periorbital region board

Question 1

What is analogous to the levator palpebrae superioris aponeurotica in the lower eyelid?

Answer 1

Capsulopalpebral fascia

Question 2

What is the cause of senile ptosis?

Answer 2

Attenuation of the levator aponeurosis.

Question 3

What is the cause of classic congenital ptosis?

Answer 3

Inadequate/nonexistent levator function

Question 4

What is the most appropriate procedure for congenital ptosis?

Answer 4

Frontalis sling

Question 5

In senile ptosis, what happens to the supratarsal crease?

Answer 5

The crease becomes cephalically displaced because of adhesion between the levator aponeurosis and dermis. The
superior crease moves with attenuation of the aponeurosis.

Question 6

What is the classic treatment of senile ptosis?

Answer 6

Levator advancement/reinsertion

Question 7

What is the most common cause of postsurgical lower ectropion?

Answer 7

The combination of lower eyelid laxity with scarring/traction on the capsulopalpebral fascia-septum interface

Question 8

What is the preferred treatment of lower eyelid ectropion?

Answer 8

Canthoplasty with capsulopalpebral spacer graft (AlloDerm, autologous dermis, palate mucosa, etc).

Question 9

What is the most commonly injured muscle in a blowout fracture?

Answer 9

Inferior oblique muscle, the only extraocular muscle to insert into bone directly

Question 10

Where is the apex of the brow?

Answer 10

The lateral limbus of the eye in forward gaze.

Question 11

What is considered an abnormal Schirmer’s test?

Answer 11

Less than 10 mm

Question 12

What does correction of ptosis in one eye do in a bilateral case?

Answer 12

Correction will make the noncorrected side more ptotic, due to dual innervation—Hering’s law

Question 13

How much of the eyelid can be sacrificed and primarily closed?

Answer 13

Up to 25% total lid loss can be primarily closed

Question 14

What nerve travels in the floor of the orbit?

Answer 14

Infraorbital nerve

Question 15

What muscles are responsible for medial brow retraction?

Answer 15

Corrugator, depressor supercili, and, to lesser extent, orbicularis oculi.

Question 16

How many fat compartments are in the upper lid?

Answer 16

Two

Question 17

How many fat components are in the lower eyelid?

Answer 17

Three

Question 18

What separates the lower eyelid central and nasal fat pads?

Answer 18

Arcuate extension of Lockwood’s ligament.

Question 19

What nerve opens the eye?

Answer 19

Cranial nerve III

Question 20

What nerve closes the eye?

Answer 20

Cranial nerve VII

Question 21

What findings make up Horner syndrome?

Answer 21

Blepharoptosis, pupil miosis, and facial anhidrosis

Question 22

What is lagophthalmos?

Answer 22

Inability to close the eye

Question 23

What is chemosis?

Answer 23

Edema of the conjunctiva

Question 24

What is the mucous spot test?

Answer 24

A subjective measure of dry eye, absence of a film layer on the eye surface indicating chronic dry eye.

Question 25

What nerve can be found adjacent to the sentinel vein?

Answer 25

Temporal branch of the facial nerve

Question 26

Should the lacrimal gland be excised if ptotic?

Answer 26

No

Question 27

What reconstructive technique is typically used for a central (full-thickness) upper eyelid with 50% defect?

Answer 27

Semicircular skin/muscle flap rotation or Tenzel flap

Question 28

What flap is commonly used for total lower eyelid loss?

Answer 28

Mustarde flap—large skin muscle cheek rotation flap

Question 29

What is the most common skin cancer on the eyelid?

Answer 29

Basal cell cancer

Question 30

What is a Hughes flap?

Answer 30

A tarsoconjunctival flap from the upper eyelid, used to reconstruct >50% lower lid defects, for posterior lining only

Question 31

What is the second most common eyelid cancer?

Answer 31

Squamous cell cancer

Question 32

What is the third most common eyelid cancer?

Answer 32

Sebaceous cell carcinoma

Question 33

What is the recovery rate for Bell palsy?

Answer 33

Approximately 84%

Question 34

What is the arcus marginalis?

Answer 34

Periosteal thickening at the orbital rim, where the orbital septum attaches

Question 35

What is the lymphatic drainage for the eyelid?

Answer 35

Medial—submaxillary lymph nodes, lateral—parotid lymph nodes

Question 36

What is the function of the procerus?

Answer 36

The muscle is continuous with the frontalis and inserts into the nasal bone to create horizontal wrinkles of the glabella

Question 37

What are the oil-secreting glands of the eyelid?

Answer 37

Meibomian and zeis

Question 38

What produces the aqueous layer of the eyelid?

Answer 38

Lacrimal gland

Question 39

What is the anterior lamellae?

Answer 39

The skin and orbicularis

Question 40

What is the posterior lamellae?

Answer 40

Conjunctiva and Mueller’s muscle in the upper eyelid. Conjunctiva and capsulopalpebral fascia in the lower eyelid

Question 41

What branches of the external carotid artery supply the lid?

Answer 41

Facial, internal maxillary, and superficial temporal

Question 42

What is the vascular supply to the eyelid, from the internal carotid system?

Answer 42

Dorsal nasal, supratrochlear, supraorbital, lacrimal, and terminal branch of the ophthalmic artery

Question 43

What is SOOF?

Answer 43

Suborbicularis oculi fat pad

Question 44

What is ROOF?

Answer 44

Retro-orbicularis oculi fat pad

Question 45

What autologous structure is useful in reconstruction of the posterior lamellae?

Answer 45

Hard palate mucosal graft

Question 46

What fascia is commonly used to perform frontalis sling?

Answer 46

Tensor fascia lata

Question 47

How many bones make up the orbit?

Answer 47

Seven

Question 48

What is the distance from the orbit rim to the apex?

Answer 48

40 to 45 mm

Question 49

Where does the nasolacrimal duct drain?

Answer 49

Beneath the inferior turbinate.

Question 50

What is the globe malposition associated with orbital blowout?

Answer 50

Enophthalmos

Question 51

What sites are involved in a zygomaticomaxillary complex (ZMC) fracture?

Answer 51

(1) Zygomaticofrontal, (2) zygomaticomaxillary, (3) zygomatic arch, (4) inferior orbital floor, and (5) anterior wall of the maxilla

Question 52

What is an entropion?

Answer 52

Inward rotation of the eyelid margin

Question 53

What is a cause of pseudoptosis?

Answer 53

Enophthalmos

Question 54

If myasthenia gravis is suspected, what test should be ordered?

Answer 54

Tensilon test—edrophonium injection leading to short-term improvement of ptosis

Question 55

When are symptoms of ptosis worse in myasthenia?

Answer 55

Later in the day