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Duke Elder exam > Eyelids > Flashcards

Eyelids Flashcards

1
Q

3 layers of eyelid skin

A

epidermis
dermis
skin adnexa

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2
Q

what do the skin adnexa include (lie deep in the dermis)

A

eyelashes

glands (eccrine, apocrine, holocrine)

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3
Q

example of eccrine glands

A

sweat glands

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4
Q

example of apocrine glands

A

modified sweat glands (e.g. gland of Moll)

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5
Q

2 examples of holocrine glands

A

gland of Zeis
meibomian glands

secrete/synthesise lipids and oily substances

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6
Q

sensory supply to lateral upper eyelid

A

lacrimal nerve (CNV1)

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7
Q

sensory supply to upper eyelid

A

supraorbital and supratrochlear nerves (branches of frontal nerve of CNV1)

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8
Q

sensory supply to medial canthal area

A

infratrochlear nerve (branch of nasociliary nerve of CNV1)

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9
Q

sensory supply to lower eyelid

A

infraorbital nerve (CNV2)

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10
Q

what type of muscle is orbicularis oculi

A

striated

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11
Q

4 parts of orbicularis oculi

A

palpebral
orbital
lacrimal
ciliary

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12
Q

nerve supply to orbicularis oculi

A

tempral and zygomatic branches of CNVII

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13
Q

2 things the fibrous later of the eyelid consists of

A

tarsal plates - provide structural support, upper tarsal plate thicker than lower
orbit septum

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14
Q

function of levator palpebrae superioris

A

striated muscle responsible for eyelid retraction - originates at lesser wing of sphenoid to insert into tarsal plate

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15
Q

nervous supply of levator palpebrae superioris

A

superior division of CNIII

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16
Q

function of Müller muscle

A

smooth muscle, sympathetic nervous system, contributes to eyelid retraction - originates from aponeurosis of levator to insert into tarsal plate

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17
Q

3 pathways which activate the blinking reflex

A

corneal stimulus - CNVI (afferent), CNVII (efferent)
light stimulus - CNII (afferent), CNVII (efferent)
auditory stimulus - CNVIII (afferent), CNVII (efferent)

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18
Q

what is Bell’s phenomenon

A

upward and outward rotation of the globe on forced lid closure - obvious in those with CNVII palsy as the lid remains open when patients are asked to close their eyes

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19
Q

what is a chalazion

A

sterile lipogranuloma due to obstruction of meibomian glands/sometimes gland of Zeis

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20
Q

2 conditions associated with chalazion

A

blepharitis

acne rosacea

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21
Q

3 ways to manage a chalazion

A

hot compresses twice daily
oral antibiotics if infected
incision/curettage

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22
Q

what is a port wine stain (naevus flammeus)

A

congenital capillary malformation of the dermis

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23
Q

how does a port wine stain present

A

pink/purple well-demarcated patches that don’t blanch on pressure

never cross the midline

typically occur along the distribution of choroidal neovascularisation (CNV)

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24
Q

what might port wine stain be associated with

A

Sturge-Weber syndrome

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25
Q

histopathology of BCC

A

clusters of darkly staining basaloid cells with peripheral palisading arrangement of nuclei

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26
Q

features of BCC

A

centrally ulcerated pearly edged papules with telangiectasia

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27
Q

most and least common location of BCC in the eyelid

A 
most = lower lid 
least = lateral canthus
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28
Q

management of BCC

A

Mohs micrographic surgical excision (layered excision)

29
Q

3 features of SCC

A

keratotic, ill-defined, may ulcerate

30
Q

features of keratoacanthoma (type of SCC)

A

dome-shaped nodule with keratin-filled crater

31
Q

2 treatments for SCC

A

Mohs surgery

radiotherapy

32
Q

where does sebaceous gland carcinoma arise from

A

meibomian glands

glands of Zeis (less commony)

33
Q

histopathology of sebaceous gland carcinoma

A

foamu vacuolated lipid-containing cytoplasm with hyperchromatic nuclei

34
Q

what might sebaceous gland carcinoma be mistaken for

A

chalaazion - appear as a yellow nodule on the upper eyelid

35
Q

what is trichiasis

A

misdirected growth of eyelash follicles - grow towards cornea or sclera

36
Q

2 most common causes of trichiasis

A

herpes zoster ophthalmicus

blepharitis

37
Q

what is distichiasis

A

formation of a pesterior row of eyelashes

38
Q

4 causes of distichiasis

A

congenital (AD inheritence)
chemical injury
Stevens-Johnson syndrome
ocular cicatricial pemphigoid

