Reconstruction of the Eyelids, Correction of Ptosis, and Canthoplasty

Question 1

the
Asians this lid crease can be found significantly lower

Answer 1

T

Question 2

The highest point of
the upper lid is typically found just on the center of the pupil

Answer 2

F The highest point of
the upper lid is typically found just medial to the center of the pupil

Question 3

lateral canthus is positioned 2 mm higher than the
medial canthus, whereas in Asians this can be found 3 mm higher

Answer 3

T

Question 4

Beneath pretarsal
skin, as well as laterally over the medial and lateral canthal ligaments,
the underlying fat is absent

Answer 4

T

Question 5

All The orbicularis oculi muscle originate from the medial canthal tendon

Answer 5

F Fibers of the orbital portion originate from the
medial orbital margin and medial canthal tendon and sweep around
the orbit in horseshoe fashion to insert back on the medial canthus.
The preseptal and pretarsal subunits originate from the medial canthal tendon and insert on the lateral horizontal raphe

Question 6

Hornor syndrome affect the levator muscle

Answer 6

F muller muscle

Question 7

he lateral canthal tendon
passes deep to the orbital septum and inserts 2 mm posterior to the
lateral orbital rim

Answer 7

T

Question 8

terminal branches of the ophthalmic
artery, which supply the medial palpebral vessel directly and the
lateral palpebral vessel via the lacrimal artery.

Answer 8

T

Question 9

The lateral two-thirds of the upper lid and lateral half of the lower lid
drain primarily through the preauricular lymph nodes

Answer 9

T

Question 10

medial portion of the upper and lower lid drain through the submandibular lymph nodes

Answer 10

T

Question 11

lymphedema of the eyelids IS a rare complication

Answer 11

T

Question 12

Grading of the lower lid lag?

Answer 12

(Grade 0), it should spring back immediately to its original position,
Grade ] laxity is observed with 2 to 3-second delay,
Grade II laxity with 4 to 5 seconds delay
Grade III laxity with >5 seconds delay and return to a position with blinking
Grade IV laxity, frank ectropion is maintained without return to the original position.

Question 13

Examination of patients with excess tear accumulation or epiphora

Answer 13

dye disappearance test or dilation and irrigation
No. 00 Bowman probe can also be
passed through the lacrimal drainage system

Question 14

Mohs micrographic surgery is frequently employed
in the periorbital region

Answer 14

T

Question 15

small defects <5 mm in the upper eyelid
that do not involve the lid margin or canthus may be left to heal

Answer 15

T

Question 16

Partial defects in the upper eyelid more than 50% can be treated with skin graft Importantly, grafts may be oversized by approximately 30%, particularly over the preseptal lid to allow for contracture

Answer 16

T

Question 17

Complications of the full thickness graft for the upper eyelid

Answer 17

hypertrophic scarring in
23% and hypopigmentation in 6%, particularly supraclavicular
and inner arm donor sites

Question 18

options for reconstraction of full thickness defect mor than 25%

Answer 18

Hughes advancement/sliding
tarsoconjunctival flap with skin graft or composite graft covered by
a myocutaneous advancement flap

Question 19

Options for composite graft?

Answer 19

free tarsal graft with conjunctiva from the
contralateral upper lid
nasal septa! cartilage-mucosa and hard palate mucosa grafts

Question 20

Wich compiste graft is preferable ?

Answer 20

free tarsal graft with conjunctiva from the
contralateral upper lid is best option
both nasal septa! cartilage-mucosa and hard palate mucosa grafts are keratinized, potentially placing the cornea at risk of abrasion and damage until metaplasia

Question 21

donorsite complication in the contralateral normal lid could be devastating.

Answer 21

T

Question 22

Option for reconstruction of the outer lamella

Answer 22

vascularized myocutaneous advancement flap is used to address
the anterior lamella. Commonly employed flaps include a sub-brow
bipedicled skin-orbicularis oculi muscle flap, paramedian forehead
flap, and modified Tenzel flap

Question 23

inverted, modified Tenzel (semicircular) flap can be used to closed up to 50 % of the upper eye;id

