ophtha-orbit, eyelids Flashcards
The orbit extends anterior to the tarsus and can thank ligaments forming
Orbital septum
Entire orbital cavity is lined with periosteum called the
Periorbita
Entire orbital contents are completely enclosed except
At palpebral fissure
4 compartments
- Subperiosteal space
- Ms cone
- Peripheral surgical space
- Episcleral space
Space Between periorbita and bone
Subperiosteal space
Space formed by recti ms and their intermuscular mem with tenon’s capsule
Ms cone
Central surgical space
Ms cone
Space between periorbita and ms cone
Peripheral surgical space
Contains orbital fat that serves as cushion for the eyeball
Peripheral surgical space
Space between sclera and tenon’s capsule
Episcleral space
Orbit is pathway of cranial nerves..
CN 2-6
In orbital vein obstruction, what can u find in ophthalmoscope
Venous stasis
Optic atrophy
A difference of __mm between eyes in exophthalmometry is abnormal
> 2mm
Assessment of compressibility of orbital contents
Orbitonometry
Decreased compressibility in orbitonometry indicates
Infiltrative or neoplastic lesion
Increased compressibility in orbitonometry indicates
Vascular tumor
Solid tumors ans endocrine exophthalmos do not yield any degree of compressibility.
True
Symptomatology of orbital pathology
- Proptosis, exophthalmos
- Displacement of globe
- Congestion or edema of lids and conjunctiva
- Bruit and pulsation
Passive forward displacement or protrusion of eyeball from its normal place
Proptosis
Active forward displacement or protrusion of eyeball from its normal place
Exophthalmos
True exophthalmos is less frequent than proptosis
True
Retrodisplacement of globe is seen in..
Horner’s syndrome
Bruit/pulsation is seen earlier in aneurysm, while Bruit/pulsation is a later sign.
Bruit is seen earlier in aneurysm, while pulsation is a later sign.
Orbital edema is characterized by
Axial proptosis
Venous congestion
Restriction of ocular movements
Orbital edema has no muscle paralysis.
Yes
Orbital hemorrhage is characterized by
Axial proptosis w. Limitation of eye movement
Ecchymosis
Intermittent proptosis, more prominent when bending the head down, blowing nose and during physical exertion
Orbital varices
Characterized by pulsationg exophthalmos of rapid onset ff a basal fracture
Carotico-cavernous fistula
Thyrotoxic exophthalmos is charac by
Slight exophthalmos
Lid retraction
Lid lag
Endocrine exophthalmos is a pituitary disfunc wherein an ____ is released initiating cellular filtration of tissue within the orbit
EPS
Func of eyelids
- Protect the globe for external injury and excessive light
- Distribute tears uniformly over anterior surface of face.
In lid, Incision of grayline splits into
Posterior part- tarsal plate and conjunctiva
Anterior part- orbicualris oculi, skin and hair follicles
Ms of eyelid
Orbicularis oculi
Levator palpebral superiosis
Palpebral smooth ms of muller
OO has 2 parts. What part squeezes the eyelid shut?
Peripheral orbital part of OO
OO has 2 parts. What part is responsible in invol blinking?
Central orbital part of OO
Each tarsus contains parallel rows of this gland which provides airtight closure of lids and provides rapid evaporation of tears.
Meibomian gland
Bld supply of eyelids
Lacrimal and ophthalmic arteries
Branch form external carotid artery thru facial, superficial, temporal and infra orbital a.
Venous return of eyelid
Cavernous sinus or
Into IJV via SOV and IOV
Lymphatic drainage of eyelid
Medial 2/3 of lower lid and medial 1/3 of upper lid - submaxillary lymph vessel
Lateral 1/3 of lower lid and lateral 2/3 if upper lid - pre-auricular lymph vessel
Innervating of eyelid
Upper lid and lateral portion of lower lid - C5-1 (ophthalmic n)
The rest is form maxillary div thru infraorbital n.
