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Ophthalmology > Unit 1 - Eyelids > Flashcards

Unit 1 - Eyelids Flashcards

1
Q

What are the three main layers of the eyelid?

A

Outer layer, middle layer, and innermost layer

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2
Q

What are the components of the outer layer of the eyelid?

A

Skin, hair follicles, and sebacious glands

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3
Q

T/F: Dogs and cats have both upper and lower lid cilia.

A

False - they only have upper lid cilia

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4
Q

What are the components of the middle layer of the eyelid?

A

Muscle, tarsal plate, and meibomian glands

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5
Q

What are the components of the innermost layer of the eyelid?

A

Palpebral conjunctiva

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6
Q

What are the functions of the eyelid?

A

Corneal protection

Production, distribution, and drainage of tear film

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7
Q

What does the orbicularis oculi muscle do and what innervates it?

A

It closes the eye lids and is innervated with the facial nerve (CN VII)

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8
Q

What does the levator palpebra superioris muscle do and what innervates it?

A

It opens the eyelid and is innervated by the oculomotor (CN III)

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9
Q

What does the Muller’s muscle do and what innervates it?

A

It elevates the upper lid and is innervated by the sympathetic nervous system

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10
Q

What provides sensation to the eyelid?

A

The ophthalmic and maxillary branches of the trigeminal nerve (CN V)

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11
Q

In what direction should eyelids close?

A

From lateral to medial

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12
Q

What is ankyloblepharon?

A

Adhesion of the eyelid margins

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13
Q

When is ankyloblepharon normal?

A

Until 10-14 days postpartum in dogs and cats

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14
Q

When is ankyloblepharon abnormal?

A

If it persists past 15 days of age

Can occur with ophthalmia neonatorum

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15
Q

How should ankloblepharon be medically managed if it has been 15+ days post partum?

A

They should be opened with gentle traction on the eyelids or by blunt dissection

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16
Q

What is eyelid agenesis?

A

When there is absence of a portion of the eyelid

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17
Q

What lesion can eyelid agenesis result in?

A

Secondary trichiasis and exposure keratitis due to the cornea being exposed

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18
Q

What species is eyelid agenesis most common in?

A

Cats, especially feral, and horses

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19
Q

If the eyelid agenesis defect is small, how should it be treated?

A

Frequent use of ocular lubricants, cryosurgery for trichiasis hairs, and a simple wedge resection

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20
Q

If the eyelid agenesis defect is large, how should it be treated?

A

Reconstructive procedure to form a functional eyelid - refer to a specialist

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21
Q

What is a micropalpebral fissure?

A

A congenital small eye opening that may accompany other congenital defects (microphthalmos)

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22
Q

What breeds typically get micropalpebral fissures?

A

Miniature breeds, sheltie, collie, chow chow, Kerry Blue terrier, and others

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23
Q

How is micropalpebral fissure treated?

A

It rarely requires surgical intervention, but lateral augmentation canthoplasty if entropion is present and problematic

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24
Q

What is macropalpebral fissure?

A

Overly large eyelid openings

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25
Q

Macropalpebral fissure in combination with a shallow orbit results in what?

A

Conformational exophthalmos

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26
Q

What breeds is macropalpebral fissure common in?

A

Brachycephalic breeds

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27
Q

What other ocular manifestions can result from macropalpebral fissure?

A

Increased proptosis risk, possible lagophthalmos, exposure keratitis, and concurrent trichiasis

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28
Q

How is macropalpebral fissure treated and when is it indicated?

A

Surgical shortening of the eyelids is indicated if pigmentation, exposure keratits, or recurrent corneal ulcers

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29
Q

What surgical treatment for marcopalpebral fissures addresses multiple issues that brahcycephalics have with their eyes?

A

medial canthoplasty

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30
Q

What is entropion?

A

Inversion of the eyelid margin

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31
Q

What is ectropion?

A

Eversion of the eyelid margin

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32
Q

What is diamond eye?

A

A combination of entropion and ectropion

Common in Bloodhounds, Clumber Spaniel, St. Bernard, and Great Dane

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33
Q

What are the clinical signs associated with entropion?

A

Pain and squinting (blepharospasm) and excessive lacrimation (epiphora)

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34
Q

What corneal sequelae result from entropion?

A

Ulceration, vascularization, pigmentation, and corneal scarring

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35
Q

What is anatomic entropion?

A

Entropion in young dogs that is breed-related

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36
Q

What is spastic entropion?