Answer 23

F tow third of upper eyelid

Question 24

Cutler-Beard flap, have fallen out of favor

Answer 24

T

Question 25

For defects more than 75%

Answer 25

mucosalized tarsal graft
and overlying myocutaneous orbicularis oculi flap

lower eyelid switch flap

Question 26

The most frequent late complication in patients undergoing upper
eyelid surgery

Answer 26

is exposure keratopathy, which can be seen in 20%

Question 27

complications after upper eyelid surgery

Answer 27

Asymmetric marginal position
ptosis following eyelid surgery should be monitored for 6 months for spontaneous recovery
exposure keratopathy
lagophthalmos, lid ectropion, orbital hematoma, corneal injury, and
conjunctiva! scarring/symblepharon

Question 28

The lower eyelid is critical for active corneal
coverage,

Answer 28

F the lower eyelid is critical for passive corneal
coverage,

Question 29

Vertical closures should be avoided when possible

Answer 29

T

Question 30

A Frost suspension suture can reduce downward pull on the lower eyelid during the early postoperative period

Answer 30

T

Question 31

Small full thickness defect 30%, moderate defect 30-50% large defect more than 50%

Answer 31

T

Question 32

In tenzer semicircular flap of the lower eyelid need to use with canthotomy and inferior cantholysis is also performed to facilitate the advancement

Answer 32

T

Question 33

When a Hughes flap is not used for posterior
lamellar reconstruction in mustardi flap, a temporary tarsorrhaphy is often useful during
the initial phase of healing to combat the mechanical effect of edema

Answer 33

T

Question 34

A Frost-style
traction suture can be placed for 2 days to provide early postoperative lid support

Answer 34

F A Frost-style
traction suture can be placed for 1 week to provide early postoperative lid support

Question 35

cicatricial ectropion may be noted. This complication has been noted
in 5% of patients

Answer 35

T

Question 36

medial canthal region is complex due to structures that may be involved and contours that are difficult to recreate

Answer 36

T

Question 37

defects in the medial canthus region are associated with a high incidence
of lacrimal system injury

Answer 37

T

Question 38

For small full-thickness defects , healing by secondary intention can be considered

Answer 38

F. For small defects limited to the anterior
lamella, healing by secondary intention can be considered

Question 39

Larg defect in the medial canthus with good vascularized bed should treat with grafting

Answer 39

T

Question 40

in case of full thickness defect with out vascularised bed what are the options for reconstruction

Answer 40

local medially based myocutaneous transposition flap from
the upper eyelid can be performed

a glabellar rotation
advancement flap may be employed

Question 41

thicker flaps result in excess tissue bulk require thinning during a secondary procedure

Answer 41

T

Question 42

In medial canthal injuries anterior fixation alone may not be adequate to restore lid-globe apposition.

Answer 42

T

Question 43

in medial canthal tendon injury, Concomitant lacrimal probing or stent placement should be considered in all cases

Answer 43

F Concomitant lacrimal probing or stent placement should be considered in select cases by

Question 44

Defects involving the lacrimal system and when a dacryocystorhinostomy with or without Jones tube is required primarily repiare of the canalicular system is required

Answer 44

F repair should be deferred until
careful postoperative observation

Question 45

Partial interruptions of the
canaliculus can be repaired over a monocanalicular or bi-canalicular silicone stent, which is generally left in place for 3 months before
removal.

Answer 45

T

Question 46

the quantity of tissue in the lateral canthus that must be reconstructed is often minimal

Answer 46

T

Question 47

Cuses of pseudoptosis?

Answer 47

enophthalmos
brow ptosis
hypertropia.

Question 48

congenital ptosis, fibrofatty
dysgenesis of the levator complex is observed, and ptosis remains
relatively constant throughout life until surgery is performed

Answer 48

T

Question 49

Poor
levator function and lagophthalmos present in congenital ptosis

Answer 49

T

Question 50

Levatore dehiscence considered a form of congenital ptosis

Answer 50

F Various forms of acquired ptosis exist, with
levator dehiscence the most common

Question 51

Classically, acquired ptosis seen from
a dehisced levator aponeurosis is associated with a lid crease that is
higher and an upper sulcus that is deeper than the uninvolved side

Answer 51

T

Question 52

lid crease that is
higher with congenital ptosis

Answer 52

F with acquired ptosis in congenital ptosis is absent

Question 53

Myogenic/neurogenic causes of ptosis

Answer 53

myasthenia gravis, oculopharyngeal muscular dystrophy, and idiopathic late-onset familial ptosis

