Flashcards in BCSC Plastics Deck (238)
What are the complications associated with botulinum toxin injection for BEB?
bruising, belpharoptosis, ectropion, epiphora, diplopia, lagophthalmos
What are the clinical features of hemifacial spasm?
intermittent synchronous gross contractures of an entire side of the face
What is the most common cause of hemifacial spasm?
vascular compression of the facial nerve at the brain stem
What is blepharochalasis?
A rare familial variant of angioneurotic edema, commonly occurring in young females, that is characterized by episodes of inflammatory edema of the eyelids
What are three complications of blepharoplasty?
Loss of vision (may be due to orbital hemorrhage), diplopia (due to injury of inferior oblique, inferior rectus, or superior oblique), and excessive removal of eyelid skin
What are procedures for treating brow ptosis?
Browpexy, direct brow lift, and endoscopic or pretrichial brow lift
What 2 of the most important characteristics in evaluating a child with congenital tearing?
1) Frequency of tearing (constant vs. intermittent) and 2) Presence or absence of mucopurulent discharge
What does constant tearing with minimal mucopurulence in a child with congenital tearing suggest?
upper nasolacrimal system block caused by punctal or canalicular dysgenesis
What does constant tearing with frequent mucopurulence in a child with congenital tearing suggest?
complete obstruction of the NLD
What does intermittent tearing with mucopurulence in a child with congenital tearing suggest?
Intermittent obstruction of the NLD, consistent with impaction of a swollen inferior nasal turbinate, as might be expected with a URI
What is the most important maneuver in examining a child with congenital tearing?
digital pressure over the lacrimal sac
What does complete absence of the punctum and canalicular system necessitate?
What percent of all congenital NLD obstructions resolve in the first year of life?
What are conservative measures for NLD obstruction?
observation, lacrimal massage, topical antibiotics
What is referred to as the "hard stop" in NLDP?
encountering the nasal aspect of the lacrimal sac and the adjacent lacrimal bone
In what percent of patients under 13 months of age is NLDP successful at relieving obstruction?
Is NLDP performed in adults?
No, probing is generally limited to the canalicular system, and does not extend to the NLD as it is potentially traumatic and rarely successful in adults at relieving obstruction
Into what two categories can patients with true epiphora be grouped?
1) hypersecretion of tears, 2) impairment of drainage
What are the tests involved in evaluation of the lacrimal drainage system?
1) Dye disappearance test, 2) Jones I test, 3) Jones II test, 4) Lacrimal drainage system irrigation, 5) NLDP 6) Nasal endoscopy, 7) contrast dacryocystography or dacryoscintigraphy
What are the potential etiologies of canalicular obstruction?
1) lacrimal plugs, 2) chemotherapeutic meds (5-FU, docetaxel, idoxuridine), 3) Infection, 4) inflammation, 5) trauma, 6) neoplasm
What does conjunctivodacryocystorhinostomy (CDCR) involve?
A bypass of the lacrimal drainage system with a glass tube (Jones tube) placed through a new opening in the caruncle, through an osteotomy, and into the middle nasal meatus
What are the potential etiologies of acquired NLD obstruction?
1) Involutional stenosis, 2) dacryolith, 3) Sinus disesase, 4) trauma, 5) inflammatory disease (sarcoid), 6) lacrimal plugs, 7) radioactive iodine for thyroid malignancy, 8) Neoplasm
What does a dacryocystorhinostomy (DCR) involve?
The creation of an anastomosis between the lacrimal sac and the nasal cavity (to bypass the NLD) through a bony ostium, either by intranasal or transcutaneous approach.
Why do most surgeons recommend repair of all canalicular lacerations?
50% of patients with one functional canaliculus will still experience epiphora and primary repairs have a much higher likelihood of success than secondary reconstructions
How soon after injury should a canalicular repair be performed?
As soon as possible, preferably within 48 hours
What is the most common pathogen involved in canaliculitis?
Should irrigation or probing of the canalicular system be performed in acute dacryocystitis?
No, irrigation and probing should be avoided until the infection subsides