Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anterior Segment Disease > 3: Eyelids- Malpositions and Twitching > Flashcards

3: Eyelids- Malpositions and Twitching Flashcards

(73 cards)

Start Studying
1
Q

dermatochalasis

A

lax and redundant upper > lower eyelid skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

dermatochalasis etiology

A

degeneration of connective tissue most commonly the result of aging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

dermatochalasis demographics

A
  • most commonly presents in the elderly

- sometimes with extreme weight loss or chronic blepharochalasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

dermatochalasis laterality

A

bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

dermatochalasis symptoms

A
  • asymptomatic
  • droopy eyelids
  • heavy eyelids
  • obstruction of superior visual field
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

dermatochalasis signs

A
  • upper eyelid skin laxity and redundancy
  • excessive skin –> “puffy” appearance
  • decreased MRD-1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

dermatochalasis management

A
  • none if asymptomatic
  • if symptomatic/cosmesis, refer out for blepharoplasty (BLUB- bilateral upper lid blepharoplasty); prior to referral, perform a VF with lids taped vs untaped, preferably super 36 aka a “ptosis VF”; if there is improvement in the VF with the lids taped, higher likelihood insurance will consider the surgery medically necessary; otherwise, patient may pursue blepharoplasty as elective cosmesis “out of pocket” procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

dermatochalasis clinical pearls:

  • BULB can be performed _____
  • never perform BULB ______
A

in office or in outpatient center;

right before intraocular surgery, the speculum will “stretch” the eyelid skin, better cosmetic outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ptosis

A

droopy upper eyelid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ptosis etiology

A

most commonly: aponeurotic; levator aponeurosis stretching or dehiscence due to aging, repetitive eye rubbing

less commonly:

  • mechanical (e.g., eyelid tumor, severe eyelid edema)
  • myogenic (e.g., muscular dystrophy, chronic progressive external ophthalmoplegia)
  • neurologic (e.g., CN III palsy, Horner syndrome, myasthenia gravis, multiple sclerosis)
  • congenital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ptosis demographics

A

depends on etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ptosis laterality

A

unilateral > bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ptosis symptoms

A
  • asymptomatic, cosmesis
  • droopy eyelid
  • obstruction of the superior visual field
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ptosis signs

A
  • drooping eyelid; UL is most commonly affected; if LL is affected, called a reverse ptosis
  • decreased MRD-1 and possibly MRD-2
  • signs of underlying cause (e.g., chalazion, EOM restriction, anisocoria, diplopia, high or absent eyelid crease if aponeurotic or congenital)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ptosis management

A
  • determine and treat the underlying condition

- if no resolution or congenital, consider referral for ptosis surgery, which involves resecting the levator aponeurosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ptosis clinical pearls:

-differentiate from ______

A

pseudoptosis; ex: dermatochalasis, brow ptosis, enophthalmos, microphthalmia, corneal protective mechanisms, contralateral eyelid retraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

entropion

A

eyelid turns inwards/towards the globe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

entropion etiology

A

most commonly age-related; horizontal eyelid laxity, retractor disinsertion, and orbicularis override

less commonly:

  • cicatricial (e.g., conjunctival scarring in trauma, burn injury, trachoma, OCP, SJS)
  • spastic (e.g., sustained orbicularis contraction due to surgical trauma, ocular irritation, or blepharospasm)
  • congenital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

entropion demographics

A

most commonly presents in the elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

entropion laterality

A

unilateral or bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

entropion symptoms

A
  • asymptomatic
  • ocular redness
  • ocular irritation (e.g., burning, FBS, pain)
  • tearing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

entropion signs

A
  • inversion of the eyelid

- signs of underlying cause (e.g., conjunctival scarring, spastic contraction of the orbicularis muscle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

entropion complications

A

trichiasis (lash bending inwards) –> ocular surface damage (conjunctival injection, SPK, pannus, corneal ulceration and scarring)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

