Eyelid Abnormalities

Question 1

name 2 subjective reasons for a ptosis

Answer 1

cosmesis and visual field loss (superiorly)

Question 2

what are some objective findings for a ptosis?

Answer 2

head posture, pupils, VA, ocular motility, palpebral fissure, marginal reflex distance (MRD1) and VF

Question 3

what is a normal palpebral fissure opening?

Answer 3

9-10mm

Question 4

what is MRD1 and what is a normal finding?

Answer 4

pupillary light reflex to upper eyelid margin

normal = 4-5mm

Question 5

what is a normal levator function finding?

Answer 5

downgaze to upgaze = 13-17mm

Question 6

what causes a congenital ptosis?

Answer 6

superior tarsal fold is usually absent or poorly developed - dystrophic levator muscle

Question 7

what causes an acquired ptosis?

Answer 7

myogenic, neurogenic, mechanical, age-related, or traumatic - stress/fatigue may make it worse

Question 8

what is an age related ptosis called?

Answer 8

dermatochalasis

Question 9

what is a neurogenic ptosis?

Answer 9

CN3 palsy from meningioma

Question 10

what is the treatment for ptosis?

Answer 10

depends on the cause - may refer to oculoplastics

Question 11

what is lagophthalmos?

Answer 11

inability to close upper eyelid(s)

Question 12

what are some subjective findings for lagophthalmos?

Answer 12

irritated eye (exposure related symptoms), cosmesis, poor sleep

Question 13

what are some objective findings for lagophthalmos?

Answer 13

VA, pupils, EOMs, palpebral fissure, MRD1, bells response, SLEx cornea

Question 14

what is a congenital cause of lagophthalmos?

Answer 14

lack of orbicularis oculi tone

Question 15

what is an acquired cause of lagophthalmos?

Answer 15

CN7 palsy, s/p cosmetic or reconstructive surgery

Question 16

what is the treatment for lagophthalmos?

Answer 16

determine cause - artificial tears/ointment, tarsorrhaphy or gold eyelid weight

Question 17

what are some signs and symptoms of floppy eyelid?

Answer 17

chronically red, irritated eye, mild mucous discharge/tearing

Question 18

floppy eyelid syndrome is typically seen in which type of patients?

Answer 18

patients that are obese with short, thick necks and sleep apnea syndrome

Question 19

what are some treatments for floppy eyelid syndrome?

Answer 19

ocular lubrications, consultation with PCP, topical antibiotic ointment, eyelid taping/shield, oculoplastics

Question 20

what is eyelid myokymia?

Answer 20

involuntary, repetitive spasms of eyelid muscles, typically continue on and off for a few days

Question 21

what are some objective items for myokymia?

Answer 21

history, external exam, and possible MRI

Question 22

what are some causes of myokymia?

Answer 22

fatigue, stress, caffeine/alcohol intake

Question 23

what is the treatment for myokymia?

Answer 23

reduce precipitating factors, consider Botox injections

Question 24

what is a blepharospasm?

Answer 24

uncontrolled blinking, twitching, closure of eyelids - always bilateral (disappears during sleep) no pain

Question 25

what are some objective items for blepharospasms?

Answer 25

history, SLEx, neuro-ophthalmic exam, MRI with attention to posterior fossa

Question 26

what are 2 causes of blapharospasms?

Answer 26

abnormal basal ganglia or secondary to systemic disease, drug induced

Question 27

what are some treatments for blepharospams?

Answer 27

tinted sunglasses with UV protection and refer to oculoplastics (Botox)