Question 54

Neurological defects are easy to treat

Answer 54

F These etiologies are particularly difficult to treat as defects are progressive and ocular surface protective mechanisms function poorly

Question 55

risk of corneal complications is high with congenital ptosis

Answer 55

F with Myogenic/neurogenic causes of ptosis

Question 56

Marcus Gunn jaw-winking phenomenon, which accounts
for 2% to 13% of congenital ptosis

Answer 56

T

Question 57

Presentation of patients with Marcus-Gunn

Answer 57

Patients with this syndrome
demonstrate both a variable degree of ptosis at rest and winking associated with jaw movement, sucking, or swallowing

Question 58

These findings are
as a result of aberrant connections between motor branches of CN V
and the superior division of CN III

Answer 58

T

Question 59

Pupillary asymmetry (anisocoria) or deficiencies
in extraocular muscle function may raise the suspicion of Horner
syndrome or CN III palsy as a cause for ptosis

Answer 59

T

Question 60

An age-appropriate visual acuity and visual field test should be performed in all patients with ptosis who are able to cooperate

Answer 60

T

Question 61

Sever ptosis is when upper eyelid ptosis more than 5 ml

Answer 61

F > 4 ml

Question 62

Levator function excursion?

Answer 62

good (> 8 mm), fair (5-7 mm),
and poor (> 4 mm)

Question 63

Which candidates for
Muller muscle-conjunctiva resection?

Answer 63

Patients who demonstrate mild ptosis (2-3 mm), good levator excursion, and an appropriate phenylephrine test are good candidates for
Muller muscle-conjunctiva resection

Question 64

Patients candidate for the muller muscle resection?

Answer 64

Patients who demonstrate mild ptosis (2-3 mm), good levator excursion, and an appropriate phenylephrine test are good candidates for
Muller muscle-conjunctiva resection

Question 65

Putterman have resulted in improved predictability and
minimized anatomic disruption

Answer 65

T

Question 66

The candidate patients for Levator Advancement and Levator Repair

Answer 66

with mild to moderate ptosis and fair to good
levator excursion (>5 mm)

Question 67

Restoration ofthe upper eyelid crease can be achieved
through reattachment of the orbicularis muscle to the levator aponeurosis

Answer 67

T

Question 68

Under correction of the eyelid ptosis is more than over-correction

Answer 68

F Both under and overcorrection have been observed

Question 69

predictability for
bilateral levator advancement is diminished due to Herring phenomenon

Answer 69

T

Question 70

Candidate for frontalis sling

Answer 70

In patients with variable degrees ofptosis and poor levator excursion
(<4 mm), as can be seen in patients with congenital ptosis,

Question 71

the double rhomboid design remains the most often
used in frontalis sling

Answer 71

T

Question 72

stab incisions may be made above the ciliary
margin in older age patients in frontalis sling

Answer 72

F Although analogous stab incisions may be made above the ciliary
margin in young children, an open lid crease technique with tarsal
dissection and sling fixation is typically performed in older patients

Question 73

Most common complication after frontalis sling

Answer 73

Lagophthalmos is common and must
be managed appropriately with liberal ocular surface lubrication

Question 74

management the consequences of lagophthalmos

Answer 74

A
temporary suture tarsorrhaphy, Frost suture, or bandage contact lens
can be helpful in the early postoperative period

Question 75

lid lag was the most frequently noted complication present in 90% with frontalis sling

Answer 75

T

Question 76

complications following ptosis correction

Answer 76

undercorrection, overcorrection,
or discrepancies in lid contour
Lagophthalmos, exposure keratitis, and corneal abrasions

Question 77

Absent of bells phenomenon is relatively contraindication to ptosis surgery

Answer 77

T

Question 78

Patients with ectropion
may have symptoms for months or years before seeking treatment

Answer 78

T

Question 79

The incidence of congenital ptosis

Answer 79

estimated at 2.9%

Question 80

The cuase of lower lid ectropian id acquired conditions only

Answer 80

F congenital or acquired conditions

Question 81

Congenital ectropion is Common

Answer 81

F Congenital ectropion is rarely isolated and may be associated with
blepharophimosis syndrome, microphthalmos, and ichthyosis

Question 82

Causes of acquired ectropion

Answer 82

most commonly involutional in nature, but
paralytic, cicatricial, or mechanical causes

