10 - Classification of Eyelid Disorders Flashcards
(151 cards)
1
Q
Type de lésions bénignes des paupières le plus fréquent?
A
Epithelial hyperplasias, or papillomas, are the most common type of benign eyelid lesions.
2
Q
À quelle période de la gestation surviennent généralement les anomalies congénitales des paupières?
A
Most congenital anomalies of the eyelids are rare and occur during the second month of gestation as a result of developmental arrest or failure of fusion.
3
Q
(Blepharophimosis– Ptosis– Epicanthus Inversus Syndrome)
Synonyme de Blepharophimosis– Ptosis– Epicanthus Inversus Syndrome (BPES)?
A
Blepharophimosis– ptosis– epicanthus inversus syndrome (BPES), also called blepharophimosis syndrome, is typically autosomal dominant in inheritance, although sporadic mutations can occur.
4
Q
(Blepharophimosis– Ptosis– Epicanthus Inversus Syndrome)
Type de transmission?
A
Blepharophimosis– ptosis– epicanthus inversus syndrome (BPES), also called blepharophimosis syndrome, is typically autosomal dominant in inheritance, although sporadic mutations can occur.
5
Q
(Blepharophimosis– Ptosis– Epicanthus Inversus Syndrome)
Classic findings du Blepharophimosis?
A
Classic findings include
* Blepharophimosis (profound shortening of the horizontal, and narrowing of the vertical, palpebral fissures)
* Telecanthus (increased soft- tissue distance between the medial canthi)
* Epicanthus inversus (fold of skin extending from the lower eyelid to the medial canthus)
* Severe bilateral ptosis, often with poor levator function
In addition to the characteristics listed above, findings may include
* Lateral lower eyelid ectropion secondary to vertical eyelid deficiency
* Flat nasal bridge
* Superior orbital rim hypoplasia
* Ear deformities
* High- arched eyebrows
* Hypertelorism
6
Q
(Blepharophimosis– Ptosis– Epicanthus Inversus Syndrome)
Mutation génétique
A
The syndrome is caused by mutations in the FOXL2 gene , located on chromosome 3.
7
Q
(Blepharophimosis– Ptosis– Epicanthus Inversus Syndrome)
Lequel des types est associé à une insuffisance ovarienne prématurée et une infertilité?
A
There are 2 types of BPES (types I and II), and both involve abnormalities of the eyelids. Type I is also associated with premature ovarian failure, and infertility or reduced fertility in women.
8
Q
(Blepharophimosis– Ptosis– Epicanthus Inversus Syndrome)
Chx pour Tx du télécanthus?
A
Medial canthal repositioning is typically addressed first with multiple Z- plasties (Fig 10-2) or with Y– V- plasties, sometimes combined with repositioning of the medial canthal tendons via transnasal wiring or suture fixation to a plate; however, horizontal traction on the upper eyelid may exacerbate the ptosis.
9
Q
(Congenital Ectropion)
Mx/Syndromes associés à un Congenital Ectropion (x3)?
A
Congenital ectropion rarely occurs as an isolated finding. It is more often associated with
* BPES
* Down syndrome
* Ichthyosis
10
Q
(Congenital Ectropion)
Physiopathologie/Cause du Congenital Ectropion?
A
Congenital ectropion is caused by a vertical insufficiency of the anterior lamella of the eyelid and may give rise to chronic epiphora and exposure keratitis.
11
Q
(Congenital Ectropion)
Conséquences d’un Congenital Ectropion?
A
Congenital ectropion is caused by a vertical insufficiency of the anterior lamella of the eyelid and may give rise to chronic epiphora and exposure keratitis.
12
Q
(Congenital Ectropion)
Tx chirurgical ?
A
If the condition is severe and symptomatic, surgical correction is similar to that used for cicatricial ectropion, with vertical lengthening of the anterior lamella with full- thickness skin grafting, and, frequently, horizontal tightening of the lateral canthal tendon.
Allongement vertical de la lamelle antérieure avec une greffe cutanée sur toute l’épaisseur et un resserrement horizontal du tendon canthal latéral.
13
Q
(Congenital Ectropion)
Causes et Tx d’une Complete eversion of the upper eyelid?
A
Complete eversion of the upper eyelids occasionally occurs in newborns (Fig 10-3).
Possible causes include
* Anterior lamellar inflammation or shortage
* Inclusion conjunctivitis
* Down syndrome.
Topical lubrication and short- term patching of both eyes may be curative.
Full- thickness sutures or a temporary tarsorrhaphy is used when necessary, followed by definitive repair.
14
Q
Congenital eyelid deformities : Ankyloblepharon vs Epiblepharon vs Epicanthus palpebralis vs Euryblepharon?
A
15
Q
(Euryblepharon)
Qu’est-ce qu’un Euryblepharon?
A
Euryblepharon is associated with both vertical shortening and horizontal lengthening of the lower eyelids and may be associated with BPES.
16
Q
(Euryblepharon)
Portion de la lower eyelid la plus souvent involved : médiale ou latérale?
