Benign eyelid disorders

Question 1

When looking at the upper and lower eyelids, we can see glands. Which of the following is NOT a gland contained in the eyelids?

1 - glands of moll
2 - glands of zeis
3 - meibomian gland
4 - glands of lacrimation

Answer 1

4 - glands of lacrimation

Sebaceous glands are also contained within the eyelids

Question 2

Which of the glands below secretes the lipid layer of the tear film that ensures tears don’t evaporate and remains in the eye for longer periods?

1 - glands of moll
2 - glands of zeis
3 - meibomian gland

Answer 2

3 - meibomian gland

Question 3

Which other part of the eye forms the inner layer of the eyelids?

1 - cornea
2 - sclera
3 - conjunctiva
4 - choroid

Answer 3

3 - conjunctiva

Question 4

Match the abnormal eyelid position with its description?

• Ptosis
• Entropions
• Ectropions
• Eyelids are protruding outwards
• Eyelids have turned inwards
• Drooping of the eyelids

Answer 4

Ectropions – Eyelids are protruding outwards

Entropions – Eyelids have turned inwards

Ptosis – Drooping of the eyelids

Question 5

Ectropions are when the eyelids are protruding outwards, most commonly caused by laxity of the canthal tendons. All of the following can cause ectropions, but which is the most common?

1 - aging (involutional)
2 - scarring caused by trauma (cictricial)
3 - paralytic causes include in cranial nerve VII nerve palsy
4 - infection

Answer 5

1 - aging (involutional)

cranial nerve VII = facial nerve

Question 6

In the image below, match the cause with the image:

A, B, C or D

• scarring caused by trauma (cictricial)
• tarsorrhaphy
• paralytic causes include in cranial nerve VII nerve palsy
• aging (involutional)

Answer 6

A = aging (involutional)
B = scarring caused by trauma (cictricial)
C = paralytic causes include in cranial nerve VII nerve palsy
D = - tarsorrhaphy (surgery that sews eyelids together to protect the surface of the eye

Question 7

Entropion is when the eyelids protrude inwards, commonly caused by which 2 of the following?

1 - laxity in the canthal tendons
2 - atrophy of lower lid retractors
3 - trauma
4 - infection

Answer 7

1 - laxity in the canthal tendons
2 - atrophy of lower lid retractors

Question 8

What do patients with Entropion typically complain of?

1 - loss of vision
2 - dry eyes
3 - foreign body sensation
4 - photophobia

Answer 8

3 - foreign body sensation

Question 9

What can Entropions increase the risk of?

1 - stye
2 - corneal scaring and ulceration of cornea
3 - chalazion
4 - all of the above

Answer 9

2 - corneal scaring and ulceration of cornea

Typically this can occur in chronic conditions causing keritisation of the cornea

Question 10

Which of the following treatments is used as a conservative management in the treatment of Entropions and Ectropions?

1 - prostoglandins
2 - NSAIDs
3 - eye drops for lubrication
4 - laser surgery

Answer 10

3 - eye drops for lubrication

Reduces risk of dry eyes, corneal scarring and ulceration

If ulceration occurs, antibiotics can be prescribed

Question 11

Which 2 of the following requirement needs to be met for patients to be referred for surgery?

1 - aged >65
2 - had problem for >5 years
3 - risk of ocular complications
4 - impaired quality of life

Answer 11

3 - risk of ocular complications
4 - impaired quality of life

Surgery aims to tighten the weakened lateral canthal tendons (Lateral tarsal strip procedure)

Question 12

Ptosis is drooping of the eyelid. All of the following cause ptosis, but which 2 are due to neurogenic causes?

1 - CNIII nerve palsy
2 - levator aponeurotic dehiscence
3 - Horner’s syndrome
4 - Myasthenia gravis

Answer 12

1 - CNIII nerve palsy
3 - Horner’s syndrome

Important to identify the cause as this determines the management

Question 13

Ptosis is drooping of the eyelid. All of the following cause ptosis, but which 2 are due to myogenic causes?

1 - Myotonic dystrophy
2 - levator aponeurotic dehiscence
3 - Horner’s syndrome
4 - Myasthenia gravis

Answer 13

1 - Myotonic dystrophy
4 - Myasthenia gravis

Important to identify the cause as this determines the management

Question 14

Does ptosis, drooping of the eyelid, due to myogenic causes associated with a unilateral or bilateral in its presentation?

Answer 14

• typically bilateral, or asymmetrical

Question 15

Ptosis is drooping of the eyelid. All of the following cause ptosis, but which is age related?

1 - Myotonic dystrophy
2 - levator aponeurotic dehiscence
3 - Horner’s syndrome
4 - Myasthenia gravis

Answer 15

2 - levator aponeurotic dehiscence

Stretching of aponeurosis

Important to identify the cause as this determines the management

Question 16

Is ptosis, drooping of the eyelid due to age such as levator aponeurotic dehiscence (stretching of aponeurosis) unilateral or bilateral in its presentation?

Answer 16

• unilateral

Can be repaired surgically

Question 17

Ptosis is drooping of the eyelid. All of the following cause ptosis, but which is mechanically caused?

1 - Myotonic dystrophy
2 - levator aponeurotic dehiscence
3 - lid lesion on upper lid or inflammation of upper lid
4 - Myasthenia gravis

Answer 17

3 - lid lesion on upper lid or inflammation of upper lid

Important to identify the cause as this determines the management