39
Q

2 types of blepharitis

A

anterior

posterior

40
Q

what is anterior blepharitis

A

inflammation of the skin around the base of the eyelashes - staphylococcal or seborrheic

41
Q

what is posterior blepharitis

A

inflammation of meibomian gland around the eyelid margins due to gland dysfunction

42
Q

what might posterior blepharitis be associated with

A

ocular rosacea

43
Q

4 rish factors for blepharitis

A

dry eyes
seborrheic dermatitis
dermodex folliculorum (associated with ocular rosacea)
long-term contact lens wear

44
Q

4 clinical features of blepharitis

A

bilateral and symmetric
dry/gritty
crusted
red

45
Q

what is staphylococcal anterior blepharitis associated with

A

atopic dermatitis

46
Q

2 signs of staphylococcal anterior blepharitis

A

lid hyperaemia and swelling

hard scales and crusting of the bases of the lashes

47
Q

3 things that might develop from staphylococcal anterior blepharitis

A

tear film instability
dry eye syndrome
trichiasis

48
Q

what is seborrhoeic anterior blepharitis associated with

A

seborrheic dermatitis

49
Q

2 signs of seborrhoeic anterior blepharitis

A

soft scales

oily lid margins

50
Q

what is posterior blepharitis associated with

A

acne rosacea

51
Q

3 signs of posterior blepharitis

A

foamy and unstable tear film

posterior lid margin hyperaemia and telangiectasia

52
Q

3 forms of treatment for blepharitis

A

eyelid hygiene
antibiotics
tea tree oil for demodex infestation

53
Q

type of antibiotics for blepharitis

A

tetracyclines (inability to inhibit fatty acid oxidation and lipase production)

54
Q

4 types of causes of ptosis

A

neurogenic (Horners syndrome, CNIII palsy)
myogenic (myasthenia gravis, myotonic dystrophy)
involutional (age-related)
congenital (levator muscle)

55
Q

what is Marcus Gunn jaw-winking syndrome

A

in 5% of patients with congenital ptosis - ptotic lid that retracts when the ipsilateral pterygoid muscle is stimulated

56
Q

4 things that pseudoptosis includes

A

dermatochalasis
blepharochalasis
microphthalmus
phthisis bulbi (atrophic, non-functioning eye that occurs as a result of severe ocular disease)

57
Q

what is dermatochalasis

A

excessive skin of upper eyelid = sagging (lateral hooding) - in elderly

58
Q

what is blepharochalsis

A

bilateral, from abnormal elastic eyelids = recurrent episodes of painless oedema of upper eyelids

leads to stretching and atrophy of skin = skin folds and ptosis

59
Q

what is floppy eyelid syndrome

A

in middle aged men with obstructive sleep apnoea - upper eyelid lax which may lead to papillary conjunctivtis and keratopathy

60
Q

7 causes of lid retrction

A 
graves ophthalmopathy
parinaud syndrome (collier sign) 
third nerve misdirection
marcuss gunn jaw-winking syndrome
progressive supranuclear palsy
down syndrome
congenital hydrocephalus (bilteral downward devciation of the globes with upper lid retraction)
61
Q

what is lid coloboma

A

incomplete development of the eyelid due to failure of lid fold fusion, either upper or lower lid

62
Q

where does lid coloboma on the upper lid form and what is it associated with

A

forms at the junction of the middle and inner thirds of the upper eyelid

Goldenhar syndrome

63
Q

what is goldenhar syndrome characterized by (5 things)

A 
upper lid coloboma
microphthalmia
optic disc coloboma
maxillary and mandibular hypoplasia 
limbal dermoids
64
Q

what are limbal dermoids

A

smooth yellow subconjunctival mass typically at inferotemporal limbus with hair protrusion

65
Q

what may limbal dermoids be associated with

A

Duane retraction syndrome

66
Q

where does lid coloboma on the lower lid form and what is it associated with

A

forms at the junction of middle and outer thirds of lower eyelid

Treacher collins syndrome

67
Q

what is a hordeolum

A

stye - external or internal

68
Q

causes of external vs internal hordeolum

A

external = infection of glands of Zeis/Moll

internal = infection of meibomian gland

usually staph

69
Q

3 treatments for stye

A

hot compresses
topical antibiotics
eyelid hygiene

Duke Elder exam (5 decks)

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