Ocular Disease: Lecture 5: Eyelids (2) Flashcards
Lid Placement Diseases
- What are 3 types of Ocular Myopathies?
- Myasthenia Gravis
- Myotonic Dystrophy
- Chronic Progressive External Ophthalmoplegia
Lid Displacement Diseases: Ocular Myopathy
Myasthenia Gravis
- Type of disease?
- What is damaged?
a. Leads to what symptom?
b. However, it doesn’t effect what muscles? - Tends to be seen more in whom?
- AI disease
- Damage to Ach receptors in Striated Muscle
a. Weakness + fatigability of skeletal muscles
b. Doesn’t effect Cardia or Involuntary Muscles - Females Predilection
Lid Displacement Diseases: Ocular Myopathy
Myasthenia Gravis
- Is it just ocular or systemic?
a. When can it occur?
b. When is it more common in women? - % that have ocular muscle involvement?
- % that will have ocular symptoms as their initial concern?
- Can be either or both.
a. Any age, but most common time is third decade
b. Less than 40 (women more likely); Equal after that. - over 90%
- 60% (2/3 have ptosis and diplopia)
Lid Displacement Diseases: Ocular Myopathy
Myasthenia Gravis: Signs/Symptoms
- 6 of them
- Difficulty breathing (rare, but serious)
- Dysarthria (speaking)
- Dysphagia (swallowing)
- Inability to chew
- Myopathic Facies
- Peripheral Weakness
Lid Displacement Diseases: Ocular Myopathy
MG
- Major Ocular Sign?
a. How does it present?
b. When is it worse? - Other Sign?
- Ptosis
a. Bilateral and Asymmetric
b. At the end of the day, or with prolonged upgaze - Cogan Twitch: Brief Upshoot of lids when moving from downgaze to primary gaze
Lid Displacement Diseases: Ocular Myopathy
MG: More ocular signs
- Diplopia: Type and how does it present?
- What type of movements and when can they be seen?
- What else is possible?
- Vertical; May present as Pseudo internuclear Ophthalmoplegia
- Nystagoid Movements; May be seen in Extreme Gaze
- Bizarre Ocular Motility is Possible
Lid Displacement Diseases: Ocular Myopathy
MG: Investigation
- What test is done?
- Edrophonium (Tensilon) Test
a. Anticholinesterase
b. Increases Ach that’s available at the NMJ.
c. Increase Muscle function for a brief period (10 minutes)
d. IV injection of Tensilon
Lid Displacement Diseases: Ocular Myopathy
MG: Investigation (2)
- What other test can be done? (probably safest)
- Ice Test; Ice placed on Ptotic Lid for 2 minutes; Improvement in Ptosis
* a 2mm Improvement is a POSITIVE RESULT!
Lid Displacement Diseases: Ocular Myopathy
MG: Treatment
- What 5 things can be done?
- Anticholinesterase Drugs
- Immunosuppression
- Plasma Exchange
- Steroids
- Thymectomy
* They HAVE to be REFERRED for Co-Management
Lid Displacement Diseases: Ocular Myopathy
Myotonic Dystrophy
- how common is it? Type of disorder?
- What is it?
- Number of types and which is less severe?
- RARE; Autosomal Dominant
- Delayed muscular relaxation after voluntary Effort
- 2 Types;
DM 2 has less severe systemic Effects and a Better Prognosis
Lid Displacement Diseases: Ocular Myopathy
Myotonic Dystrophy: Ocular Manifestations
- Type of Cataract and what does it look like?
- One other common thing?
- 4 Uncommon manifestations
- Early onset cataract. CHRISTMAS TREE
- Ptosis
- a. External Ophthalmoplegia
b. Hypotony
c. Optic Atrophy
d. Pigmentary Retinopathy
Lid Displacement Diseases: Ocular Myopathy
Myotonic Dystrophy: Ocular Manifestations
- Type of Cataract and what does it look like?
- One other common thing?
- 4 Uncommon manifestations
- Early onset cataract. CHRISTMAS TREE
- Ptosis
- a. External Ophthalmoplegia
b. Hypotony
c. Optic Atrophy
d. Pigmentary Retinopathy
Lid Displacement Diseases: Ocular Myopathy
Myotonic Dystrophy:
- What 2 treatments are there?
- Exercise
2. Prevent Muscle Wasting
Lid Displacement Diseases: Ocular Myopathy
Chronic Progressive External Ophthalmoplegia
- It refers to a group of disorders w/various etiologies, but it involves what 2 things?
- Can be an independent condition or associated with what 2 other conditions?
- Ptosis, and Progressive Bilateral Ocular Immobility
2. Kearns-Sayre Syndrome; Oculopharyngeal Dystrophy
Lid Displacement Diseases: Ocular Myopathy
Chronic Progressive External Ophthalmoplegia
- What’s usually the first sign?
a. Uni or bilateral?
b. Symmetric or asymmetric?