Embryological origin of eyelid
From fronto-nasal processes
Embryological origin of lower lid
Maxillary process
Inflammation of lid margin
Blepharitis
Redness limited to lid margins, aggravated by smoke, chemical fumes, and smog, and produce greasy scaling of skin
Squamous blepharitis
Blepharitis that is usually secondary to seborrheic dermatitis of scalp and eyebrows
Squamous blepharitis
Ulcerative blepharitis is caused by what organism
Staph aureus
Red inflamed margins with yellow crust which may become adherent to base of lashes
Ulcerative blepharitis
In ulcerative blepharitis, lashes may be lost due to destruction of hair follicles called
Madarosis
In ulcerative blepharitis, chronically, lid margins hypertrophies and thickens which cause upper lid to droop down giving ruse to sleepy appearance called
Tylosis
Management if blepharitis, hordeolum and Meibomianitis
Warm moist compress
Acute staph infection of asso gland of lids charac with circumscribed red, swollen and tender mass
Hordeolum
Hordeolum involving meibomian gland
Internal hordeolum
Hordeolum involving gland of zeiss and moll
External hordeolum
Swelling of this hordeolum is away from lid margin
Internal hordeolum
Swelling of this hordeolum is at lid margin
External hordeolum
Chronic granulomatous inflammation of meibomian gland, charac by painless swelling of g without inflammatory signs
Chalazion
Chalazion can cause glaucoma
True
Chronic inflammation of meibomian gland which is usually bilateral and preceded or asso with blepharitis
Meibomianitis
Local inflam which affects skin of lid
Contact dermatitis
Chronic/acute contact dermatitis with weeping eczema
Acute local dermatitis
Chronic/acute contact dermatitis with dry skin, indurated and itchy
Chronic local dermatitis
Infection of lids by crab louse (pediculosis pubis or capitis)
Phthiriasis palpebrarum
Infection of lid characterized by vesicle formation along lash line, edema tours lid margin and dermatitis may appear
Herpes febrilis
Infection of gasserian ganglion charac by unilateral vesicular eruption along distribution of 1st and 2nd division of CN5
Herpes zoster ophthalmicus
Result of accidental inoculation or localization of virus in a ore-existing break in skin during period of view is (2-6d ff vaccination)
Lid vaccinia
Provides passive ab against vaccinia organism
VIG vaccinia immunoglobulin
Viral wart of lid that is slow growing and with mild infectivity
Verruca
Form of verruca that is round
Verruca vulgaris
Form of verruca that is threadlike
Verucca filiformis
Form of verruca that is flat
Verucca plana
Form of verruca that is filiform
Verucca digitala
Inflammatory condi of lid charac by formation of nodules with umbilicated craters (with waxy materials)
Molluscum contagiosum
Inflam sequela wherein eyelashes are misdirected to cornea
Trichiasis
Scarring of conj and lid margin cause by inflammation, injuries and operation is ff by
Entropion
Thermal burns, lid injuries and skin infection may result in
Ectropion
Part of palpebral conj is adherent to bulbar conjunctiva
Symblepharon
When upper and lower old are fused after inflammation subsides
Ankyloblepharon
Notching of defect in continuity if lid margin
Coloboma
Lid coloboma usually occurs in
Inner and middle 1/3 of upper lid
Outer and middle 1/3 of lower
Vertical fold of skin from inner eyebrow to root of nose
Epicanthus
Reduced length and width of palpebral fissure
Blepharophimosis
Another row of eyelashes, usually towards the cornea
Distichiasis
Abnormal drooping of upper lid due to absence or weakness of levator palpebral ms or lesion to CN3
Congenital Ptosis or blepharoptosis
What IOM is involved in ptosis
Superior rectus ms
Rare type in which the affected eyelid elevates when the pt opens his mouth while chewing or laterally moves his jaw. Ptosis reappears when mouth is closed.
Marcus-Gunn or jaw-winking phenomenon
Blinking is a protective mechanism, it involves the contraction of tarsal part of OO lasting
0.3 s every 5s
Blinking is absent in infant
True
Blinking is diminished in what condition
Hyperthyroidism and Parkinson’s disease
Marked invol twitching of eyelid caused by eye strain, nervous tension and weakend body resistance
Myokymia
Exaggerated contraction of orbital part of OO. A marked reflex of blinking.
Blepharoclonus
Inability of lids to close due to paralysis of CN7
Lagophthalmos
Forcible closure of lids which is usually bilateral caused by marked contraction of OO and corneal lesion
Blepharospasm
Dehiscence of orbital septum giving ties to localized swelling in lid when orbital fat prolapsed
Baggy eyelid
Loss of elasticity of skin of lids in aging
Blepharochalasis
Small cylindrical benign growth in eyelid
Cutaneous horn
Small pinhead sized yellowish white elevation due to sebaceous gland retention
Milium
Skin deposition of lipid materials in inner part of upper and lower lid. Lesion is yellowish and slightly elevated plaque with sharply demarcated margins
Xanthelasma
Small vesicles with clear content due to sweat gland obstruction
Sweat gland cyst
Port wine stain
Nevus flammeus
Hemangioma of Irreg blue red patch of variable size formed by diffuse telangiectasis of mature vessel of dermis
Nevus flammeus
Hemangioma of soft red lesions which disappears spontaneously
Capillary hemangioma
Hemangioma wherein the lesion is composed of simple endothelial line spaces larger than capillary hemangioma
Cavernous hemangioma
Most common malignant tumor of eyelid
BCC
BCC of lid is common in m/f, lower/upper lid
M, lower lid
SCC of lid is common in m/f, lower/upper lid
M, upper lid
BCC/SCC starts as elevated nodule with central dimple and pearly borders
BCC
BCC/SCC starts as warty growth with keratotic covering gradually eroding until ulcer develops
SCC
BCC of lid spreads by
Hematogenous spread
SCC of lid spreads by
Lymphatic spread
Yellowish white tumor on tarsal portion of lid. Mistaken for and asso with Chalazion
Meibomian gland Ca