A
The lateral portion of the eyelid is typically more involved than the medial aspect, and the palpebral fissure often has a downward slant due to an inferiorly displaced lateral canthal tendon.
17
Q
(Euryblepharon)
Upward slant ou Downward slant de la fissure palpébrale?
A
The lateral portion of the eyelid is typically more involved than the medial aspect, and the palpebral fissure often has a downward slant due to an inferiorly displaced lateral canthal tendon.
18
Q
(Euryblepharon)
Pourquoi L’Euryblepharon peut-il occasionner une kératite d’exposition?
A
Impaired blinking and lagophthalmos may lead to exposure keratitis.
19
Q
(Euryblepharon)
Tx de l’Euryblepharon?
A
- If the condition causes symptoms, reconstruction may include lateral canthal repositioning along with suspension of the suborbicularis oculi fat to the lateral orbital rim to support the lower eyelid.
- If excess horizontal length is present, a lateral tarsal strip or eyelid margin resection may be required.
- Skin grafts may occasionally be necessary.
20
Q
(Ankyloblepharon)
Qu’est-ce que l’Ankyloblepharon?
A
Ankyloblepharon is a partial (ankyloblepharon filiforme adnatum) or complete fusion of the eyelid margins.
In severe cases, under lying ocular abnormalities may exist.
21
Q
(Epicanthus)
Qu’est-ce qu’un Epicanthus?
A
Epicanthus is a medial canthal fold (pli canthal médial) that may result from immature midfacial bones or a fold of skin and subcutaneous tissue.
The condition is usually bilateral, and an affected child may appear esotropic owing to decreased scleral exposure nasally (pseudostrabismus).
22
Q
(Epicanthus)
4 types of epicanthus?
A
Traditionally, 4 types of epicanthus have been described:
* epicanthus tarsalis, in which the fold is most prominent in the upper eyelid
* epicanthus inversus, in which the fold is most prominent in the lower eyelid
* epicanthus palpebralis, in which the fold involves the upper and lower eyelids equally
* epicanthus supraciliaris, in which the fold extends from the eyebrow region to the lacrimal sac
23
Q
(Epicanthus)
Type d’epicanthus associé à la population Asiatique?
A
Epicanthus tarsalis can be a normal variation of the Asian eyelid, whereas epicanthus inversus is often associated with BPES.
24
Q
(Epicanthus)
Type d’epicanthus associé au Blépharophimosis?
A
Epicanthus tarsalis can be a normal variation of the Asian eyelid, whereas epicanthus inversus is often associated with BPES.
25
# (Epicanthus)
V ou F : Most forms of epicanthus become more apparent with normal growth of the facial bones.
Faux. Most forms of epicanthus become less apparent with normal growth of the facial bones.
26
# (Epicanthus)
Tx d'un epicanthus?
* Most forms of epicanthus **become less apparent with normal growth** of the facial bones.
* If **no associated eyelid anomalies** are present, **observation** is recommended **until** the face achieves **maturity**.
* Epicanthus **inversus**, however, **rarely resolves** with facial growth.
* Most cases of isolated epicanthus requiring treatment are corrected by soft- tissue revisions such as **Z- plasty or Y– V- plasty**.
* Epicanthus **tarsalis** in an Asian patient may be eliminated by a **Y– V- plasty** with or without formation of an upper eyelid crease.
27
# (Epiblepharon)
Chez quelle population l'Epiblepharon est-il plus fréquent?
Epiblepharon is most common in **Asian children**.
28
# (Epiblepharon)
Physiopathologie de l'Epiblepharon?
* In this condition, the lower eyelid pretarsal muscle and skin ride above the lower eyelid margin to form a horizontal fold of tissue, causing the cilia to assume a vertical position.
* Pathophysiologically, this condition results from a deficiency in the attachment of the lower eyelid retractors (capsulopalpebral fascia) to the skin.
*Le muscle préseptal de la PI et la peau dépassent le rebord de la PI, ce qui crée un pli horizontale et déplacement des cils.*
29
# (Epiblepharon)
Est-ce que les cils touchent la cornée dans l'Epiblepharon?
The cilia often do not touch the cornea except in downgaze, and this rarely causes corneal staining.
30
# (Epiblepharon)
Tx de l'Epiblepharon?
* Epiblepharon may not require surgical treatment, as it tends to **diminish with maturation of the facial bones**.
* However, it occasionally results in **acute or chronic corneal epithelial irritation**; in that case, repair is performed by **excision of the excess skin and pretarsal orbicularis muscle** combined with placement of **marginal rotation sutures**.
31
# (Epiblepharon)
Pathologie associée à un inversion de la marge de la paupière?
In contrast to epiblepharon, eyelid margin inversion is present in congenital entropion.
32
# (Distichiasis)
Définir le Distichiasis?
Distichiasis is a rare, sometimes hereditary condition in which an extra row of eyelashes is present in place of the meibomian gland orifices.
33
# (Distichiasis)
Physiopathologie du Congenital distichiasis?
Congenital distichiasis occurs when embryonic pilosebaceous units improperly differentiate into hair follicles.
34
# (Distichiasis)
Indication et Tx du Distichiasis?
