Q

nospEcs

A 
class 4
extraocular muslce involvemen
191
Q

nospeCts

A 
class 5
corneal involvement
192
Q

nospecS

A 
class 6
sight loss (optic nerve involvement
193
Q

VISA

A

order of what should be treated first

Vision loss
Inflammation / congestion and Activity in TED
Strabismus / motility
Appearance / exposure

Ocular Disease (7 decks)

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