entropion management

A
  • determine and treat the underlying condition; if no resolution, refer out for entropion surgery for definitive treatment
  • supportive management for trichiasis and resulting ocular surface damage; lash epilation, electrolysis, cryotherapy, or radiofrequency epilation; aggressive topical lubrication; BCL or scleral contact lens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
entropion clinical pearls: | -trichiasis without entropion is typically _____
idiopathic and only involves a few lashes; can cause irritation of the ocular surface; epilate lashes in office
26
ectropion
eyelid turns out/away from the globe
27
ectropion etiology
most commonly age-related; horizontal eyelid laxity less commonly: - mechanical (e.g., eyelid tumor) - cicatricial (e.g., shortening of the anterior lamella from trauma, burn injury, actinic damage, chronic inflammation, atopic dermatitis) - neurologic (e.g., CN VII palsy) - congenital
28
ectropion demographics
most commonly presents in the elderly
29
ectropion laterality
unilateral or bilateral
30
ectropion symptoms
- asymptomatic - ocular redness - ocular irritation (e.g., burning, FBS, pain) - tearing
31
ectropion signs
- eversion of the eyelid; LL is most commonly affected | - signs of underlying cause (e.g., eyelid tumor, eyelid scarring, paralysis of the facial muscles)
32
ectropion complications
lagophthalmos --> exposure keratopathy; more common in paralytic cases (ex: Bell's palsy)
33
ectropion management
- determine and treat the underlying condition; if no resolution, refer out for surgery for definitive treatment - supportive management for exposure keratopathy; aggressive topical lubrication - BCL, but lens may fall out due to lid positioning
34
eyelid retraction
excessive elevation of the eyelid
35
eyelid retraction etiology
most commonly due to thyroid eye disease; increased sympathetic tone acting on Muller's muscle, contraction of the levator, proptosis, and/or scarring between the lacrimal gland and levator less commonly: - mechanical (e.g., surgical overcorrection of ptosis) - cicatricial (e.g., scarring of the levator and/or Muller's muscle) - neurologic (e.g., dorsal midbrain syndrome) - pharmacological (e.g., sympathomimetic drops, like phenylephrine) - congenital (rare)
36
eyelid retraction demographics
women > men
37
eyelid retraction laterality
unilateral or bilateral
38
eyelid retraction symptoms
- asymptomatic - ocular redness - ocular irritation (e.g., burning, FBS)
39
eyelid retraction signs
- excessive elevation of the eyelid; UL is most commonly affected; in general, eyelid position is abnormal if superior sclera is exposed in primary gaze - increased MRD-1 and/or MRD-2 - signs of underlying cause (e.g., proptosis, deficiency of upward gaze, UL retraction and pupillary constriction on down gaze or adduction, dilated pupil)
40
eyelid retraction complications
lagopthalmos --> exposure keratopathy
41
eyelid retraction management
- determine and treat the underlying condition; if no resolution, refer out for surgery for definitive treatment - supportive management for exposure keratopathy
42
eyelid retraction clinical pearls: | -lower eyelid retraction can be ____
a normal anatomic variant
43
floppy eyelid syndrome (FES)
flaccid/loose upper eyelids due to a lax tarsal plate
44
floppy eyelid syndrome (FES) etiology
- unknown etiology | - commonly associated with obstructive sleep apnea
45
floppy eyelid syndrome (FES) demographics
- typically presents between the ages of 45-65. years | - men (obese) > women
46
floppy eyelid syndrome (FES) laterality
bilateral
47
floppy eyelid syndrome (FES) symptoms
- asymptomatic - ocular redness - ocular irritation (e.g., burning, FBS, itching) - mild mucous discharge - symptoms are typically unilateral (side that the patient sleeps) and worse upon waking (due to eyelid eversion during the night)
48
floppy eyelid syndrome (FES) signs
- upper eyelids that are easily everted without exerting counter pressure - rubbery superior tarsal plate - eyelid imbrication (UL overrides the LL on closure) - conjunctival injection - palpebral papillae superior (due to eyelid eversion during sleep and rubbing against bedding) - superficial punctate keratitis (SPK) - mild mucous discharge - ptosis (due to redundancy of skin surrounding tarsal plate)
49
floppy eyelid syndrome (FES) complications
- lagophthalmos (due to eyelid imbrication) --> exposure keratopathy - bacterial conjunctivitis (due to eyelid eversion during sleep)
50
floppy eyelid syndrome (FES) management
- supportive management (topical lubricant, eyelid taping or patching qhs with topical lubricant, refrain from sleeping face down) - refer out for surgery for definitive treatment - if not previously diagnosed, refer to PCP for sleep apnea
51
lagophthalmos
incomplete closure of the eyelids
52
lagophthalmos etiology
- mechanical (e.g., eyelid laxity, eyelid tumor, post eyelid surgery, proptosis, FES, severe conjunctival chemosis) - cicatricial (e.g., eyelid scarring, eyelid retractor muscle scarring) - neurologic (e.g., dorsal midbrain syndrome, CN VII palsy) - congenital
53
lagophthalmos demograhpics
depends on etiology
54
lagophthalmos laterality
unilateral or bilateral
55
lagophthalmos symptoms
- asymptomatic - ocular redness - ocular irritation (e.g., burning, FBS, pain) - tearing
56
lagophthalmos signs
- inadequate blinking or closure of the eyelids - signs of underlying cause (e.g., eyelid tumor, proptosis, chemosis, eyelid scarring, restriction in up gaze, paralysis of the facial muscles)
57
lagophthalmos complications
exposure keratopathy
58
lagophthalmos management
- determine and treat the underlying condition; if no resolution, refer out for surgery for definitive treatment - supportive treatment for exposure keratopathy (aggressive AT regime, topical steroid for SPK, Restasis or Xiidra bid, sleep mask, BCL, scleral lens, AMT with BCL)
59
eyelid myokymia
subtle eyelid twitch due to spontaneous contracture of the orbicularis muscle
60
eyelid myokymia etiology
- unknown etiology | - commonly triggered by stress, caffeine, alcohol, ocular irritation, lack of sleep
61
eyelid myokymia demographics
no predilection
62
eyelid myokymia laterality
unilateral***
63
eyelid myokymia symptoms
eyelid twitch
64
eyelid myokymia signs
eyelid twitch is typically subtle and difficult to observe
65
eyelid myokymia management
- self-limiting - modify/avoid triggers - 5-6 oz tonic water (anecdotal); contains quinine which may inhibit nerve impulses
66
eyelid myokymia clinical pearls: | -differentiate from _____
hemifacial spasm (unilateral contracture of the entire side of the face; requires brain MRI to rule out tumor)
67
blepharospasm
spastic (involuntary muscular contraction) twitching, blinking, or closure of the eyelids due to contraction of the orbicularis muscle
68
blepharospasm etiology
- unknown etiology | - may be associated with Meige's syndrome
69
blepharospasm demographics
women > men
70
blepharospasm laterality
bilateral***
71
blepharospasm symptoms
- increased blink rate initially - spasmodic eyelid closure as it progresses; disappears during sleep - interference with ADLs; may be functionally blind - ocular redness - ocular irritation (e.g., burning, FBS) - tearing
72
blepharospasm signs
- spastic twitching, blinking, or closure of the eyelids - conjunctival injection - superficial punctate keratitis (SPK)
73
blepharospasm management
- refer out for Botox or surgery; Botox is currently gold standard - supportive management for dry eye - Meige's syndrome is characterized by dystonia (movement disorder in which a person's muscles contract uncontrollably); often of the jaw, tongue, and eyelids

Anterior Segment Disease (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions