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Ocular Disease > Ocular Disease: Lecture 4: Eyelids > Flashcards

Ocular Disease: Lecture 4: Eyelids Flashcards

1
Q

What are the 6 Acquired Anomalies?

A
  • Blepharochalasis
  • Brow Ptosis
  • Dermatochalasis
  • Eyelid Imbrication
  • Floppy Eyelid Syndrome
  • Involutional Ptosis
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2
Q

Acquired Anomalies: Floppy Eyelid Syndrome (1)

  1. How common is it and usually seen in whom?
  2. Uni or bilateral?
  3. What are they at risk for at night and why?
  4. 6 other Associations?
A
  1. Uncommon: But usually affects Obese Middle Aged Men
  2. Both (uni or bilateral LAX LID)
  3. Exposure Keratopathy; this is 2ndary to poor lid coverage at night
  4. Diabetes; Hyperelastic Skin; Joint Hypermobility; Keratoconus; Mental Retardation; Sleep Apnea
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3
Q

Acquired Anomalies: Floppy Eyelid Syndrome (2): Symptoms

  1. What is seen for the upper lid skin?
  2. What happens to the Tarsal Plate?
  3. What else is seen superiorly?
  4. 2 other things possible?
A
  1. Redundant upper lid skin
  2. becomes loose and rubbery: easily reverts w/pressure below the brow
  3. Chronic, Severe Micropapillary Conjunctivitis seen superiorly
  4. Keratopathy (Puncate, filamentary); and Superior Corneal Vascularization is possible
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4
Q

Acquired Anomalies: Floppy Eyelid Syndrome (3): Treatment

  1. What 2 things can be done?
A
  1. Mild: Lubrication

2. Severe: Horizontal Shortening of Upper Lids

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5
Q

Acquired Anomalies: Involutional Ptosis (1)

  1. Related to what?
  2. Usually uni or bi lateral?
  3. What is it?
  4. Tends to worsen when?
A
  1. Age-related
  2. Usually Bilateral
  3. Disinsertion, Stretching, rupture of aponeurosis of levator
  4. At the end of the day.
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6
Q

Acquired Anomalies: Involutional Ptosis (2): Symptoms

  1. Major symptom?
  2. What about the function of the Levator?
A
  1. Bilateral Ptosis w/very High upper lid crease. (crease may be absent in very severe cases)
  2. Good levator Function
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7
Q

Acquired Anomalies: Involutional Ptosis (3): Treatment

  1. 3 things can be done
A
  1. Levator Resection
  2. Levator Advancement with re-insertion
  3. Anterior Levator Repair
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8
Q

Acquired Anomalies: Dermatochalasis (1)

  1. What is it?
  2. Often associated with what?
  3. What defect is normally seen?
  4. What other 2 things are felt?
  5. Management?
A
  1. Laxity and redundancy of upper lid tissue
  2. with Prolapse of Orbital Fat
  3. Superior VF Defect (2ndary to Pseudoptosis)
  4. Heavy Sensation; Brow Ache
  5. Blepharoplasty (Remove excess skin)
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9
Q

Acquired Anomalies: Blepharochalasis (1)

  1. How common is it?
  2. What is it?
  3. Onset at what?
  4. Episodes resolve how?
A
  1. uncommon
  2. Recurrent episodes of painless Edema of Upper Lids
  3. At Puberty (Frequency decreases over time)
  4. Spontaneously in 1-2 days
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10
Q

Acquired Anomalies: Blepharochalasis (2)

  1. 3 Complications?
A
  1. Redundant Skin
  2. Orbital Fat Prolapse
  3. Ptosis (Severe Cases)
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11
Q

Acquired Anomalies: Blepharochalasis (3)

  1. 2 treatments possible
A
  1. Blepharoplasty

2. Ptosis Correction if Necessary

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12
Q

Acquired Anomalies: Eyelid Imbrication (1)

  1. How common is it?
  2. Uni or bi lateral?
  3. What is it?
  4. Associated with what 5 things?
A
  1. Uncommon
  2. Either
  3. Upper lid Overlaps the Lower Lid
  4. a. Complications from surgery
    b. Eyelid tumors
    c. Floppy Eyelid Syndrome
    d. Mucous Membrane Disease
    e. Self Injury
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13
Q