A

Lid spasm associated with pain

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37
Q

What is cicatrical entropion?

A

Entropion resulting from previous surgery, trauma, or chronic eyelid inflammation

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38
Q

How is entropion temporarily corrected?

A

Eyelid tacking

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39
Q

When is temporary entropion treatment indicated?

A

In cases of anatomic entropion and spastic entropion

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40
Q

How is entropion permanently corrected?

A

Hotz-Celsus (or Others)

41
Q

When is permanent correction of entropion indicated?

A

Anatomic entropion in mature animals or cicatrical entropion

42
Q

How is temporary entropion correction done?

A

Place nonabsorbable vertical mattress sutures or skin staples on the lower eyelid to pull it out of the eye. Leave in for 3-4 weeks or longer

43
Q

Describe the Hotz-Celsus procedure.

A

Incise 2 mm from, while arcing parallel to, the eyelid margin.
Make a second incision at maximal entropion degree and arc it to connect both ends
Remove adequate subcutaneous tissues (test that cut margins can passively stay together)
Close with 5-0 suture; simple interrupted.

44
Q

What should be done to determine how much skin to remove?

A

Assess the eyelid conformation with minimal restraint in a conscious, unsedated animal
Apply topical anesthetic to relieve a spastic component
Delay permanent correction until the animal is skeletally mature

45
Q

What should you NOT do when determining how much skin to remove?

A

Do not over correct - you could end up causing iatrogenic ectropion

46
Q

What are the rough guidelines for excision width in permanent entropion treatment?

A

Mild: 4-5 mm
Moderate: 6-7 mm
Severe: 8-9

47
Q

When is ectropion typically corrected?

A

If there is associated problem conjunctivitis or corneal disease

48
Q

What is the conservative treatment for ectropion?

A

Eyewash rinsing +/- gel lubricant

49
Q

What surgeries can be done to treat ectropion?

A

Wedge resection, V to Y plasty, or blepharoplasty

50
Q

Where are V or Y plasties centered?

A

on the ectropic area

51
Q

What is trichiasis?

A

Normal facial hairs that contact the cornea/conjunctiva.

52
Q

What is distichiasis?

A

Hairs that emerge from meibomian gland openings

53
Q

What is ectopic cilia?

A

Hairs that emerge through the palpebral conjunctiva

54
Q

When does trichiasis cause a problem?

A

In combination with entropion
Bristly nasal fold trichiasis
When combined with KCS
When combined with functional NLD obstruction

55
Q

How is nasal fold trichiasis treated?

A

Nasal fold excision or medial canthoplasty if irritation or ulceration

56
Q

How is medial canthus trichiasis or hairy caruncle treated?

A

Medial canphoplasty or cryotherapy if irritating or tear wicking

57
Q

In cases of entropion trichiasis, how can it be treated?

A

entropion correction

58
Q

What is a good way to ID distichiasis?

A

Look for a mucus glob on the eyelid margin

59
Q

What are the ways to treat distichiasis?

A

Benign neglect, epilation, electrolysis, cryosurgery, thermal cautery, and laser excision (ill advised)

60
Q

Epilation is a _______ fix. It helps to establish the significance of distichia.

A

temporary

61
Q

Cryosurgery for distichiasis uses _______ or ____ to destroy the follicles but can cause __________ and ________.

A

Nitrous oxide or liquid nitrogen

temporary eyelid depigmentation and swelling

62
Q

What is the preferred treatment for distichiasis?

A

thermal cautery

63
Q

What is the typical signalment for ectopic cilia?

A

They are typically a young patient with a nonhealing or recurrent superficial corneal ulcer - most common dorsally

64
Q

How is ectopic cilia treated?

A

Remove the follicle completely and treat area with cryotherapy or thermal electroccautery

65
Q

What is hordeolum (stye)?

A

Infection of the eyelid glands

66
Q

What is chalazion?

A

Granuloma formation from inspissated meibomian gland secretions

67
Q

How is hordeolum and chalazion treated?

A

Hot compresses, manual expression of lesions, surgical incision and curettage, and/or topical and systemic antibiotics

68
Q

What is blepharitis?

A

Inflammation of the eyelids

69
Q

What is the general workup protocol for blepharitis?

A

Derm database - impression, skin scraping, hair pluck, cytology +/- culture, biopsy and histopath

70
Q

What is the clinical presentation for juvenile cellulitis?

