what happens with the eyes on primary telecanthus
the inner canthi are farther apart, and the outer canthi are normal
this is neoplasm involving the Meibomian glands ; rare but highly malignant
sebaceous gland carcinoma
this is an infectious disease of the skin caused by a large DNA pox virus ; transmission by direct person to person contact
molluscum contagiosum
what are the stages of blepharochalasis
- edema stage - transient painless lid swelling with mild redness 2. atonic ptosis stage- skin assumes a reddish brown color, becoming telangiectatici and loose \3. ptosis adipose stage- involves dehiscence of the orbital septum with herniation of orbital fit into the eyelid ( steatoblepharon) ( slide 16)
this results from any process in the eyelid or orbit that restricts eyelid elevation
mechanical blepharoptosis- most COMMON ptosis seen in children and adolescents
this is a neoplasm arising from epidermal melanocytes
malignant melanoma - mgt same as SCC and BCC
what is the most common cause of eyelid laceration
domestic violence
how do we manage lid laceration
clean with betadine scrub and irrigate ; if partial thickness with no levator involvement apply Ab ointment and sterile dressing; if full thickness cover and refer to oculoplastics ; cases involving levator need surgery
this is characterized by horizontal enlargement of the palpebral fissure and the eyelid is shortened vertically ; assoc with lateral ectropion
euryblepharon - slide 39
this is an autosomal dominant dystrophy presenting in the 3rd-4th decade of life ; progressive atrophy and weakness of the hypopharyngeal and ocular muscles
oculopharnygeal dystrophy slide 23
this is defined as the inability to completely close the eyelids, resulting in ocular exposure ; caused by cicatricial ( injury), iatrogenic , and neurological
lagoopthalmos
this is a rare multisystem disorder characterized by fluid accumulation in the legs and distichiasis; occurs around puberty ; caused by mutations of the FOXC2 gene and inherited as an autosomal dominant trait
lymphedema distichiasis syndrome
Is molluscum contagiosum a reactivation infection ( ie lies dormant)
Nope
this is a change in the type of adult cells in a tissue to a form that is abnormal for that tissue
metaplasia ( shift rom benign to malignant)
how do we manage blepharochalasis
therapy during acute stages is controversial; Sx necessary for cosmesis
how does seborrheic blepharitis present
assoc with seborrheic dermatitis, bilateral, symptoms like itching, burning, grittiness,
this is a deep , dermal, nodular lesion arising from the matrix of the hair follicle ; uncommon tumor, BENIGN BUT PROGRESSIVE
pilomatricoma
this infection of the lid can spread to adjacent glands, lid tissue ( Preseptal cellulitis) or the orbit ( orbital cellulitis); rare association with necrotizing fasciitis
hordeolum
this is a condition where the eyelids cant be fully retracted; sometimes referred to as BPEI or BPES; key features of this disorder - blepharophimosis, ptosis, and epicanthus inversus
Blepharophimosis
how do we manage demidicosis
lid scrubs and Ab/steroids are inadequate ; requires removal with chemical assault ; some tx options: baby shampoo, topical metronidazole gel, mercury oxude, pilocarpine gel ( interferes with their respoiration and motility via toxic muscarinic effects) , and TTO therapy ( best therapy )_
management for blepharospasm
supportive- eye protection , lid hygiene medical - botox ( temporary relief) surgical- myectomy
management of syringoma
asymptomatic cases require no tx; medical therapy limited to case reports and anecdotal series; surgical care ( ie electrodessication)
how can we manage entropions
conservative: lube, taping the lid medical: botox for spams sx: sutures, vertical shortening procedures
this type of blepharoptosis reps a muscular etiology, typically where there is loss of muscle tone affecting the levator
myogenic blepharoptosis
which glands are involved with internal hordeolums
Meibomian
T or F: Melanoma is the most aggressive type of eyelid cancer
T
how is the meibomiam gland expression graded
grade 0- clear meibum easily expressed grade 1- cloudy meibum expressed with pressure grade 2- cloudy meibum expressed with more than moderate pressure grade 3- mebium cannot be expressed even with pressure
this is a sudoriferous cyst that is caused by abnormal proliferation of these modified apocrine secretory glands ;
Cysts of moll - these glands lie posterior to the lashes and beneath the gray line
what is the management option for molluscum contagiosum
self limiting, no antivirals efficacious, keratolytic agents ( KOH, and salicylic acid or cantaharidin), imiquimod cream; surgical therapy is useful for solitary uncomplicated lesions ( ie Electrodessication with the Ellman unit)