Acquired Anomalies: Eyelid Imbrication (2):

  1. 2 signs/symptoms?
A
  1. Chronic Papillary Conjunctivitis

2. Staining of upper lid margin

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14
Q

Acquired Anomalies: Eyelid Imbrication (3)

  1. 2 types of treatment?
A
  1. Surgery to correct for loose lids (full thickness wedge)

2. Other surgery to tighten lid position

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15
Q

Acquired Anomalies: Brow Ptosis (1)

  1. What is it?
  2. May be caused by what?
  3. Often Accompanies what other Acquired Anomaly?
  4. Treatment?
A
  1. Excessive Skin on brow and forehead, leading to a pseudoptosis
  2. due to 7th nerve palsy
  3. Dermatochalasis
  4. Brow Lift (Often combined with blepharoplasty)
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16
Q

Neurologic Lid Disorders

  1. 4 Facial/Eyelid Twitch Disorders?
A
  1. Benign Eyelid Twitch
  2. Benign Essential Blepharospasm
  3. Hemifacial Spasm
  4. Meige Syndrome
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17
Q

Neurologic Lid Disorders

  1. What other 2 disorders?
A
  1. Pseudo-Graefe

2. Marcus Gun Jaw Winking

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18
Q

Neurologic Lid Disorders: Benign Essential Blepharospasm (BEB) (1)

  1. How common is it?
  2. When does it normally present? (decade)
  3. More common in whom?
  4. What is it?
  5. Three types
A
  1. Uncommon, but a Distressful disorder
  2. In the 6th Decade
  3. Women
  4. Bilateral Involuntary Spasm of Orbicularis Oculi and Some facial Muscles
  5. Spastic BEB, Pseudo Apraxic BEB, and Combined BEB
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19
Q

Neurologic Lid Disorders: Benign Essential Blepharospasm (BEB) (2)

Spastic BEB (BEBs)

  1. What is ti?
  2. Frequency and Severity?
  3. When does it stop?
A
  1. Synchronous, Forceful closing of BOTH Eyes
  2. Varies
  3. Abates during sleep
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20
Q

Neurologic Lid Disorders: Benign Essential Blepharospasm (BEB) (3)

Pseudo-Apraxic BEB (BEBa)

  1. What is it?
  2. Can also be what?
  3. When does it stop?
  4. Combined BEB (BEBc): Is characteristic of what?
A
  1. Synchronous, Drifting close of eyes
  2. Asymmetric
  3. Abates during sleep
  4. of Both BEBs and BEBa
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21
Q

Neurologic Lid Disorders: Meige Syndrome

  1. What is it?
A
  1. BEBs, BEBa or BEBc

PLUS

Spasm/Writhing movement of

(Lower face (mouth/tongue), Midface (cheeks), and possibly the neck)

22
Q

Neurologic Lid Disorders: Benign Eyelid Twitch (Eyelid Myokymia) (1)

  1. What is it?
  2. Involves which lid more often?
  3. What do they say happens subjectively?
  4. Objectively what do we see?
A
  1. Fine fasciculation of the muscles of the lid on one eye
  2. Lower Lid > upper lid
  3. Eye moves wildly
  4. there is minimal movement
23
Q

Neurologic Lid Disorders: Benign Eyelid Twitch (Eyelid Myokymia) (2)

  1. Type of frequency?
  2. Duration?
  3. Resolution?
  4. Associated with what 4 things?
A
  1. Episodic (seconds to hours)
  2. Minutes to months
  3. usually resolves WITHOUT Treatment is the norm.
  4. a. Anxiety
    b. Excess Caffeine
    c. Fatigue
    d. Stress
24
Q

Neurologic Lid Disorders: Hemifacial Spasm

  1. uni or bilateral?
  2. What is it?
  3. When does it come on? (decade)
  4. Cause (2)?
  5. Treatment? (2)
A
  1. Unilateral
  2. Spastic contraction of Muscles of the entire 1/2 of the face. (closure of one eye)
  3. 5th-6th decade
  4. Idiopathic; Irritation of 7th nerve near Brainstem
  5. Neuroimaging; referral
25
Q