A

Usually young of age, acute pyoderma of the head, bilateral eyelid involvement, and pyogranulomatous dermatitis with furunculosis and panniculitis

71
Q

How is juvenile cellulitis treated?

A

Systemic corticosteroids +/- systemic antibiotic if bacteria on cytology

72
Q

What is the signalment for bacterial blepharitis?

A

adult dogs

73
Q

What bacterial agents typically cause bacterial blepharitis?

A

Staphylococcus and Streptococcus

74
Q

How is blepharitis treated?

A

Treat the underlying cause if known

Cleanse eyelid with dilute baby shampoo

75
Q

____% of canine eyelid tumors are benign.

A

75%

76
Q

What are the most common eyelid neoplasms in dogs in order from most to least?

A

Meibomian gland adenoma»> melanocytoma> papilloma

77
Q

T/F: Most feline eyelid neoplasias are malignant.

A

True

78
Q

What are the most common eyelid neoplasms in cats in order from most to least?

A

SCC > mast cell > hemangiosarcoma

79
Q

What are the most common eyelid neoplasms in horses in order from most to least?

A

SCC > sarcoid > melanoma

80
Q

What are the most common eyelid neoplasms in cows?

A

SCC

81
Q

What is the therapeutic goal for eyelid masses?

A

Destroy the tumor while preserving eyelid function and cosmesis

82
Q

What are the treatment options for eyelid masses?

A

surgical resection, debulk and cryotherapy, CO2 laser, and benign neglect

83
Q

Describe the procedure for a wedge or ‘house’ resection.

A

Make an excision that is 30% the width of the length of the eyelid.
From base to apex, make the height of the incision twice the excision width.
Perform a 2-layer closure with 5-0 vicryl

84
Q

How do you perform the 2-layer closure for a wedge resection?

A

Place a few sutures buried in the deep layer if there is a large defect. For the skin and margin closure, make a figure-eight suture at the eyelid margin then interrupted skin sutures. Tie the suture ends into subsequent knots like a ‘ponytail’

85
Q

Specifically how do you do a figure-eight suture?

A

Start skin through subcutaneous tissue (side A).
Subcutaneous through meibomian gland opening of the opposite side (side B).
Meibomian gland opening through subcutaneous of the opposite side (side A).
Subcutaneous through skin exit of the opposite side (side B).

86
Q

For what type of eyelid tumor is debulking and cryosurgery recommended?

A

adenoma

87
Q

How are eyelid adenomas debulked and cryo-ed (lol verbs are hard)?

A

Place the patient under general anesthesia or deep sedation
Place a chelazion clamp to stabilize the eyelid and provide hemostasis
Incise conjunctival surface and debulk
Freeze with two fast freeze/slow thaw cycles

88
Q

Postoperatively, what will occur in a patient that just had debulking and cryosurgery?

A

Focal swelling and temporary depigmentation

89
Q

For what eyelid tumor type is a CO2 laser indicated?

A

adenoma

90
Q

How is a CO2 laser used to remove an adenoma?

A

Outline and excise the mass w/ laser while minimizing eyelid margin loss. Treat/ablate remaining tissue bed

91
Q

When is an advanced eyelid tumor removal indicated?

A

If the tumor is malignant or too large for a wedge resection - refer

92
Q

T/F - A complete ophthalmic exam is not necessary if there is eyelid trauma

A

False - need to look at the whole eye. Globe perforation is more important to manage

93
Q

What is the medical therapy for blunt injury to the eyelid?

A

Systemic anti-inflammatory +/- topical for uveitis

94
Q

What is the recommended surgical prep for penetrating injury to the eyelid?

A

Use betadine solution and saline prep.

95
Q

When should repair for recent eyelid lacerations be done? Older injuries?

A 
Recent injuries (<6 hours) ASAP
Older injuries when severe swelling has subsided
96
Q

How are eyelid lacerations repaired?

A

Minimal debridement. 2-layer closure with figure-eight margin suture.
Assure apposition of lid margin and that there are no sutures contacting the cornea

97
Q

What can result if there is poor lid margin apposition when repairing eyelid lacerations?

A

Trichiasis, exposure keratitis, and scar tissue that can abrade the cornea

98
Q

What is the postoperative management for eyelid lacerations?

A

Topical antibiotic, systemic antibiotic, systemic anti-inflammatory, pain control, cold compresses, and e-collar (prevent further trauma)

99
Q

When should eyelid laceration repair be rechecked and sutures removed?

A

10-14 days

Ophthalmology (13 decks)

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