Treatment is indicated if the patient is symptomatic or if keratopathy develops.
Lubricants and soft contact lenses may be sufficient; if not, electrolysis, radiofrequency ablation, and eyelid splitting with removal of the follicles are alternatives.
35
# (Congenital Coloboma)
Localisation du Colobome congénital a/n de la paupière?
A coloboma is an embryologic cleft that is usually an isolated anomaly when it occurs in the **medial upper eyelid**.
36
# (Congenital Coloboma)
Qu'est-ce qu'un true coloboma?
A true coloboma includes a **defect in the eyelid margin**.
37
# (Congenital Coloboma)
Localisation d'un colobome de la paupière associé à d'autres conditions congénitales?
When located in the lower eyelid, however, a coloboma is frequently associated with other congenital conditions such as facial clefts (eg, Goldenhar syndrome) and lacrimal deformities.
38
# (Congenital Coloboma)
Conditions congénitales parfois associées?
When located in the lower eyelid, however, a coloboma is frequently associated with other congenital conditions such as **facial clefts** (eg, **Goldenhar syndrome**) and **lacrimal deformities**.
39
# (Cryptophthalmos)
Définition Cryptophthalmos?
Cryptophthalmos is a rare condition that presents with partial or complete **absence** of the **eyebrow, palpebral fissure, eyelashes, and conjunctiva**.
The partially developed adnexa are fused to the anterior segment of the globe.
Histologically, the orbicularis oculi, levator muscle, tarsus, conjunctiva, and meibomian glands are attenuated or absent; thus, attempts at reconstruction are difficult.
Severe ocular defects are present in the under lying eye, which can be microphthalmic or associated with an orbital cyst.
40
# (Infantile (Capillary) Hemangioma)
Hx d'un hémangiome capillaire infantile?
In the typical natural course, the lesion usually **develops within a few weeks or months** after birth, **increases in size over the first year**, and gradually **involutes over the next 3–7 years**.
41
# (Infantile (Capillary) Hemangioma)
Indications de Tx
Hemangiomas are associated with a high incidence of **amblyopia**; therefore, treatment is recommended for patients who present with **occlusion of the visual axis, anisometropia, or strabismus**, as well as for lesions causing **significant disfigurement**.
42
# (Infantile (Capillary) Hemangioma)
Tx de l'hémangiome infantile?
* Timolol gel : lésion limitée a/n eyelid, moins d'ES
* Intralesional steroids : /!\ risque nécrose paupière, occlusion rétinienne embolique, suppression adrénergique systémique
* Systemic propranolol : more widespread or deeper orbital involvement
* Oral corticostreoids : more widespread or deeper orbital involvement, élimine risque de nécrose et embole mais augmentation des ES systémiques
* Topical clobetasol propionate
* Interferon alfa : cas life-threatening ou sight-threatening lesions, risque of serious adverse effects
* Surgical excision : rare well-circymscribed lesions
* Topical cutaneous lasers : superficielle (1-2 mm), ne pénètre pas pronfondément
43
# (Chalazion)
Glande(s) obstruée(s) dans un chalazion?
A chalazion is a focal inflammation of the eyelids that results from an obstruction of the **meibomian glands**.
44
# (Chalazion)
Conditions souvent associées avec un chalazion?
This common disorder is often associated with conditions such as **rosacea** and **chronic blepharitis**.
45
Que produisent les glandes de Meibomius? Type de glande?
The meibomian glands are **oil- producing sebaceous glands** located in the tarsal plate.
46
# (Chalazion)
Physiopathologie du chalazion?
If the gland orifices on the eyelid margin become **plugged**, the contents of the glands (**sebum**) are **released into the tarsus and the surrounding eyelid soft tissue**, eliciting an **acute inflammatory response** accompanied by pain and erythema.
47
# (Chalazion)
Type d'inflammation à l'histologie d'un chalazion?
Histologically, these lesions are characterized by **chronic lipogranulomatous inflammation**.
Histologie : réaction lipogranulomateuse
* Granulomateuse = présence de macrophages (gros noyau excentrique)
* Lipo : macrophages autour de lipides
48
3 types de grosses ¢ à l'histologie?
3 types de grosses ¢ à l'histologie :
* ¢ de Touton
* ¢ de Langerhans
* ¢ à corps étrangers
49
# (Chalazion)
Tx du chalazion?
CAT :
Compresses tièdes + Hygiène des paupières
Anti-inflammatoire et ATB topique (ex. Tobradex x 2 sems)
ATB PO (si plusieurs chalazions, ex. 3-4)
* Doxycycline : 100 mg PO BID x 1 mois puis 100 mg PO DIE x 1 mois
* Tétracycline
* Azithromycine : possibilité de faire un loading dose
Surgical management
Injection locale de cortico : moins efficace que la chx, skin depigmentation
50
Contre-indications des tétracyclines?
/!\ Tétracyclines CI chez enfants et F enceintes
51
# (Chalazion)
À quel endroit la réponse inflammatoire est-elle la plus grande dans un chalazion : posterior or anterior eyelid?