Question 83

Causes Involutional ectropion

Answer 83

occurs with increased horizontal lid laxity due to age-related weakness in canthal ligaments
and pretarsal orbicularis muscle, often coupled with disinsertion of
the capsulopalpebral fascia
Negative vectors

Question 84

Patients with negative orbital vectors are
also at increased risk as 92% of eyelids with involutional ectropion

Answer 84

T

Question 85

scarring of the posterior lamella can considered one of the causes of ectropion

Answer 85

scarring of the anterior
and/or mid lamella

Question 86

Causes of aquired ectropion

Answer 86

facial nerve palsy, scarring of the anterior
and/or midlamella, disinsertion of capsulopalpebral fascia, and lower
eyelid tumors, such as neurofibromas

Question 87

patient with lower lid laxity management?

Answer 87

begins with lubrication if significant corneal exposure is present.
Taping of the inferolateral
canthal skin in a superolateral direction may also provide temporary
relief.
Surgical correction

Question 88

a canthopexy
may have a greater risk of rounding at the reconstructed canthus.

Answer 88

F a canthoplasty
may have a greater risk of rounding at the reconstructed canthus.

Question 89

The candidate patients for tarsal tuck?

Answer 89

mild lid laxity
minimal distensibility and a firm snap back of the lower lid

Question 90

In Tarsal Tuck lateral tarsus is tucked inside the rim and the lateral canthus is
elevated

Answer 90

T

Question 91

patients with involutional ectropion best treated with tarsal tuck

Answer 91

F Lateral Tarsal Strip

Question 92

The candidate for Lateral Tarsal Strip

Answer 92

involutional ectropion
lower lid laxity secondary to paralytic
cicatricial etiologies

Question 93

a lateral tarsal strip has gained ascendency why?

Answer 93

due to the restoration of a sharp lateral canthal angle and avoidance of layered closure of the lid margin, with the associated risk of trichiasis and notching.

Question 94

For repair of frank ectropion, reinsertion of the
capsulopalpebral fascia via a transconjunctival approach is often
required as well to produce a durable result

Answer 94

T

Question 95

the first-line procedure for involutional ectropion with excess horizontal lid laxity is the tarsal tuck

Answer 95

F Tarsal strip

Question 96

adjunctive procedures such as retractor
reinsertion are necessary in all cases

Answer 96

F adjunctive procedures such as retractor
reinsertion are necessary in some cases

Question 97

Complications of the tarsal strip?

Answer 97

lateral canthal irregularity with or without trichiasis and recurrence of laxity

Question 98

in Canthoplasty we can mobilized the upper crus only

Answer 98

Canthoplasty . Mobilization
of both the upper crust and lower crus of the lateral canthal tendon can lengthen the palpebral fissure and reorient the position
of the entire lateral canthus

Question 99

iN canthoplasty division of the lateral canthus always required to achieve mobilization of the lateral canthus

Answer 99

F Depending on the degree of tendinous laxity, the division of the tendon body from the underlying periosteum may or may not
be required

Question 100

Complications following canthoplasty infrequent and most commonly minor

Answer 100

T

Question 101

Causes of Recurrence?

Answer 101

periosteal fixation is not achieved
the eyelids are too lax
other periocular vector forces are not fully addressed

Question 102

Recurrent lid malposition can be noted in up to 20% of patients,

Answer 102

T

Question 103

Lower eyelid fold is absent in children

Answer 103

F. Present

Question 104

Schrimer test is don routinely for. eye ptosis

Answer 104

F

Question 105

lower eyelid fold, particularly in children, can also be found approximately 3 to 5 mm from the lid margin.

Answer 105

T

Question 106

Blood supply to the eye

Answer 106

Facial artery: This vessel forms the angular, lateral nasal, and inferior medial palpebral arteries.
Transverse facial artery: This vessel forms the zygomaticofacial and inferior palpebral arteries.
Superficial temporal artery: This vessel forms the superior medial palpebral artery (peripheral arcade).
Ophthalmic artery: This vessel forms the lacrimal, supraorbital, medial palpebral, and dorsal nasal vessels.

