the lids and the lacrimal system Flashcards
what are the muscles of the eye responsible for retraction ?
levator palpebral superiors
the superior tarsal muscles - Muller muscles
what muscles are responsible for the closure of thee eye ?
orbicularis occuli
what aree the different glands found in the tarsal of the eye ?
meibomian glands
glands of zeiss (sebaceous gland )
glands of Moll ( modified sweat glands )
what is blepharitis ?
inflammation of the lid and one of the most common conditions encountered
what is the course and nature of blepharitis ?
chronic condition with frequent remission and exacerbations
what are the anatomical divisons of blepharitis ?
anterior
posterior
what are the causes of anterior bleepharitis ?
staphylococcal
seborrheic blepharitis
what are the causes of posterior blepharitis ?
Meibomian gland dysfunction
what are the components of tear film ?
mucin component - goblet cells
aqueous component - lacrimal gland
lipid layer - meibomian gland
what is the clinical presentation of staphylococcal blepharitis ?
redness
oedema
scales
loss of lashes
eversion of lid margin
what is the clinical presentation of seborrheic blepharitis ?
sticky, glued together lashes
oily scales
foamy tear film
what is the presentation of posterior blepharitis ?
meibomian gland openings clogged with oil
tenelgectasia
multiple and recurrent chalazia
what is a common association and must be excluded with posterior blepharitis ?
rosacea
what is the management for blepharitis ?
eyelid hygienee
warm compresses and lid massage upwards
topical lubricants to manage dryness
topical ab +/- topical steroids
Oral antibiotiics ( doxycycline )
what are the contraindications for doxycycline drops ?
history of allergy
pregnancy
breast feeding
children under 8 years old
what are the differeent eyelid lesions and swellings ?
stye
hordeolum/Chalazion
molluscum contagiousum
xanthelasma
what are styes and hordeolums usually secondary toand what may they progress to ?
they are usually secondary to staphylococcal infections and may progress into preseptal cellulitis
what is the management associated with styes and chalazion ?
warm compresses
topical antibiotics ( tobramycin and dexamethasone combo )
oral ab only if preseptal cellulitis develops
chalazion may need excision
what is molluscum contangiousum ?
viral infectiion caused by pox virus
associated with follicular conjunctivitis
pale waxy nodule with an umbilical centre on the lid margin
what is the management associated with molluscum contagiousum ?
resolves spontaneously
if it causes conjunctivitis then it needs surgical excision
what is xanthelasma ?
lipid deposits around the eye associated with hyperlipidemia
what is the management of xanthelasma ?
surgical excision
what are the different lid malpositions ?
either entropion (lid inverted inwards ) or ectropion ( lid everted outwards)
or trichiasis
what are the types of lid entropion ?
involutional ( laxity with age )
cicatricial ( scarring as with trachoma )
congenital
what are thee types of lid ectropion ?
iinvoloutional
cicatricial
mechanical
paralytic
congenital
what is trichiasis ?
malposition of thee eye lashes where they point towards the eye
what is thee treatment for trichiasis ?
electrolysis
what is the mode of prevention for eye lid malposition ?
treat cicatricial conjunctival disease
when can we diagnose ptosis ?
when the upper eyelid covers more than 2mm of the superior limbus
what are the different types of ptosis in adults ?
involutional / aponeurotic ptosis
myogenic
neurogenic
mechanical
what is the cause of involutional ptosis ?
dehiscence of levator muscle aponeurosis
good levator function
with a high lid crease
what are the causes of pseudoptosis ?
contralateral proptosis
contralateral lid retraction
blepharospasm
dermatochalasis
brow ptosis
what are thee types of surgeries for different types of ptosis ?
good levator function - levator resection
poor levator function - frontalis suspension
for aponeurotic ptosis - aponeurosis advancement
what is tthe most common cause of ptosis in adults ?
aponeurotic ptosis/involutional
what is the most common type of ptosis in congenital ptosis ?
myogenic ptosis
what are thee causes of abnormal tear distribution ?
eye lid malposition
tear film abnormalities like sebehrroic blepharitis
what are the lacrimal system obstructions in newborns vs adults ?
newborns : membranous obstruction of hasner valve
adults : naso-lacrimal duct obstruction
what is dacrocystitis ?
infection of thee lacrimal sac
what is the workup for epiphora ?
sit lamp examination and anterior segment examination
in newborns congenital glaucoma must be excluded
lacrimal system investigations
what are the lacrimal system investigations ?
dye disappearance test
lacrimal probing and irrigation
what is the management in adult NLDO ?
dacryocystorhinostomy
management is always surgical
newborns can resolve with conservative management
what must be excluded in congenital epiphora ?
congenital glaucoma
what are the types of periorbital infections ?
preseptal cellulitis - ant to orbital septum
post septal cellulitis - post to orbital septum
orbital cellulitis
what is the source of infection in preseptal cellulitis ?
local face or eye infection
or due to trauma
what are thee causative organisms in preseptal cellulitis ?
staph aureus
strep. pneumonia
strep. pyogens
what is the presentation of preseptal cellulitis ?
- Tenderness, swollen, inflamed eye lids ,+/- fever
- Normal pupil, ocular motility and VA, no Proptosis
what is the treatment for preseptal cellulitis ?
- Oral antibiotics eg Amoxicillin/Clavulanic acid
- Warm compresses
what is the source of infection in orbital cellulitis ?
- Direct spread: Sinusitis( Most common) Spread from face or teeth infection(Less common)
- Hematogenous spread: Immunocompromised patients and children
- Complication of trauma or surgery
what are the causative organisms in cases of orbital cellulitis ?
same as preseptal except
no pyogens , h.influenza instead
what is the clinical picture of orbital cellulitis ?
- Fever, periocular pain, inflamed eyelids
- Proptosis, limited ocular motility, RAPD, conjunctival chemosis
what are the complications associated with orbital cellulitis ?
CRAO,CRVO, cavernous sinus thrombosis
why is there a risk off infection spreading intracranially in orbital cellulitis ?
Orbital venous system drains into cavernous sinus therefore there is a risk of infection spreading intracranially
what are the investigations for orbital cellulitis ?
- CBC:Leucocytosis and neutrophilia
- CT/MRI (Orbit and sinuses)
what is the management for orbital cellulitis ?
medical emergency
hospital admission
Iv antibiotics - 3rd generation Cephalosporin (Ceftriaxone ) +/-Glycopeptide ( Vancomycin), Metronidazol
regular assessment of visual function
if no improvement repeat CT
what is the gold standard for differentiating between pre septal or orbital cellulitis ?
CT is the gold standard
