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BCSCSAP Review > Oculoplastics > Flashcards

Oculoplastics Flashcards

1
Q

DDx

A

“arterialized” episcleral vessels.

Carotid cavernous fistula

cavernous sinus thrombosis

venous malformations

scleritis with vortex vein blockade

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2
Q

Posterior orbital mass with sclerotic changes

A

metastatic prostate cancer

a/w osteobalstic lesions

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3
Q

MC orbital metastasis in men

A

Lung cancer

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4
Q

MC orbital metastasis in women

A

breast cancer

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5
Q

MC leukemia to metastasize to the orbit

A

ALL

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6
Q

Muscle and nerve of the lacrimal pump system

A

pretarsal orbicularis oculi muscle

CN VII

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7
Q

Features of this syndrome

A

telecanthus (widended intercanthal distance)

epicanthus inversus (fold of skin extending from the lower to upper eyelid but most prominent in the lower eyelid)

severe ptosis

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8
Q

90% of eyelid malignancies are this type

A

BCC

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9
Q

Location of occurance of BCC

A

lower eyelid (50%-60%)

medial canthus (25%-30%)

upper eyelid

lateral canthus

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10
Q

Inheritance pattern of blepharophimosis syndrome

A

AD

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11
Q

Inheritance of myogenic congenital ptosis

A

AR

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12
Q

Typical presentation

A

Keratoacanthomas (KAs)

growth over 4-8 weeks, spontaneous regression over several months

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13
Q

Hypoplasia of the orbit, eyelids, and adnexal structures

A

anophthalmia

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14
Q

Retrobulbar injection results in

A

incyclotorsion and depression of eye

Trochlear nerve (IV) intact incyclotorsion and infraduction

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15
Q
A
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16
Q

45 yo M pain right orbit x 9 months. Next step

A

incisional biopsy of lacrimal gland

lacrimal gland with calcification and adjacent bony thinning/erosion

adenoid cystic carcinoma

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17
Q

prevents reflux of tears from the lacrimal sac into the canaliculi

A

valve of Rosenmuller

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18
Q

Tx for microphthalmia

A

Socket expansion techniques SOON AFTER BIRTH

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19
Q

Next step

A

full-thickness biopsy and possible conjuncitival map biopsies

sebaceous adenocarcinoma

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20
Q

Asian with mechanical entropion of the lower eyelid margin

A

epiblepharon

lower eyelid pretarsal muscle and skin ride above the lower eyelid margin to form horizontal fold of tissue that causes cilia to assume vertical position

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21
Q

Arteries that supply blood to the bulbar conjunctiva

A

anterior ciliary arteries

arise from muscular branches of the ophthalmic artery

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22
Q

differenitates hemifacial spasm from benign essential blepharospasm

A

hemifacial spasms persist in sleep

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23
Q

lacrimal gland biopsy should avoid these structures

A

lacrimal ducts of palpebral lobe.

Only biopsy orbital lobe

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24
Q

characteristic of cicatricial entropion of the lower eyeld

A

posterior lamellar shortening

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25
Q

large flat eyelid lesion with irregular borders and varied pigmentation. Dx and next step?

A

superficial spreading melanoma

total surgical excision with margin evaluation

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26
Q

unsafe to dissect from upper face to lower face arcoss anterior zygomatic arch because risk for damaging this structure

A

temporal branch of facial nerve

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27
Q

Treatment to eliminate epiphora in patients with total obstruction at common canaliculus

A

conjunctivodacryocystorhinostomy (CDCR)

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28
Q

Next step

A

thickening of left MR muscle and tendon = myositis

Cytoplastmic staining pattern (c-ANCA)

Antinuclear antibody (ANA)

ACE

Lysozyme

IgG4

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29
Q

anterior lamellar deficiency

A

cicatricial ectropion of lower eyelid

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30
Q

unilateral involvement of eyelid protractor muscles that persist at night

A

hemifacial spasm

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31
Q

bilateral involvement of eyelid protractors with s/s abate at night

A

benign essential blepharospasm (BEB)

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32
Q

Contraindication for laser resurfacing techniques for eyelid periocular skin surface irregularities or rhytids (skin rinkles)

A

significant uncorrected lower eyelid laxity

collagen vascular disease (SLE)

unrealistic expectations

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33
Q

Direction globe displaced when child with congenital orbital cleft cries

A

inferolaterally

herniation of intracranial contents into orbit (meningoceles , encephaloceles, meningoencephaloceles)

