Neuromuscular Lid Disorders Flashcards
You have a 65 year old patient that complains of obicularis involuntarily closing in both eyes. What is your diagnosis?
A. Blepharospasm B. Blepharoclonus C. Myokymia D. Pseudograefe E. Jaw Winking/ Marcus Gunn
Blepharospasm
Key:
Involuntary orbicularis in both eyes
What is the treatment for blepharospasm?
A. Botox B. Quinine C. Tonic H2O D. Surgery E. Do nothing
Botox
Key:
You want to stop muscle spasm.
You have a patient that’s unable to stop blinking that occurred a few days after the had an inflamed sclera. What is your diagnosis?
A. Blepharospasm B. Blepharoclonus C. Myokymia D. Pseudograefe E. Jaw Winking/ Marcus Gunn
Blepharoclonus
Key:
Secondary to ocular inflammation.
You have a patient that is complaining of one eye jumping or quivering. He notes he’s on medication for fatigue and stress. Also is a binge drinker. What is your diagnosis?
A. Blepharospasm B. Blepharoclonus C. Myokymia D. Pseudograefe E. Jaw Winking/ Marcus Gunn
Myokymia
What is the best long term management for myokymia?
A. Botox B. Quinine or tonic H2O C. Surgery D. Cold compress and topical anesthetics E. Do nothing
Quinine or tonic H2O
What is best temporary relief for myokymia?
A. Botox
B. Cold compresses and anesthetics
C. Surgery
D. Do nothing
Cold compresses and anesthetics
You have a patient that comes in that complains of their eye moving upwards when the move their eye in. The patient also noted that this came after they had an injury that caused a 3rd nerve palsy. What is the diagnosis?
A. Blepharospasm B. Blepharoclonus C. Myokymia D. Pseudograefe E. Jaw Winking or Marcus Gunn
Pseudogreafe
You have a patient that has a ptosis since birth. You also note that when patient open mouth that the ptosis improves. What is the diagnosis?
A. Blepharospasm B. Blepharoclonus C. Myokymia D. Pseudograefe E. Jaw Winking or Marcus Gunn
Jaw winking or Marcus Gunn
What is the best long term management for Marcus Gunn/Jaw Winking?
A. Botox B. Quinine or tonic H2O C. Surgery D. Cold compress and topical anesthetics E. Do nothing
Surgery
Describe Blepharospasm
- bilateral involuntary orbicularis
- occurs mostly in females, onset 6th decadeh
- Tx: Botox every few weeks to decrease muscle response
Describe Blepharoclonus
- excessive blinking
- subsequent to secondary ocular inflammation
Describe Myokymia
- Fasciculations (twitching) of orbicularis
- complains of jumping, quivering
- etiology: fatigue, stress, medications, excess alcohol consumption
- Tx: cold compress and topical anesthetics temporarily, quinine or tonic H2O to reduce quivering
Describe Psedograefe
- aberrant regeneration secondary to traumatic 3rd nerve palsy. MR fivers go to Levator palpebrae superioris.
- Concurrent elevation upon adduction
Describe Jaw winking or Marcus Gunn
- occurs in 5% congenital ptosis
- patient opens mouth improves ptosis
- Tx: Surgery