Question 107

a skin crease can be found approximately 8 to 9 mm superior to
the eyelid margin in men and 9 to 11 mm in women

Answer 107

T

Question 108

With the eye open, the palpebral fissure measures 28 to 30 mm
in length and approximately 15 mm in height

Answer 108

F With the eye open, the palpebral fissure measures 28 to 30 mm
in length and approximately 9 mm in height

Question 109

the lid margin resting l to 2 mm below the superior limbus in
adults

Answer 109

T

Question 110

A greater number of sebaceous glands can be found in the nasal portion of the lids

Answer 110

T

Question 111

There is
relatively minimal subcutaneous fat in the eyelids, which can mostly
be found beneath preorbital and preseptal skin

Answer 111

T

Question 112

Beneath pretarsal
skin, as well as laterally over the medial and lateral canthal ligaments,
the underlying fat is absent

Answer 112

T

Question 113

The orbital subunit functions in forced closure, whereas the preseptal and pretarsal subunits are employed for blinking and voluntary winking

Answer 113

T

Question 114

Eyelid retractors

Answer 114

the levator palpebrae superioris and
Miiller muscle in the upper lid, and capsulopalpebral fascia in the
lower lid

Question 115

The levator palpebrae superioris fuse with with the orbital
septum anteriorly after attaching to the superior tarsal plate posteriorly.

Answer 115

F prior to attaching to the superior tarsal plate posteriorly.

Question 116

the sympathetically innervated Miiller
muscle contributes an additional 2 to 3 mm lid elevation

Answer 116

T

Question 117

With decreased sympathetic tone, as in
Horner syndrome, loss of Muller muscle function results in sever ptosis

Answer 117

F results in mild ptosis

Question 118

capsulopalpebral fascia come from the superior rectus muscle

Answer 118

f the inferior rectus muscle

Question 119

capsulopalpebral fascia. insert in the the inferior border of the lower tarsal plate,
only

Answer 119

the inferior border of the lower tarsal plate,
though minor fibers also insert on the conjunctiva of the inferior
fornix,

Question 120

sympathetically innervated fibers are intimately
involved with the posterior surface of the capsulopalpebral fascia,
although they are typically not identifiable as a distinct anatomical layer

Answer 120

T

Question 121

Orbital Septum Has variable
indistinct fusion with tarsal plate , however, can result in more prominent orbital fat
projection in different ethnicities, and with age

Answer 121

T

Question 122

The
central fat pad is broad and yellow secondary to higher levels of
carotenoids and is found in between the orbital septum and levator
aponeurosis

Answer 122

T

Question 123

The medial fat pad, which is more pale yellow or white
in color

Answer 123

T

Question 124

the superior oblique muscle separate The medial fat pad from the central
fat pad

Answer 124

T

Question 125

The inferior oblique
muscle separates the medial and central fat pad

Answer 125

T

Question 126

whereas the arcuate
expansion extending from the capsulopalpebral fascia separates the
medial and lateral fat pads.

Answer 126

T

Question 127

torsional diplopia. can result from the injury to the superior oblique muscle

Answer 127

F inferior oblique muscle

Question 128

The superior tarsal plate is
typically 10 to 12 mm in height centrally, narrowing medially, and
laterally to assume a crescentic shape

Answer 128

T

Question 129

The inferior tarsal plate is more
rectangular and measures approximately 4 mm in height centrally.

Answer 129

T

Question 130

Within the upper and lower eyelid, tarsus can be found
25 to 40 sebaceous meibomian glands.

Question 131

These empty at the lid margin
anterior to the gray line

Answer 131

F These empty at the lid margin
posterior to the gray line

Question 132

The lateral canthal tendon
passes deep to the orbital septum and inserts 2 mm posterior to the
lateral orbital rim on a bony prominence known as Whitnall tubercle.

Answer 132

T

Question 133

The palpebral conjunctiva lines the posterior surface
of the upper and lower eyelid and is firmly adherent to the tarsal

Answer 133

T

Question 134

Goblet cells within the
conjunctiva produce mucin, whereas accessory lacrimal glands are
responsible for basal secretion of aqueous tears

Answer 134

T

Question 135

Conjunctiva! tissue
loss can result in lid malposition and limitation in ocular motility

Answer 135

T

Question 136

The lacrimal glands responsible for the reflex secretion of the aqueous layer of
the tear film