MC location medial canthus near bridge of nose

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34
Q

protrusion of meninges through congenital cleft

A

meningocele

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35
Q

protrusion of brain tissue through congenital cleft

A

encephalocele

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36
Q

protrusion of meninges + brain tissue through congenital cleft

A

meningoencephalocele

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37
Q

Removal of BCC from lacrimal sac or NLD, when should lacrimal outflow system be reconstructed

A

5 years to minimize tumor spread

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38
Q

Causative source of orbital cellulitis in child

A

single organism

Haemophilus

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39
Q

Causative source of orbital cellulitis in adult

A

polymicrobial

staphylococcus or streptococcus species

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40
Q

5-7 year old sudden onset and rapid evolution of proptosis. Diagnosis and types?

A

embryonal (MC)“everyone” 80% of cases, 95% 5-year survival

alveolar (worst)“awful” 9% of cases, 65% 5-year survival

pleomorphic (LC, best prognosis)“please” 97% 5-year survival

Botryoid

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41
Q

Hughes tarsoconjunctival flap contraindicated in young children because..

A

risk of amblyopia

requires 2-4 wees of occlusion

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42
Q

Location with lowest risk of systemic lymphoma

A

conjunctiva

greater for orbital

highest for eyelid

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43
Q

frequent cause of acute spastic entropion

A

intraocular surgery

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44
Q

Treatment for tearing with absent lacrimal system

A

conjunctivodacryocystorhinostomy (CDCR)

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45
Q

repair large lower defect involving 50% of eyelid

A

modified Hughes procedure

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46
Q

tissue layer that the temporal (frontal) branch of CN VII is found

A

temporoparietal fascia

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47
Q

results from failure of the choroidal fissure to close in the embryo

A

microphthalmia with orbital cyst

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48
Q

NLD opens into the

A

inferior meatus

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49
Q

posterior ethmoidal cells open into

A

superior meatus under the superior turbinate

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50
Q

structures that drain into the middle meatus

A

frontal sinus

maxillary sinus

anterior and middle ethmoid air cells

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51
Q

Mutation in blepharophimosis syndrome

A

FOXL2 gene on chromosome 3

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52
Q

Sum of MRD1 and MRD2

A

vertical interpalpebral fissure height

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53
Q

Test levator function

A

measuring upper eyelid excursion from downgaze to upgaze with frontalis muscle function negated

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54
Q

lytic bony changes on CT and superotemporal orbital mass

Diagnosis and associated condition?

A

eosinophilic granuloma

diabetes insipidus

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55
Q

Small tuft of eyelashes a few milimeters lateral to and above the eyelash line in 2 year old with epiphora?

A

aberrant lacrimal ductules

Tx: simple excision

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56
Q

MC ocular finding in infant with unilateral small orbit and no visible eye

A

microphthalmia

no visible eye but actually have microphthalmic globe. Anopthalmia is very rare

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57
Q

DDx for scleritis + nasal inflammation

A

cANCA associated vasculitis (granulomatosis with polyangiits) (GPA)

relapsing polychondritis

syphilis

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58
Q

% of patients with GPA that have scleritis

A

25%

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59
Q

Surgical approach for tumor of lacrimal gland

A

eyelid crease incision

60
Q

anterior and posterior origins of the medial canthal tendon fuse just temporal to what structure

A

lacrimal sac

61
Q

located where the levator muscle transitions into the levator aponeurosis

A

Whitnall ligament

(superior transverse ligament)

62
Q

MC s/s of TED

A

Eyelid retraction 90%

Exophthalmos (60%)

restrictive extraocular myopathy (40%)

ON dysfunction (5%)

63
Q

sheets of poorly differntiated malignant cells showing few cross striations

A

Embryonal rhabdomyosarcoma

64
Q

fibrovascular strands with rounded rhabdomyoblasts along strands or freely floating in alveolar spaces

A

Alveolar rhabdo (most malignant)

65
Q

easily visualized cross-striations

A

Pleomorphic rhabdo

least common, best prognosis

66
Q

originate from undifferentiated orbital mesenchymal cells

A

rhabdomyosarcoma

67
Q

Location of injury in traumatic optic neuropathy

A

lesser wing of the sphenoid bone

fx through or adjacent to optic canal

68
Q

elevated eyelid crease with normal levator function (> 15 mm) with ipsilateral compensatory eyebrow elevation