Neurologic Lid Disorders: Aberrant Regernation of CN 3 (third nerve misdirection) (1)

  1. 2 ways to get it?
  2. Follows CN 3 palsy in causes (4)?
  3. Cause?
    a. Innervation of what?
    b. Results in what happening?
A
  1. Congenital or acquired
  2. Compressive; Congenital; Not ischemic; Traumatic
  3. Due to misdirection of regenerating CN 3 axons
    a. of Incorrect muscles
    b. in Bizarre movements of lid and sometimes the pupil
26
Q

Neurologic Lid Disorders: Aberrant Regernation of CN 3 (third nerve misdirection) (2)

Symptoms/Signs

  1. Major symptom/sign?
  2. Other sign?
A
  1. Lid Synkinesis: Pseudo Graefe Sign (Lid elevation with adduction or elevation)
  2. Czarnecki’s Sign: Pupil Constriction with Adduction or Elevation
27
Q

Neurologic Lid Disorders: Marcus Gunn Jaw Winking Syndrome (1)

  1. Uni or bilateral?
  2. Can be associated with what congenital disease?
  3. Etiology?
A
  1. Usually Unilateral
  2. Congenital Ptosis
  3. Possible Misdirection of Mandibular Division of CN 5 to Levator
28
Q

Neurologic Lid Disorders: Marcus Gunn Jaw Winking Syndrome (2)

Signs/Symptoms

  1. Retraction of Ptotic Lid with Stimulation of what?
  2. Does it improve with age?
A
  1. of Ipsilateral Pterygoid Muscles (Chewing, Sucking, opening mouth)
  2. No. But they learn to Mask it.
29
Q

Neurologic Lid Disorders: Marcus Gunn Jaw Winking Syndrome (3)

  1. Treatment?
A
  1. Surgery
    a. Levator Resection
    b. Levator Disinsertion
    c. Bilateral Levator Disinsertion
30
Q

Diseases of Lid Displacement

  1. Four of them
A
  1. Ptosis
  2. Ectropion
  3. Entropion
  4. Ocular Myopathy
31
Q

Diseases of Lid Displacement: Ptosis (1)

  1. 6 classifications of it
A
  1. Aponeurotic
  2. Mechanical
  3. Myogenic
  4. Neurogenic
  5. Congenital
  6. Pseudoptosis
32
Q

Diseases of Lid Displacement: Ptosis

Aponeurotic

  1. How common is it?
  2. Associated with 5 things?
  3. What is it?
  4. What muscle still functions well?
A
  1. Most common form of ptosis
  2. Age; Eye Surgery; Chronic Swelling; Pregnancy; Trauma
  3. Disinsertion or Defect of Levator Aponeurosis
  4. Levator muscle
33
Q

Diseases of Lid Displacement: Ptosis

Mechanical

  1. What happens?
A
  1. Decreased elevation of the Eyelid Secondary to either Eyelid Mass or Scarring
34
Q

Diseases of Lid Displacement: Ptosis

Myogenic

  1. What is it?
  2. 3 causes?
A
  1. Weakness of the Actual Levator Muscle
  2. a. Chronic Progressive External Ophthalmoplegia
    b. Myotonic Dystrophy
    c. Myasthenia Gravis
35
Q

Diseases of Lid Displacement: Ptosis

Neurogenic

  1. Cause?
    a. What nerve branch?
A
  1. Innervation defect (CN 3 to Levator)

a. Sympathetic- Muller (horners syndrome)

36
Q

Diseases of Lid Displacement: Ptosis

Congenital Ptosis

  1. Already talked about previously
  2. Uni or bilateral?
  3. Function?
A
  1. Either

3. Poor function from birth

37
Q

Diseases of Lid Displacement: Ptosis

Signs/Symptoms

  1. What VF defect is seen?
  2. Ache occurs at what location?
  3. what happens to VA?
  4. 3 things to consider
A
  1. Superior VF defect
  2. Brow Ache
  3. Decreased VA
  4. a. Ensure no risk of deprivation Amblyopia in a child
    b. VF to measure Superior VF Loss
    c. Can refer for surgical correction if Visual or cosmetic concerns
38
Q