Answer 136

T

Question 137

Two lobes of lacrimal gland are esperated by levator aponeurosis

Answer 137

T

Question 138

nasolacrimal duct open in inferior nasal meatus

Answer 138

T

Question 139

Decreased
tear production can lead to keratoconjunctivitis sicca

Answer 139

T

Question 140

second peripheral arcade
can be found above the tarsal plate on the posterior surface of the
Muller muscle,

Answer 140

F second peripheral arcade
can be found above the tarsal plate on the anterior surface of the
Muller muscle,

Question 141

In the lower eyelid, only one, more rudimentary arcade can be
found approximately 2 mm below the inferior tarsal margin

Answer 141

T

Question 142

lymphedema of the eyelids has high rates of recurrence

Answer 142

T

Question 143

Schirmer’s test

Answer 143

a filter paper strip is inserted into the lower
sulcus for 5 minutes to measure moisture. Tear production is considered to be diminished with less than 15 mm in the absence of a topical anesthetic and with 5 to 10 mm when a topical anesthetic is given

Question 144

tear production can also be evaluated by administering
fluorescein eye drops to determine whether there is interpalpebral
staining of the cornea

Answer 144

T

Question 145

For patients with excess tear accumulation or epiphora, a dye disappearance test or dilation and irrigation can be performed

Answer 145

T

Question 146

under sedation and anesthetic, a No. 00 Bowman probe can also be
passed through the lacrimal drainage system to determine the precise
locus of obstruction

Answer 146

T

Question 147

distances in an adult are 8 to 10 mm to
the common canaliculus, 10 to 12 mm to the lacrimal sac, and 24 mm
to the proximal end of the nasolacrimal duct

Answer 147

T

Question 148

tumor resection is the most common indication for
reconstruction of the upper eyelid

Answer 148

T

Question 149

For partial-thickness defects involving
less than 50% of the upper eyelid, primary closure is ideal,

Answer 149

T

Question 150

for larger partial-thickness defects involving greater than 50% of the upper eyelid

Answer 150

Fullthickness skin grafts are preferable to split-thickness skin grafts due
to less contracture postoperatively

Question 151

Depending on laxity, full-thickness defects of the upper lid up to 25%
of the horizontal length may be closed primarily,

Answer 151

T

Question 152

in older
patients defects up to 1/3 may closed primerly

Answer 152

T

Question 153

The lid margin is approximated
with 5-0 or 6-0 silk vertical mattress suture placed through the meibomian gland orifices in a far-far, near-near fashion to help evert the
wound edges.

Answer 153

T

Question 154

Importantly,
4 mm of tarsus is necessary to maintain stability at the lid margin

Answer 154

T

Question 155

A sliding tarsoconjunctival flap can also be
elevated from either the medial or lateral eyelid remnant and swung
into an adjacent defect

Answer 155

T

Question 156

the larger the diameter, the greater the advancement is possible.in inverted, modified Tenzel

Answer 156

T

Question 157

A skin-muscle flap is
undermined in the preseptal plane and kept superficial beyond the
orbital rim to avoid injury to the temporal branch of the facial nerve

Answer 157

T

Question 158

Total or near-total upper eyelid reconstruction

Answer 158

• using a musicalized tarsal graft and overlying myocutaneous orbicularis oculi flap, as previously discussed, but the graft typically has insufficient horizontal length and
  needs to be combined with hinged periosteal flaps or other adjunctive techniques.
• lower eyelid switch flap

Question 159

the lower eyelid is shorter in height and less mobile,
and from a functional standpoint, it contributes minimally to closure

Answer 159

t

Question 160

Lowe lid reconstruction must focus on appropriate lid position and tone.

Answer 160

T

Question 161

Local myocutaneous transposition flaps FOR lower eyelid

Answer 161

transposition flaps
temporally hinged monopedicle or bipedicle (Tripier) flaps fromthe ipsilateral
upper lid

Question 162

The
pedicle is kept as wide as possible laterally and should be at least I :4 in
base to length dimensions to preserve vascularity

Answer 162

t

Question 163

With defects less than 30% of the eyelid width, primary closure
can often be performed for lower eyelid

Answer 163

T

Question 164

When
excess tension is encountered, a lateral canthotomy and inferior
cantholysis can be considered. with primery repair of the lower eye lid

Answer 164

T

Question 165

A Tenzel semicircular rotation flap is typically used to repair
lower eyelid defects of larg size

Answer 165

F A Tenzel semicircular rotation flap is typically used to repair
lower eyelid defects of moderate size

Question 166

A Tenzel semicircular rotation flap is typically used to repair
lower eyelid defects of moderate size In tenzel flap

Answer 166

T

Question 167

a Hughes sliding transconjunctival flap contraindicated in

Answer 167

patients sighted only in the involved eye or in younger patients of
amblyogenic age.