In most cases, the greatest inflammatory response is on the **posterior eyelid**, and an incision through tarsus and conjunctiva is appropriate for drainage.
52
# (Chalazion)
Décrire le surgical management du chalazion?
* In most cases, the greatest inflammatory response is on the posterior eyelid, and an incision through tarsus and conjunctiva is appropriate for drainage.
* Sharp dissection, curettage, and excision of all necrotic material, including the cyst wall, are indicated.
* This procedure results in a posterior marsupialization of the chalazion.
* Caution is required when removing inflammatory tissue at the eyelid margin or adjacent to the punctum.
53
# (Chalazion)
Indications d'envoyer le specimen de chalazion en pathologie?
Given the risk of masquerade conditions, including sebaceous cell carcinoma, pathologic examination is appropriate for **atypical or recurrent chalazia**.
The combination of excision and steroid injection yields a 95% resolution rate.
54
# (Orgelet)
Définition de l'orgelet?
* An **acute infection** (usually staphylococcal) can involve the sebaceous secretions in the glands of Zeis (external hordeolum, or stye) or the meibomian glands (internal hordeolum).
* In the case of external hordeola, the infection may appear to center around an eyelash follicle, and the eyelash can be epilated to promote drainage.
Souvent présence d'un point douloureux/dlr exquise avec l'orgelet (vs chalazion)
55
# (Orgelet)
Glandes atteintes dans un orgelet?
* An acute infection (usually staphylococcal) can involve the **sebaceous secretions in the glands of Zeis (external hordeolum, or stye) or the meibomian glands (internal hordeolum)**.
* In the case of external hordeola, the infection may appear to center around an eyelash follicle, and the eyelash can be epilated to promote drainage.
56
# (Orgelet)
Tx de l'orgelet?
* Most hordeola resolve **spontaneously**, but diligent **application of hot compresses and topical antibiotic ointment** may be helpful.
In rare cases, hordeola may progress to superficial cellulitis, or even abscesses, of the eyelid.
* In such cases, **systemic antibiotic** therapy and **possible surgical incision and drainage** may be required.
57
# (Orgelet)
External hordeolum vs Internal hordeolum?
An acute infection (usually staphylococcal) can involve the sebaceous secretions in the **glands of Zeis (external hordeolum, or stye)** or the **meibomian glands (internal hordeolum)**.
58
À quel pathogène faut-il penser en présence d'un abcès périoculaire?
SARM
59
Tx ATB du SARM?
Si abcès périoculaire : penser à SARM
ATB couvrant le SARM :
* Tétracycline
* Doxycycline
* Bactrim
* Lizénozides
60
# (Floppy Eyelid Syndrome)
Présentation clinique (signes et sx)?
Floppy eyelid syndrome is characterized by
* Ocular irritation
* Redness
* Eyelash ptosis
* Loss of eyelash parallelism
* Mild mucus discharge that is frequently worse on awakening
Patients have chronic papillary conjunctivitis and a superior tarsal plate that is rubbery, flaccid, and easily everted.
During examination, the lax upper eyelid everts spontaneously, especially laterally, when pulled up toward the forehead.
61
# (Floppy Eyelid Syndrome)
Trouvaille à l'histologie?
Histologic examination has demonstrated a marked **decrease in the number of elastin fibers within the tarsus**.
62
# (Floppy Eyelid Syndrome)
Position de sommeil souvent associée?
Patients often report sleeping in a **prone position** (position ventrale), which can cause mechanical upper eyelid eversion, with the superior palpebral conjunctiva rubbing against the pillow or bedding.
63
# (Floppy Eyelid Syndrome)
Conditions associées?
Associations have been reported with
* Obesity
* Sleep apnea
* Keratoconus
* Eyelid rubbing
* Hyperglycemia
64
# (Floppy Eyelid Syndrome)
Tx du Floppy Eyelid Syndrome?
* **Sleep studies** are recommended to rule out sleep apnea.
* Initial conservative treatment consists of **viscous lubrication and a patch or shield at night**.
* Surgical correction, if warranted, consists of **wedge resection and horizontal eyelid tightening**.
* If the patient has been diagnosed with sleep apnea, use of a continuous positive airway pressure device may reduce prone position sleeping and minimize recurrence after surgical correction.
65
# (Floppy Eyelid Syndrome)
Type de conjonctivite associé au Floppy Eyelid Syndrome?
Floppy Eyelid Syndrome
66
# (Eyelid Imbrication Syndrome)
Définir le Eyelid Imbrication Syndrome?
Eyelid imbrication syndrome occurs **when a lax upper eyelid with a normal tarsal plate overrides the lower eyelid margin during closure**; this results in chronic mechanical conjunctivitis.
67
# (Eyelid Imbrication Syndrome)
Tx du Eyelid Imbrication Syndrome?
* Management consists of topical lubrication in mild cases.
* In more severe cases, horizontal tightening of the upper eyelid is indicated.
68
# (Trichotillomania)
Définir la Trichotillomania? Population/Onset? CAT?
* Trichotillomania is an impulse- control disorder most commonly seen in **preteen or teenaged girls**.