- Ptosis
a. Bilateral
b. Asymmetric
Lid Displacement Diseases: Ocular Myopathy
Chronic Progressive External Ophthalmoplegia
Kearns-Sayre Syndrome
- Cause
- What does it do to EOMs?
- What does the fundus look like?
- Mitochondrial DNA Deletions
- “Ragged” EOMs: Accumulate Abnormal Mitochondria
- “Salt and pepper” Fiundus
Lid Displacement Diseases: Ocular Myopathy
Chronic Progressive External Ophthalmoplegia
Kearns-Sayre Syndrome
- Cause
- What does it do to EOMs?
- What does the fundus look like?
- Mitochondrial DNA Deletions
- “Ragged” EOMs: Accumulate Abnormal Mitochondria
- “Salt and pepper” Fiundus
Disorders of Lashes: Trichiasis
- How common is it?
- What does it cause?
- Chronic Rubbing leads to what 3 things?
- May be 2ndary to what?
- Very
- Posterior Misdirection of Lashes
- Corneal Pannus; Corneal Ulceration; P.E.E. of Cornea
- May be 2ndary to Scarring or can Occur Independently
Disorders of Lashes: Trichiasis
Cause
- One cause is Independent of what?
- Scarring of Lid Margin (3)?
- Independent abberant Growth
2. Chronic Blepharitis; Herpes Zoster; Trauma
Disorders of Lashes: Trichiasis
Treatment
- 5 types of treatment?
- Argon Laser Ablation
- Cryotherapy
- Electrolysis
- Epilation
- Surgery
Disorders of Lashes: Distichiasis
- What is it?
- Where does it emerge from?
- 2 ways you can get it?
- Partial or Complete Second Row of Lashes
- Emerge at or behind Meibomian Gland Orifice
- Congenital or can be Acquired
Disorders of Lashes: Distichiasis
Congenital
- Type of Genetic condition?
- What goes wrong?
- Aberrant Lashes are what 2 things, and may be directed which way?
- Autosomal Dominant; Inherited Condition
- Cells destined to be Meibomian Glands will differentiate into a Pilosevaceous Unit
- Thinner and Shorter; May be directed Posteriorly
Disorders of Lashes: Distichiasis
Congenital: Treatment
- Lower Lid (1)?
- Upper Lid? (2)
- Cryotherapy
2. Cryotherapy and Lamella Division
Disorders of Lashes: Distichiasis
Acquired
- Due to what?
- Called what?
a. 3 things
- Due to de-differentiation of Meibomian Glands
- Cicatrizing Conjunctivitis
a. Chemical Injury
b. Ocular Pemphigoid
c. Stevens Johnson
Disorders of Lashes: Distichiasis
Acquired: Treatment
- Mild form?
- Severe?
- Same as trichiasis
2. Lamellar Eyelid Division and Cryotherapy
Disorders of Lashes: Eyelash Ptosis
- What is it?
- It can be IDIOPATHIC or associated with what 3 things?
- No turning of what?
- Downward Sag of upper eyelid lashes
- a. Dermatochalasis
b. Facial Palsy
c. Floppy Eyelid Syndrome - No turning in of the Lid Margin
Disorders of Lashes: Eyelash Ptosis
Treatment
- Main thing to treat?
- Other things to think about?
- Treat underlying Etiology
- a. Supportive
b. Surgery to change position is possible but only if VERY Symptomatic (Anterior Lamellar Repositioning)
Disorders of Lashes: Trichomegaly
- What is it?
- Acquired Causes? (4)
- Congenital Causes? (4)
- Excessive eyelash Growth
- a. AIDS
b. Drug Induced
c. Hypothyroidism
d. Malnutrition - a. Cornelia de Lange Syndrome
b. Goldstein Hutt Syndrome
c. Hermansky Pudlak Syndrome
d. Oliver McFarlane Syndrome
Disorders of Lashes: Trichomegaly
- treatment? (3)
- a. Epilation
b. Lash Trimming
c. Lubrication
Disorders of Lashes: Madarosis
- What is it?
- Causes? (9)
- Decrease in the number of Lashes
- a. Alopecia
b. Burns
c. Chronic Lid Margin Disease
d. Leprosy
e. Lid Tumor
f. Psoriasis
g. SLE
h. Syphilis
i. Trichotillomania***
Eyelid Neoplasms: General Considerations
- What is more common?
- Which is more varied?
- Characteristics of benign? (5)
- Benign more common than Malignant
- Benign more varied
- a. Lack of induration or ulceration
b. Limited/No Growth
c. Preservation of normal lid margin structure
d. Regular border
e. Uniform Color