Question 168

The largest full-thicknessdefects of the lower eyelid particularly those
involving the entirelid or with a vertical dimension greater than the horizontal one

Answer 168

reconstructed using a Mustarde cheek rotation flap
in conjunction with a composite graft or Hughes flap (

Question 169

Marking the flap well above the level of the lateral canthus
before extending to the periauricular skin is critical to correctly position
the lateral canthal angle. in mustardi

Answer 169

T

Question 170

Dermal anchorage of the Mustarde cheek flap to the lateral orbital rim periosteum is also key to minimizing vertical tension on
the reconstructed lid

Answer 170

T

Question 171

Color and texture match for
full-thickness skin grafts for lateral canthus can best be achieved by harvesting nearby
tissue and the postauricular donor site is frequently employed with
minimal donor-site morbidity

Answer 171

T

Question 172

computed
tomography scanning should be considered in appropriate patients
as part of a preoperative evaluation

Answer 172

T

Question 173

Preoperative evaluation of ptosis patients?

Answer 173

testing orbicularis oculi function, corneal sensation, strength of Bell
phenomenon, and in adults with dry eye symptoms, a Schirmer test
for tear function

Question 174

Severity of ptosis is classified as mild
(1-2 mm), moderate (2-3 mm), or severe (<’.4 mm)

Answer 174

t

Question 175

Normal levator excursion is usually greater than 12 mm

Answer 175

T

Question 176

evaluation of the sympathetically innervated Millier muscle function can be performed by instilling 2.5%
phenylephrine eye drops and evaluating changes to marginal reflex
distance after 10 minutes

Answer 176

T

Question 177

Draw bak of Muller muscle resection

Answer 177

little
room for intraoperative adjustment and violation of the conjunctiva! surface may increase risk for postoperative corneal irritation

Question 178

The levator advancement is widely applicable to
patients with senescent/involutional ptosis, traumatic ptosis, and
even some with congenital ptosis who have some preserved levator
function

Answer 178

t

Question 179

A Wright fascia needle is then passed starting from the brow incisions
in a pre periosteal plane, exiting the lid incisions in the postorbicularis
fascia plane in frontalis sling tech

Answer 179

T

Question 180

lid lag was the most frequently noted complication present in 90%.2 Iwith frontalis sling

Answer 180

T

Question 181

Common complications following ptosis correction

Answer 181

eyelid
asymmetry, which can result from undercorrection, overcorrection,
or discrepancies in lid contour

Question 182

Overcorrection is most frequently observed

Answer 182

Under correction is most frequently
observed and may arise from inadequate advancement ofthe levator
or postoperative relaxation of a frontalis sling

Question 183

Undercorrection is most frequently
observed and may arise from inadequate advancement ofthe levator
or postoperative relaxation of a frontalis sling

Answer 183

t

Question 184

the terms canthoplasty and canthopexy describe distinct procedures. Though both are
designed to provide support to the lower eyelid

Answer 184

T

Question 185

shortening the lid can occur with tarsal tuck

Answer 185

F It provides support without
shortening the lid and can be performed alone or in concert with
other procedures such as lower lid blepharoplasty

Question 186

lateral tarsus is tucked inside the rim and the lateral canthus is
elevated

Answer 186

T

Question 187

in patients with more significant lid laxity,
increased tucking required may result in bunching oftissue and the
lower lid may lose its apposition to the globe. In such patients, a lateral tarsal strip should instead be performed

Answer 187

T

Question 188

A lateral canthotomy and inferior cantholysis are first performed with a lateral tarsal strip

Answer 188

T

Question 189

A triangle of
redundant anterior lamella and lashes is then excised and the lateral canthal angle reformed with tarsal strip

Answer 189

T

Question 190

tightening of the lower eyelid
may result in the upper lid prolapsingover the lower lid margin and
irritation of the upper eyelid palpebral conjunctiva from eyelashes.
In these cases, the upper lid should be concomitantly shortened to
avoid a lid length discrepancy

Answer 190

T