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Flashcards in BCSC Plastics Deck (238)
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151

Under what condition can direct closure of an upper eyelid defect be performed?

<= 33% of the eyelid margin is involved.

152

What procedure can be performed in a patient in whom extensive sacrifice of the canaliculi has occrred in the resection of a tumor?

A conjunctivodacryocystorhinostomy with a Jones tube can be performed, but only after an observed recurrence-free period often lasting up to 5 years.

153

How many days prior to elective periocular surgery is warfarin generally stopped?

2-5 days, if approved by PCP

154

How many days prior to elective periocular surgery is aspirin generally stopped?

5 days, if approved by PCP

155

How many days prior to elective periocular surgery are NSAIDs generally stopped?

3 days, if approved by PCP

156

What are the five classes of ectropion?

1) congenital; 2) involutional; 3) paralytic; 4) cicatricial; 5) mechanical

157

What is the most common cause of ectropion?

Involutional ectropion (which is itself most often due to horizontal eyelid laxity either in the medial or lateral canthal tendons)

158

Does involutional ectropion usually affect the upper or lower lid?

Lower lid

159

What are the 3 most commonly used surgical procedures in treating involutional ectropion?

Medial spindle procedure, Tarsal strip proceudre, and Reinsertion of the lower eyelid retractors

160

What are the steps in surgically treating cicatricial ectropion of the lower eyelid?

1) surgical release of vertical cicatricial traction; 2) horizontal tightening with a lateral tarsal strip operation; 3) vertical lengthening of the anterior lamella via a midface lift or full-thickness skin graft

161

What are the 4 types of entropion?

1) congenital; 2) acute spastic; 3) involutional; 4) cicatricial

162

What is the most common situtation in which acute spastic entropion develops?

Postoperative development due to ocular irritation and inflammation sustained during intraocular surgery in a patient with unrecognized or mild involutional eyelid changes

163

How is horizontal laxity of the eyelid detected?

1) Poor eyelid tone (snapback test) or 2) ability to pull the eyelid more than 6mm from the globe (distraction test)

164

What are the clinical signs that may indicate disinsertion of the eyelid retractors?

1) a white subconj line several millimeters below the inferior tarsal border caused by the leading edge of the detached retractors; 2) deeper than normal inferior fornix; 3) lower eyelid margin sitting higher than normal; 4) little or no inferior movement of the lower eyelid on downgaze (limited lower lid excursion)

165

What are the three types of procedures for repair of involutional entropion?

1) Temporizing measures, 2) Horizontal tightening procedures, 3) repair of the retractors

166

What are common temporizing measures for repair of involutional entropion?

Quickert sutures and thermal cautery

167

What are the three etiologic factors in involutional entropion?

1) disinsertion of the eyelid retractors, 2) overriding orbicularis, 3) horizontal laxity

168

How quickly can trichiasis recur after mechanical epilation?

3-8 weeks

169

What are the therapies available for trichiasis?

Mechanical epilation, electrolysis, radiofrequency ablation, cryotherapy, argon laser, full-thickness pentagonal resection with primary closure

170

What are the five etiologic variants of ptosis (blepharotosis)?

1) myogenic, 2) aponeurotic, 3) neurogenic, 4) mechanical, 5) traumatic

171

What is the most common etiology of congenital ptosis?

poorly developed levator muscle (myogenic cause)

172

What is the most common etiology of acquired ptosis?

stretching or disinsertion of the levator aponeurosis (aponeurotic cause)

173

What are the 5 clinical measurements used to evaluate ptosis?

1) margin-reflex distance, 2) vertical interpalpebral fissure height, 3) upper eyelid crease position (distance from UL crease to UL margin), 4) levator function (upper eyelid excursion), 5) presence of lagophthalmos

174

What is MRD1?

the distance from the upper eyelid margin to the corneal light reflex in primary position (may be zero or negative)

175

What is MRD2?

the distance from the corneal light reflex to the lower eyelid margin

176

What does the sum of MRD1 and MRD2 represent?

The vertical interpalpebral fissure height

177

How is levator function measured?

By fixating the brow to eliminate frontalis contributions and measuring the distance moved by the upper eyelid margin from downgaze to upgaze (ULE or upper lide excursion)

178

What are conditions in which synkinesis of the lid and EOM or jaw occurs?

Marcus Gunn jaw-wink, aberrant regeneration of CN III or CN VII, certain forms of Duane sydnrome

179

Does ptosis tend to improve or worsen in downgaze when congenital?

Congenital ptosis improves in downgaze, unlike acquired ptosis, which worsens.

180

Is the crease in the typical Asian eyelid higher or lower than in the typical Caucasian eyelid?

lower