A

involutional or aponeurotic ptosis

69
Q

absent or poorly formed eyelid crease

A

congenintal ptosis

70
Q

Child with craniofacial abnormalities and fingers that are fused together

A

Apert syndrome

71
Q

premature closure of one or more sutures of the skull bones

A

craniosynostosis

72
Q

MC craniosynostosis

A

Crouzon syndrome

73
Q

Craniofacial clefting

A

Treacher Collins and Godenhar syndrome

74
Q

Underdeveloped lower jaw

A

Treacher Collins-Franceschetti syndrome or mandibulofacial dysostosis

75
Q

incomplete development of the first and second branchial arches resulting in unilateral ear, nose soft palate lip and mandible deformities

A

Goldenhar syndrome or oculoauriculovertebral syndrome

76
Q

A/w Goldenhar syndrome

A

limbal dermoid and strabismus

77
Q

Where does the orbital septum of the upper eyelid fuse with the levator aponeurosis?

A

2-5 mm above the supreior tarsal border

78
Q

Acts as a pulley for the force of the levator muscle and provides suspensory support for the upper eyelid and the superior orbital tissues

A

Whitnall ligament

79
Q

Structure involved in all Le Fort fractures

A

pterygoid plates

By definition, Le Fort fractures must extend posteriorly through the pterygoid plates

80
Q

pulsating exophthalmos after MVA

A

orbital roof fx

Zygomaticomaxillary complex (ZMC) are quadripod fractures because zygoma is fractured at 4 of its articulations with adjacent bones

81
Q
A
82
Q

adhesion of conjunctival surfaces

A

symblepharon

83
Q

vertical shortening and horizontal lengthening of the affected eyelid

A

euryblepharon

84
Q

30% upper eyelid defect but primary closure results in too much tension. Best option?

A

lateral canthal lysis

Cut superior limb of lateral canthal tendon to allow 3mm to 5 mm of mobilization

85
Q

Assesses the stability of tear film

A

tear breakup time

TBUT

86
Q

Toddler with ptosis and chin-up position. Important determinant of surgical technique and next step

A

Levator function

moderate to good - levator resection

Poor - frontalis sling

87
Q

Subconjunctival granulomas with bx revealing noncaseating granulomas with epithelioid cells (histiocytes)

A

Sarcoidosis

88
Q

MC orbital site affected in sarcoid

A

lacrimal gland

89
Q

Laser used to ablate lash follicle

A

argon laser

90
Q

Laser used for skin resurfacing

A

erbium:YAG

CO2

91
Q

Tx for nasolabial folds

A

hyaluronic acid filler

92
Q

mass effect that weigs or pulls down the upper eyelid

A

mechanical ptosis

93
Q

Vessels that pass through the superior ophthalmic fissure

A

recurrent branch of middle meningeal artery

superior ophthalmic vein

94
Q

epicanthus in which fold is most prominent in the upper eyelid (Normal Asian)

A

epicanthus tarsalis

95
Q

epicanthus in which fold is most prominent in the lower eyelid

A

epicanthus inversus

96
Q

epicanthus in which fold involves upper and lower eyelids equally

A

epicanthus palpebralis

97
Q

epicanthus in which fold arises from eyebrow region and runs to lacrimal sac

A

epicanthus supraciliaris

98
Q

Type 1 blepharophimosis-ptosis-epicanthus inversus syndrome BPES differes from type 2 in this way

A

type 1 includes early loss of ovarian function in women

99
Q

Sites for orbital decompmression

A
100
Q

Congenital choristomas lined by keratinized epithelium and dermal appendages

A

orbital dermoid cysts

101
Q

Best imaging for orbital varices

A

contrast enhanced radiologic imaging (sprial CT) or contrast MRI during a valsalva (or other means of decreasing venous return) - shows enlargement of engorged veins

102
Q

low flow venous malformation that result from vascular dysgenesis

A

orbital varices

103
Q

high flow developmental anomalies that result from vascular dysgenesis

A

arteriovenous malformations (AVMs)

104
Q
A
105
Q

Obese, ocular irritation, mild mucous discharge worse on awakening and chronic papillary conjunctivitis. Next step?

A

Sleep studies to r/o sleep apnea

106
Q

Tx for cicatricial entropion

A

address underlying cause

tarsal fracture operation (mild to moderate cicatricial changes)

tarsal plate graft (severe cicatricial changes)

107
Q

baseball to head with optic neuropathy and retinal arterial pulsations

A

decreased perfusion of globe and optic nerve (OCS) from retrobulbar hemorrhage

remember OCS is a clinical diagnosis!!!