* It is characterized by the **repeated desire to pull out hairs, frequently eyebrows or eyelashes**.
* Diagnosis may be elusive, as affected patients usually deny the behavior; therefore, parental counseling or psychiatric consultation may be indicated.
* Characteristically, **multiple hairs are broken off and regrow at different lengths**, a finding that guides the diagnosis.
69
Malignant lesions that most frequently affect the eyelids?
The malignant lesions that most frequently affect the eyelids are
* Basal cell carcinoma
* Squamous cell carcinoma
* Sebaceous cell carcinoma
* Melanoma
70
A/n de quelle couche de la peau se développement la majorité des lésions bénignes ou malignes?
Most lesions, whether benign or malignant, develop from the **epidermis**, the rapidly growing superficial layer of the skin.
71
FdR de développer un cancer de la peau?
* A history of prior skin cancer
* Excessive sun exposure, especially blistering sunburn
* Previous radiation therapy
* A history of smoking
* Celtic or Scandinavian ancestry, with fair skin, red hair, and blue eyes
* Immunosuppression
72
Signs suggesting malignancy?
Signs suggesting malignancy are
* Ulceration or chronic, nonhealing lesion
* Bleeding, crusting, drainage
* Destruction of normal eyelid margin architecture (especially meibomian orifices)
* Loss of cilia (madarosis)
* Heaped-up, pearly, translucent margins with central ulceration
* Fine telangiectasias
* Pigmentary changes
* Loss of fine cutaneous wrinkles or vellus hair (perte des fines rides cutanées)
73
V ou F : Une induration palpable s'étendant au-delà des marges visiblement apparentes suggère une infiltration tumorale dans le derme et le tissu sous-cutané.
Vrai. Une induration palpable s'étendant au-delà des marges visiblement apparentes suggère une infiltration tumorale dans le derme et le tissu sous-cutané.
74
Que faire à l'e/o si lésion suspecte près du punctum?
Lesions near the puncta should be evaluated for punctal or canalicular involvement.
**Probing and irrigation** may be required to exclude lacrimal system involvement or to prepare for surgical reconstruction.
75
Types de néo cutanées nécessitant évaluation des ADNP pour recherche de métastases?
In addition, regional lymph nodes should be palpated for evidence of metastases in cases of suspected
* Squamous cell carcinoma
* Sebaceous cell carcinoma
* Melanoma
* Merkel cell carcinoma
76
Signes suggestifs (x2) d'une extension orbitale de la néo cutanée?
**Restriction of ocular motility** and **proptosis** suggest orbital extension.
77
NC à évaluer lors d'un e/o pour une néoplasie cutanée?
Assessment of the function of **cranial nerves V and VII** can reveal deficiencies that may indicate perineural tumor spread.
78
L'invasion périneurale est caractéristique de quelle néo cutanée?
Perineural invasion is a characteristic of **squamous cell carcinoma**.
79
Autres organes à évaluer lors de métastases d'un mélanome ou d'un ADK sébacé de la paupière?
Systemic evidence of **liver, pulmonary, bone, or neurologic involvement** should be sought in cases of sebaceous adenocarcinoma or melanoma of the eyelid.
80
Synonyme d'une hyperplasie épithéliale?
Papillome
81
Synonyme de Papillome
Hyperplasie épithéliale
82
Most common type of benign eyelid lesions
Papillomes (hyperplasies épithéliales)
83
V ou F : le terme papillome implique une association avec le papillomavirus.
Faux. This designation does NOT necessarily imply any association with the papillomavirus.
84
Ddx des hyperplasies épithéliales (papillomes)?
Included within this group are
* Seborrheic keratosis
* Pseudoepitheliomatous hyperplasia
* Verruca vulgaris (wart)
* Acrochordon (also called skin tag, fibroepithelial polyp, or squamous papilloma)
* Basosquamous acanthoma
* Squamous acanthoma
* And many others.
85
Tx chirurgical des hyperplasies épithéliales?
All of these benign proliferations can be managed with **shave excision at the dermal– epidermal junction**.
86
Apparence de la kératose séborrhéique?
* Its clinical appearance varies; it may be **sessile or pedunculated** and have **varying degrees of pigmentation and hyperkeratosis**.
* On facial skin, seborrheic keratosis typically appears as a smooth, greasy, stuck-on lesion.
* On the **thinner eyelid skin**, however, it can be **more lobulated, papillary, or pedunculated, with visible excrescences (excroissance) on its surface**
87
Comment appelle-t-on une kératose séborrhéique impliquant un follicule pileux?
A seborrheic keratosis involving a hair follicle, called an **irritated follicular keratosis**, may be more elevated and nodular.
It can be confused with a keratoacanthoma or squamous cell carcinoma.
KS **irritative** : A/n d'un follicule pileux
88
Qu'est-ce que la pseudoepitheliomatous hyperplasia?
Pseudoepitheliomatous hyperplasia is not a discrete lesion but rather a **pattern of reactive changes in the epidermis** that may develop over areas of inflammation or neoplasia.
89
Types de virus impliqués dans la verrue vulgaire? Tx de la verrue vulgaire?
