Diseases of Lid Placement Flashcards Preview

Ocular Disease Winter '12 > Diseases of Lid Placement > Flashcards

Flashcards in Diseases of Lid Placement Deck (26)
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1
Q

Congenital Entropion

A
  • lower lid turned inward
  • rare
  • often confused with epiblepharon: extra horizontal skin fold, self resolves; common in orientals
  • true congenital occurs form improper aponeurosis insertion of the retractor muscle
2
Q

Involutional Entropion

A
  • lower lid turned inward
  • most common form and is age related
  • due to decreased horizontal lid tone, weakness of lid retractor muscle, and orbital tissue atrophy
3
Q

Cicatricial Entropion

A
  • lower lid turned inward

- occurs secondary to conjunctival scarring

4
Q

Spastic Entropion

A

-lower lid turned inward
-due to severe irritation of the anterior segment (lid) causes spasms
-associated with generalized blepharospasm
-starts as trichiasis, progresses to corneal scarring and pannus
Tx: surgery, epilation of offending lashes, glue

5
Q

Involutional Ectropion

A
  • an outward rolling of the lid, in which lid everts; exposes cornea and conjuntiva
  • related to age and due to increased lid laxity
6
Q

Cicatricial or Mechanical Ectropion

A
  • an outward rolling of the lid, in which lid everts; exposes cornea and conjuntiva
  • occurs secondary to scarring, as with burns, dermatoses, tumor, trauma
  • Tx: surgery or steroids
7
Q

Paralytic Ectropion

A
  • an outward rolling of the lid, in which lid everts; exposes cornea and conjuntiva
  • Bell’s palsy: leads to paralysis of obicularis muscle
  • when occuring with lagophthalmos, can lead to exposure and epiphora
  • medically induced with BOTOX
8
Q

Congenital Ectropion

A

-an outward rolling of the lid, in which lid everts; exposes cornea and conjuntiva
-associated with other lid problems
Tx: taping and lubrication used in mild and young patients
-surgical repair will be needed in older, progressed patients

9
Q

Nocturnal Lagophthalmos

A
  • incomplete lid closure
  • idiopathic condition
  • spouse/family members typically diagnose
  • Patient may present with inferior morning SPK with no other lid margin diseases
  • adults most commonly present due to decreased tear production
  • Dx: instill NaFl and recline patient, close their eyes. use Burton lamp to see if NaFl visible between incomplete closed lids
10
Q

Orbital Lagophthalmos

A
  • incomplete lid closure
  • orbital lagophthalmos occurs with Pt proptosis
  • Grave’s ophthalmopathy, orbital pseudotumor or mucocele, cavernous sinus fistula
11
Q

Mechanical Lagophthalmos

A
  • incomplete lid closure

- results due to ocular or facial scarring

12
Q

Paralytic Lagophthalmos

A

-Bell’s palsy on CNVII (unilateral paralysis); impacts orbicularis so lids cannot close completely
-often viral etiology with self-limiting inflammation
-face and forehead are flaccid (in stroke face uneven)
Bell’s resolves within three months, but can recur with residual damage
-Tx: supportive, involving lubricants, taping, tarsorrhaphy (sew eye lids closer together to narrow fissure)

13
Q

Congenital Ptosis

A
  • drooping upper lid
  • autosomal dominant, improper development of levator palpebrae superioris
  • in down gaze the congenital ptotic lid appears HIGHER than the normal lid
14
Q

Blepharophimosis Ptosis

A
  • drooping upper lid, autosomal dominant trait
  • moderate to severe BILATERAL ptosis
  • other ocular signs: telecanthus, epicanthus inversus, lateral ectropioc, hypoplastic superior orbital rim and bridge
15
Q

Horner’s Ptosis

A
  • occurs with the triad: ptosis, miosis, anhydrosis
  • Congenital: associated with a heterochromia
  • Acquired: loss of sympathetic innervation along three step path (central, pre-ganglionic @ chest/breast/lungs area, post-ganglionic-benign, no loss of sweating); no heterochromia
  • Dx:
    1. cocaine testing will dilate normal eye but not Horner eye and tests for oculosympathetic paresis
    2. hydroxyamphetamine will not dipate post-ganglionic as there will be no NE release
    3. Phenylephrine elevates the affected side because Mueller’s will be hypersensitive (rules out malignancy in central/post-ganglionic) *does this go here, or it’s just important to rule it out?
16
Q

Myotonic Dystrophy

A
  • autosomal dominant; Pt will exhibit muscle wasting and mournful expression
  • Ocular signs: ptosis, cataract, retinopathy, near-light reflex dissociation, low IOPs
  • patient has trouble relaxing a muscle after it is contracted
  • associate with cardiac+pulmonary problems
17
Q

Myasthenia Gravis

A
  • autoimmune disease causing loss of receptors and leading to muscle fatigue and weakness
  • more in females, onset age between 20-50
  • majority of patients will experience ocular symptoms (60% will present with ocular symptoms)
  • Sx: ptosis, diplopia, nystagmus, fatigue
  • Dx: tensilon test; inject edrophonium (anticholinesterase) should improve ptosis
  • can have patient walk on toes, see if increased fatigue impacts ptosis
  • Tx: steroids, immunosuppressants, anticholinesterases, thymectomy
18
Q

Floppy Eyelid Syndrome

A
  • seen in obese middle-aged men with loose skin
  • eyelids easily everted, can expose/dry the cornea, palpebral conj
  • leads to redness and papillary response
  • associated with sleep apnea and keratoconus
  • Tx: lid taping or surgery
19
Q

Dermatochalasis

A
  • common bilateral condition in elderly
  • redundancy of skin, orbital fat protrudes through septum, indistinct creases in lid
  • Tx: if invades visual field with blepharoplasty
20
Q

Symblepharon

A

-adhesion between lid and conjunctiva

21
Q

Ankyloblepharon

A

-lid to lid adhesion, loss of canthus

22
Q

Epicanthus

A

-the skin fold of the upper eyelid

23
Q

Lid coloboma

A
  • cleft in lid due to incomplete closure of embryonic tissue
  • 90% upper lid, typically at junction of middle/medial 1/3 of lid
  • associated with dermoids, strabismus, and corneal opacity
  • can lead to corneal exposure problems
  • Tx: surgery at age 3-6 months, supportive treatments to reduce corneal exposure problems
24
Q

Cryptophthalmia

A
  • fusion of lids, skin is continuous over the eyelids; can cause malformed cornea
  • no treatment
25
Q

Ablepharon

A
  • congenital absence of the eyelid

- treat with surgery

26
Q

Microblepharon

A
  • vertical shortening of the eyelids, too small to blink

- treat with surgery