108
Q

enophthalmos at rest with proptosis on valsalva

A

venous malformation - orbital varix

109
Q

MC benign neoplasm of the orbit

A

cavernous hemangiomas

110
Q

Lethal tumor from the meibomian glands of tarsal plate; from glands of Zeis a/w eyelashes

A

sebaceous adenocarcinoma

111
Q

Etiology of orbital inflammation?

A

Infectious

Vasculitic

Autoimmune

Nonspecific

Granulomatous

‘I VANG’

112
Q

American thyroid association recommends initial screening with

A

TSH and free T4

Sensitivity of 99.5% and specificity of 98%

113
Q

Muscle included in myectomy for facial dystonia

A

orbicularis oculi (protractor)

myectomy removes much of the protractors of the eyelids

114
Q

retractor of the lid

A

levator palpebrae

115
Q

Tx for punctal ectropion

A

medial spindle procedure

shortens posterior lamella of medial eyelid

116
Q

Tx for Tarsal ectropion

A

horizontal tightening (lateral tarsal strip) and advancement and reattachment of lower lid retractors to correct vertical laxity

117
Q

Eyelid is completely everted

A

tarsal ectropion

118
Q

Orbital fracture that may cause trismus? (lockjaw)

A

Zygomatic fracture

119
Q

Le Fort I

A

pyramidal break that involves lower portion of maxillary bone, “floating palate”

no ophthalmic problems

120
Q

Cylindroma

A

adenoid cystic carcinoma

121
Q

drawback to dermis-fat graft for acquired anophthalmos

A

unpredictable resorption of volume

122
Q

may result in continued orbital expansion in a child born with microphthalmic eye

A

dermis-fat graft

123
Q

lentigo simplex prognosis

A

flat pigmented spots larger in diameter than ephelides (freckles) benign and do not require treatment

124
Q

MC melanoma on eyelid

A

lentigo maligna melanoma - invasive vertical growth phase in 10%-20%

nodular melanoma

125
Q

variant of angioneurotic edema, rare condition characterized by intermittent swelling of the eyelid resulting in thin and wrinkled skin that can give appearance similar to dermatochalasis

A

blepharochalasis -

126
Q

variant of this disease

A

angioneurotic edema

blepharochalasis

127
Q

embryologic origin of solitary fibrous tumor

A

mesenchymal

spindle-shaped cells strongly CD34 positive

128
Q

embryologic origin of fibrous histiocytoma

A

mesenchymal

129
Q

embryologic origin of osteomas

A

mesenchymal

130
Q

embryologic origin of fibrous dysplasia

A

mesenchymal

131
Q

Blunt trauma to right orbit with droopy eyelid and MRD1 of 1.5 mm and levator function of 5mm. Dx and Tx

A

traumatic ptosis

observation for 6 months before surgical intervention

132
Q

Tx for optic nerve sheath meningioma

A

observation

133
Q

Surgical space accessed to drain abscess a/w ethmoid sinusitis

A

subperiosteal space - between bone and periorbita

most peripheral space in orbit closest to sinuses

134
Q
A
135
Q

Abscesses usually occur in this space

A

subperiosteal space

136
Q

How to minimize notching of the eyelid margin

A

precise suture placement and critical suture tension

137
Q

Best approach for superior lesions

A

vertical lid-splitting orbitotomy

138
Q

At risk for

A

oculodermal melanocytosis (Nevus of Ota)

Glaucoma - 10% with pigmentation of TM and GL

139
Q
A
140
Q

Multiple eyelid lentigines, flat, pigmented spots larger than ephelides may be a/w

A

Peutz-Jeghers syndrome

melanotic macules - fade in early adulthood, persist in buccal mucosa. Not in malar surface like freckles. On lips and eyelids

intestinal polyposis with increased risk for colon cancer

141
Q

branch of facial nerve that innervates corrugator supercilii muscle

A

temporal (frontal)

innervates the superior part of the facial mimetic muscles

142
Q

treatment of lacrimal sac carcinomas

A

aggressive surgical resection including exenteration if necessary

50% recurrence rate of malignant invasive squamous and transitional cell carcinoma of the lacrimal gland

143
Q

MC site for traumatic orbital fractures

A

1. lamina papyracea

  1. maxillary bone (posteriomedial)
144
Q

misdirection of the lashes with normal origin from anterior aspect of lid

A

trichiasis

145
Q

abnormal growth of lashes from meibomian gland orifices

A

distichiasis

146
Q

congenital condition in which eyelashes are abnormally long greater than 12 mm central and 8 mm in peripheral

A

Trichomegaly

147
Q
A

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