Flashcards in BCSC Plastics Deck (238)
Under what condition can direct closure of an upper eyelid defect be performed?
<= 33% of the eyelid margin is involved.
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.
How many days prior to elective periocular surgery is warfarin generally stopped?
2-5 days, if approved by PCP
How many days prior to elective periocular surgery is aspirin generally stopped?
5 days, if approved by PCP
How many days prior to elective periocular surgery are NSAIDs generally stopped?
3 days, if approved by PCP
What are the five classes of ectropion?
1) congenital; 2) involutional; 3) paralytic; 4) cicatricial; 5) mechanical
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)
Does involutional ectropion usually affect the upper or lower lid?
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
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
What are the 4 types of entropion?
1) congenital; 2) acute spastic; 3) involutional; 4) cicatricial
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
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)
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)
What are the three types of procedures for repair of involutional entropion?
1) Temporizing measures, 2) Horizontal tightening procedures, 3) repair of the retractors
What are common temporizing measures for repair of involutional entropion?
Quickert sutures and thermal cautery
What are the three etiologic factors in involutional entropion?
1) disinsertion of the eyelid retractors, 2) overriding orbicularis, 3) horizontal laxity
How quickly can trichiasis recur after mechanical epilation?
What are the therapies available for trichiasis?
Mechanical epilation, electrolysis, radiofrequency ablation, cryotherapy, argon laser, full-thickness pentagonal resection with primary closure
What are the five etiologic variants of ptosis (blepharotosis)?
1) myogenic, 2) aponeurotic, 3) neurogenic, 4) mechanical, 5) traumatic
What is the most common etiology of congenital ptosis?
poorly developed levator muscle (myogenic cause)
What is the most common etiology of acquired ptosis?
stretching or disinsertion of the levator aponeurosis (aponeurotic cause)
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
What is MRD1?
the distance from the upper eyelid margin to the corneal light reflex in primary position (may be zero or negative)
What is MRD2?
the distance from the corneal light reflex to the lower eyelid margin
What does the sum of MRD1 and MRD2 represent?
The vertical interpalpebral fissure height
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)
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
Does ptosis tend to improve or worsen in downgaze when congenital?
Congenital ptosis improves in downgaze, unlike acquired ptosis, which worsens.