Verruca vulgaris (wart), caused by epidermal infection with the human papillomavirus, rarely occurs in thin eyelid skin.
Cryotherapy or excision may eradicate the lesion and minimize the risk of viral spread.
* Cutanée : 6 et 11
* Conjonctivale sessile : 16, 18, 33
* Conjonctivale pédonculé : 6, 11 et 16
90
Qu'est-ce que le Dermatosis papula nigra?
Dermatosis papula nigra :
* Presence of multiple, small, 1–5 mm diameter, smooth, firm, black or dark brown papules on face and neck
* Common in people with skin of colour, with Fitzpatrick skin phototype 4, 5 or 6
* Up to 35% of Black Americans
* Comédien Morgan Freeman
91
Définir le Leser-Trélat sign?
Leser-Trélat sign
* Abrupt appearance of multiple seborrheic keratoses that rapidly increase in their size and number
* Association avec ADK GI
92
Définir le terme Cutaneous horn?
Cutaneous horn is a descriptive, nondiagnostic term referring to **exuberant hyperkeratosis**.
93
Pathologies cutanées associées à une cutaneous horn?
This lesion may be associated with various benign or malignant histologic processes, including
* Seborrheic keratosis
* Verruca vulgaris
* Squamous or basal cell carcinoma
Biopsy of the base of the cutaneous horn is recommended.
94
Second most common type of benign periocular cutaneous lesions?
After papillomas, **cysts of the epidermis** are the second most common type of benign periocular cutaneous lesions, accounting for approximately 18% of excised benign lesions.
95
Comment distinguer le kyste tarsal d'un chalazion?
Kyste tarsal :
* Absence d'inflammation (versus un chalazion)
* Si voussure plus localisée (moins diffuse comme dans le chalazion), éverser la paupière = zone claire/blanc > parfois hyperpigmentée
96
Type le plus fréquent de cysts of the epidermis?
Most of these are epidermal inclusion cysts, which arise from the infundibulum of the hair follicle, either spontaneously or following traumatic implantation of epidermal tissue into the dermis.
Rupture of the cyst wall may cause an inflammatory foreign- body reaction.
The cysts may also become secondarily infected.
97
Composition des kystes épithéliaux d'inclusion ?
Although these cysts are often called sebaceous cysts, they are actually filled with **keratin**.
98
Tx des epidermal inclusion cysts?
* Recommended treatment for **small** cysts is **excision or marsupialization**, which involves excising around the periphery of the cyst but **leaving the base of the cyst wall** to serve as the new surface epithelium.
* **Larger or deeper** cysts may require **complete excision**, in which case the **cyst wall should be removed intact** to reduce the possibility of recurrence.
99
Milia
100
Epidermal inclusion cyst
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Définir le Milia? Population/Onset? Tx?
* **Multiple tiny epidermal inclusion cysts** are called milia.
* They are particularly common in **newborn infants**.
* Generally, milia **resolve spontaneously**, but they may be **marsupialized with a sharp blade or needle**.
* Multiple confluent milia may be treated with **topical retinoic acid cream**.
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Définir le pilar cyst?
* A less common epidermal cyst is the pilar, or trichilemmal, cyst.
* Such cysts are **clinically indistinguishable from epidermal inclusion cysts**, but they tend to **occur in areas containing large and numerous hair follicles**.
* Approximately **90%** of pilar cysts occur on the **scalp**; in the **periocular** region, they are generally found in the **eyebrows**.
* The cysts are filled with **desquamated epithelium**, and **calcification** occurs in approximately 25% of cases.
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Ddx d'une conjonctivite folliculaire chronique (x4)?
Ddx d'une conjonctivite folliculaire chronique :
* Molluscum contagiosum (qui n'est pas toujours directement sur la marge)
* Médicamenteuse/Toxique
* Virale
* ITSS
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Pathogène impliqué dans le Molluscum contagiosum?
Poxvirus
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Populations à risque de Molluscum contagiosum?
Enfants et patients immunosupprimés (aka SIDA)
* Molluscum contagiosum is a viral infection of the epidermis that often involves the eyelid in **children** with an associated follicular conjunctivitis.
* Occasionally, multiple exuberant lesions appear in adult patients with **AIDS**.
* The lesions are characteristically waxy and nodular, with a central umbilication.
* They may produce an associated follicular conjunctivitis.
* Treatment is observation, oral cimetadine, excision, controlled cryotherapy, or curettage.
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Tx du Molluscum contagiosum?
* Molluscum contagiosum is a viral infection of the epidermis that often involves the eyelid in children with an associated follicular conjunctivitis.
* Occasionally, multiple exuberant lesions appear in adult patients with AIDS.
* The lesions are characteristically waxy and nodular, with a central umbilication.
* They may produce an associated follicular conjunctivitis.
* Treatment is **observation, oral cimetadine, excision, controlled cryotherapy, or curettage**.
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Apparence d'un Molluscum contagiosum?
* Molluscum contagiosum is a viral infection of the epidermis that often involves the eyelid in children with an associated follicular conjunctivitis.