Diseases of Lid Displacement: Pseudoptosis

  1. It’s a FALSE Ptosis due to what 5 things?
A
  1. Brow Ptosis
  2. Contralateral Lid Retraction
  3. Decreased Orbital Volume
  4. Dermatochalsis
  5. Ipsilateral Hypotropia
39
Q

Diseases of Lid Displacement: Ectropion (1)

  1. What is it?
  2. 4 types of Classifications?
A
  1. Outward Rolling of Lower Lid
  2. a. Involutional
    b. Cicatricial
    c. Paralytic
    d. Mechanical
40
Q

Diseases of Lid Displacement: Ectropion (2)

Involutional (age-related)

  1. Due to changes including what 4 things?
A
  1. Disinsertion of Lower Lid Retractors
  2. Horizontal Lid Laxity
  3. Lateral Canthal Tendon Laxity
  4. Medial Canthal Tendon Laxity
41
Q

Diseases of Lid Displacement: Ectropion (3)

Involutional (age-related)

  1. Treatment?
A
  1. Horizontal Lid Shortening
42
Q

Diseases of Lid Displacement: Ectropion

Cicatricial

  1. Cause is due to what?
    a. 3 things that can do this?
  2. What does it do?
  3. What accentuates it?
A
  1. Scarring and Contracture
    a. Burns; Chronic Inflammation; Trauma
  2. Pulls lid away from the eye
  3. Opening the mouth
43
Q

Diseases of Lid Displacement: Ectropion

Cicatricial

  1. What usually resolves Ectropion?
  2. 2 types of treatment?
A
  1. Release of Traction

2. Excision of Scar tissue; Severe cases may need a Skin Graft

44
Q

Diseases of Lid Displacement: Ectropion

Paralytic

  1. Cause?
A
  1. Ipsilateral CN 7 Palsy (may be temporary)
45
Q

Diseases of Lid Displacement: Ectropion

Mechanical

  1. Cause?
  2. Treatment?
A
  1. Lesion in or near lid margin (weight of it causes the lid eversion)
  2. Removal of lesion
46
Q

Diseases of Lid Displacement: Entropion

  1. What is it?
  2. 3 Classifications?
A
  1. Inward rolling of lid

2. Involutional; Cicatricial; Congenital

47
Q

Diseases of Lid Displacement: Entropion

Involutional

  1. Mainly affects what lid?
  2. Due to what 4 things?
A
  1. Mainly Lower Lid
  2. Horizontal Lid Laxity
    b. Vertical Instability
    c. Orbital Septum Laxity
    d. Overriding of Pretarsal Orbicularis by Preseptal Orbicularis
48
Q

Diseases of Lid Displacement: Entropion

Involutional: Signs/Symptoms

  1. What are the 4 main symptoms?
A
  1. Corneal Punctate Epithelial Erosion
  2. Corneal Pannus
  3. Corneal Ulceration
  4. Pseudotrichiasis
49
Q

Diseases of Lid Displacement: Entropion

Involutional

  1. 4 types of Temporary treatment
A
  1. Botox
  2. Bandage CL
  3. Lid Taping
  4. Lubricants
50
Q

Diseases of Lid Displacement: Entropion

Involutional: Treatment

  1. What surgical treatments are there?
  2. Over-riding treatments?
A
  1. a. Horizontal Laxity: (Canthal Sling or Full thickness Wedge)
  2. a. Everting Sutures
    b. Weis Procedure
    c. Jones Procedure (usually reserved for recurrence)
51
Q

Diseases of Lid Displacement: Entropion

Cicatricial

  1. Cause?
    a. Why does this cause it?
  2. Secondary to what 4 things?
A
  1. Scarring of Palpebral Conjunctiva
    a. Traction on upper or lower lid leading to rolling in of lid towards the globe
  2. a. Chemical burn
    b. Cicatrizing Conjunctivitis
    c. Trachoma
    d. Trauma
52
Q

Diseases of Lid Displacement: Entropion

Congenital

  1. upper Lid?
  2. Lower lid?
    a. Treatment?
A
  1. Mechanical Effects of microphthalmos
  2. Improper development of Inferior retractor aponeurosis
    a. Hotz Procedure

Ocular Disease (11 decks)

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