* Occasionally, multiple exuberant lesions appear in adult patients with AIDS.
* The lesions are **characteristically waxy and nodular, with a central umbilication**.
* They may produce an associated follicular conjunctivitis.
* Treatment is observation, oral cimetadine, excision, controlled cryotherapy, or curettage.**
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Définition Xanthélasma? Localisation? Tissus atteints?
* Xanthelasmas are yellowish plaques that occur commonly in the medial canthal areas of the upper and lower eyelids.
* They represent lipid- laden macrophages in the superficial dermis and subdermal tissues.
* Deep extension into the orbicularis oculi muscle can occur.
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Conditions parfois associés au Xanthélasma?
In rare instances, xanthelasmas are associated with **hyperlipidemia** or **congenital disorders of lipid metabolism**, so patients whose lipid levels are unknown may benefit from having them checked by their primary care physician.
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Tx des Xanthélasmas?
* When excising these lesions, the surgeon must be careful to avoid causing cicatricial ectropion or eyelid retraction.
* Other treatment options include serial excision, laser ablation, and topical trichloroacetic acid.
* Xanthelasmas may commonly recur after excision.
CAT :
* Excision chx (meilleure option)
* Ablation au laser (ne traite pas la zone plus profonde donc plus récurrence)
* Acide trichloroacétique (ne traite pas la zone plus profonde donc plus récurrence)
L'excision chx est la meilleure option pour prévenir les récidives. L'ablation au laser et l'acide trichloracétique ne traitent pas la zone plus profonde du Xanthélasma = plus grande risque de récurrence.
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Rayon UV associé au photovieillissement?
UVA : photoveillissement
UVB : coup de soleil (B = Burn)
UVC : absorption par couche d'ozone
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Rayon UV associé aux coups de soleil?
UVA : photoveillissement
UVB : coup de soleil (B = Burn)
UVC : absorption par couche d'ozone
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Rayon UV absorbé par la couche d'ozone?
UVA : photoveillissement
UVB : coup de soleil (B = Burn)
UVC : absorption par couche d'ozone
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Quel rayon UV est le plus associé au développement de la cataracte?
* UVA : les pire pour développement cataractes
* UVB : filtrer par l'H.A.
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Type de lésion maligne associé à des expositions intenses et de courtes durées au soleil?
Expositions intenses et de courtes durées : **mélanome**
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Types de lésion maligne associés à des expositions moins intenses et de longues durées au soleil?
Exposition de longue durée et moins intense : CBC et épidermoïde
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Les glandes de Moll sont des glandes [...] ?
Types de glandes : Endocrines ou Exocrines
Parmi les glandes **exocrines** :
* **Apocrine** (Moll)
* Holocrine (Meibonius, Zeis)
* Mérocrine (glande lacrymale et glandes de Wolfring et de Krause)
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Les glandes de Meibomius sont des glandes [...] ?
Types de glandes : Endocrines ou Exocrines
Parmi les glandes **exocrines** :
* Apocrine (Moll)
* **Holocrine** (Meibomius, Zeis)
* Mérocrine (glande lacrymale et glandes de Wolfring et de Krause)
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Les glandes de Zeis sont des glandes [...] ?
Types de glandes : Endocrines ou Exocrines
Parmi les glandes **exocrines** :
* Apocrine (Moll)
* **Holocrine** (Meibomius, Zeis)
* Mérocrine (glande lacrymale et glandes de Wolfring et de Krause)
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Les glandes lacrymales sont des glandes [...] ?
Types de glandes : Endocrines ou Exocrines
Parmi les glandes **exocrines** :
* Apocrine (Moll)
* Holocrine (Meibomius, Zeis)
* **Mérocrine** (glande lacrymale et glandes de Wolfring et de Krause)
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Les glandes de Wolfring sont des glandes [...] ?
Types de glandes : Endocrines ou Exocrines
Parmi les glandes **exocrines** :
* Apocrine (Moll)
* Holocrine (Meibomius, Zeis)
* **Mérocrine** (glande lacrymale et glandes de Wolfring et de Krause)
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Les glandes de Krause sont des glandes [...] ?
Types de glandes : Endocrines ou Exocrines
Parmi les glandes **exocrines** :
* Apocrine (Moll)
* Holocrine (Meibomius, Zeis)
* **Mérocrine** (glande lacrymale et glandes de Wolfring et de Krause)
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Type de mécanisme de sécrétion des glandes eccrines?
Les glandes eccrines sont des glandes sudoripares qui sécrètent par mécanisme mérocrine.
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Periocular adnexal oil glands (x3)?
Periocular adnexal oil glands include
* The meibomian glands within the tarsal plate
* The glands of Zeis, associated with eyelash follicles
* Normal sebaceous glands that are present as part of the pilosebaceous units in the skin hair
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Sweat glands in the periocular region (x2)?
Sweat glands in the periocular region include
* The **eccrine sweat glands**, which have a general distribution throughout the body and are responsible for thermal regulation
* The **ciliary glands** with apocrine secretion (the glands of Moll), which are located in the eyelid margin.
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# Lesions of oil gland origin
Présentation clinique d'un Sebaceous hyperplasia? Apparence? Localisation? Âge de onset?
* Sebaceous gland hyperplasia presents as **multiple small yellow papules** that may have **central umbilication**.
* They tend to occur on the **forehead and cheeks** and are common in patients older than **40 years**.
* These lesions are sometimes mistaken for basal cell carcinoma because they may have central umbilication and fine **telangiectasias**.
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# Lesions of oil gland origin
Syndrome associé à l'hyperplasie sébacée?
Patients with **multiple acquired sebaceous gland adenomas, adenomatoid sebaceous hyperplasia, or basal cell carcinomas** with sebaceous differentiation have an **increased incidence of visceral malignancy (Muir- Torre syndrome [MTS])** and should be evaluated accordingly.
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# Lesions of oil gland origin
Qu'est-ce que le Syndrome Muir-Torre?
Patients with multiple acquired sebaceous gland adenomas, adenomatoid sebaceous hyperplasia, or basal cell carcinomas with sebaceous differentiation have an increased incidence of visceral malignancy (Muir- Torre syndrome [MTS]) and should be evaluated accordingly.
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Sebaceous hyperplasia
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Caractéristiques d'un hidrocystome eccrine? Taille? Localisation? Lésion unique ou groupé? Tx?
* Eccrine hidrocystomas are common **cystic lesions 1–3 mm in diameter** that occur in **groups** and tend to **cluster around the lower eyelids and canthi and on the face**.
* They are considered to be ductal retention cysts, and they often **enlarge in conditions such as heat and increased humidity**, which stimulate perspiration (échange respiratoire par la peau).
* Treatment consists of **surgical excision**.
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Comment différencier hidrocystome eccrine de l'hidrocystome apocrine?
Eccrine hidrocystomas often enlarge in conditions such as heat and increased humidity, which stimulate perspiration.
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Caractéristiques d'un Synringome? Apparence? Localisation? Sexe? Syndromes associés? Tx?
* Benign eccrine sweat gland tumors found commonly in **young females**
* Syringomas present as **multiple small, waxy, elevated nodules 1–2 mm in diameter on the lower eyelids**
* Syringomas can also be found in the axilla and sternal region.
* They become more apparent during puberty.
* Because the eccrine glands are located within the dermis, these lesions are too deep to allow shave excision.
* Removal requires complete **surgical excision**.
* Syndromes : Marfan et Down
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Localisation des adénomes pléomorphe?
* This rare benign tumor occurs most commonly in the **head and neck region** and **may involve the eyelids**.
* Histologically, the tumor is identical to pleomorphic adenoma of the salivary and lacrimal glands.
* Treatment is complete surgical excision.
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Tumors of eccrine sweat gland origin (x3)
Adénome pléomorphe
Hidrocystome eccrine
Syringome
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Tumors of apocrine sweat gland origin (x2)
Hidrocystome apocrine
Cylindrome
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Tumors of Oil gland origin (x4)
Chalazion
Orgelet
Hyperplasie sébacée
Adénome sébacé
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Caractéristiques d'un hidrocystome apocrine? Localisation? Glande impliquée? Apparence? Tx?
* A very common, smooth cyst arising **from the glands of Moll along the eyelid margin**, apocrine hidrocystoma is considered to be an adenoma of the secretory cells of Moll rather than a retention cyst (Fig 10-32).
* These lesions are **typically translucent or bluish, and they transilluminate**.
* They may be **multiple and often extend deep** beneath the surface, especially in the canthal regions.
* Treatment for **superficial** cysts is **marsupialization**.
* **Deep** cysts require **complete excision** of the cyst wall.
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Caractéristiques des cylindromes? Apparence? Acquisition? Turban tumors? Tx?
* Cylindromas (eccrine spiradenomas) are rare tumors that can be solitary or multiple and may be dominantly inherited.
* Lesions are **dome- shaped, smooth, fleshcolored nodules** of varying size that tend to affect the scalp and face.
* They may occur so profusely in the scalp that it is entirely covered with lesions, in which case they are called **turban tumors**.
* Treatment is **surgical excision**, which may be difficult if multiple lesions involve a large surface area.
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Syndromes/Pathologies associés au Pilomatricome?
Multiple lesions or familial cases may be associated with
* Gardner syndrome
* Familial adenomatous polyposis
* Turner syndrome
* Myotonic dystrophy
* Rubinstein- Taybi syndrome
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Concernant le pilomatricome :
* Apparence?
* Âge at onset?
* Tx?
* Récurrence?
* Also known as pilomatrixoma, this lesion most often affects children and young adults.
* It usually occurs in the eyebrow and central upper eyelid as a nontender, reddish purple subcutaneous mass attached to the overlying skin (Fig 10-36).
* Pilomatricomas may become quite large, measuring up to 5 cm or more.
* Excision is usually curative, and recurrence is rare.
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Trichofolliculoma
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Trichoepithelioma
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Trichilemmoma
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Trichofolliculoma vs Trichoepithelioma vs Pilomatrixoma vs Trichilemmoma ?