this is aka atopic eczema ; type I, IGE mediated hypersentivity reaction l focal manifestation of a systemic condition
atopic dermatitis
this condition represents proliferations of melanocytes in contact with each other, forming nests ; formed during childhood ; these are benign neoplasms
acquired melanocytic nevus
what are some special considerations with blink lagoophtlamos
incomplete blink mainly with prolonged visual tasking
these represent localized, bacterial infections of the eyelid sebaceous glands with abscess formation: most commonly caused by Staph Aureus and epidermis
hordeolum
this is upper lid retraction with downgaze or adduction ; pupillary constriction with downgaze or adduction; and limitation of vertical gaze
aberrant 3rd nerve regeneration
this type of trauma results from blunt force; non penetrating injury ; reps rupture of capillaries,
eyelid contusion
this represents a true sebaceous cyst; caused by acquired obstruction of the sebaceous gland duct, with subsequent accumulation of glandular sebum and intradermal expansion , the Zeis glands lie distal and anterior to the lashes
cysts of Zeis
this is a vertical skin fold of redundant tissue at the medial and ( sometimes lateral ) canthus ; found in pts with down syndrome, FAS; bilateral; can create appearance of esotropia
Epicanthal folds
these represent multiple tiny epidermoid cysts ; caused by occlusion of pilosebaceous units resulting in retention of keratin ; pearly white domed lesions ; common in infants , benign
milia
how do keratoacathoma present
fair skinned male, > 60 YO, solitary , firm , round or oval lesion with central ulceration or keratin plug ; symptoms = PAIN ( slide 34, dysplastic disorders)
this means hidden eye
cryptophthalmos - complete : eyelids do not form ; incomplete : facial skin fuses to the medial aspect of the globe ; abortive : upper eyelid is adherene to the superior aspect of the globe and fuses with the upper cornea
T or F: MGD is the primary cause of evaporative dry eye
T
when do the eyelids during embryogenesus
at week 8- they separate again at 25 weeks
T or F: HZO is unilateral and HSV is bilateral
T
this is the formation of presence of a new, abnormal growth of tissue
neoplasia
this type of blepharoptosis is dehiscence or disinsertion of the levator aponeurosis from the superior tarsal plate; bilateral and no pupillary involvement
aponeurotic blepharoptosis - Most COMMON and least difficult to treat - slide 14 disorders eyelid
how does HZO present
more common over 70 YO; symptoms- facial pain, fever and malaise, redness and welling, tearing of affected eye, variable visual impairment; dermatomal skin rash that doesn’t cross midline ; swelling ptosis of eyelid ( slide 51, infect. disorders)
this is complete absence of ocular tissue within the orbit ; can be unilateral or bilateral ; simple type : assoc absence of EOM and microblepharon with cyst: globe is replaced by a cyst
anopthalmos
this condition is more commonly in children; symptoms include pain and tenderness on palpation and tearing; rash around eye and eyelid ; ulcers and erosions of the lid margin; eyelid edema and redness ; swollen PA nodes
herpes simplex blepharitis
this condition is characterized by diminished meibum flow that results in increased tear evaporation and hyperosmolarity ; its exacerbated by resident bacteria mainly Staph Epidermis and P. Acnes ; assoc with rosacea and diet and nutrition
MGD
how do we manage seborrheic keratosis
medical therapy : dichloroacetic acid, cryotherapy ; surgical removeal is the TREATMENT OF CHOICE for cosmesis or biopsy
this refers to a loss of lashes ; a cause could be trichotillomania
madarosis - slide 11
how does verruca present
pt tend to be younger ( 5-20 YO) ; pts usually have cosmetic concerns, lesions arise from the skin of the eyelid or adnexa , possible secondary infection from “ pickers”; may be flat or stalked, solitary or multiple, uniform pigmentation of diff colors ( Y, Pink, Br, Blk); tiny red or black dots near the surface
how do we manage aponeurotic blepharoptosis
Sx repair - 3 main techniques 1. Mullers muscle resection 2. levator advancement 3. frontalis sling
how can we manage Preseptal cellulitis
hot compresses tid- qid, Ab therapy mainly orals ( cephalexin250-500 mg bid-qid) oral analgesics for pain
this type of blepharitis deals with disorders of the Meibomian glands; non inflammatory obstructive disorder
posterior blepharitis
if nevus cells are derived from epidermial melanocytes what are they termed
junctional, compound, or intradermal
what are the two presentations of herpes simplex blepharitis
classic vesicular or pustular form and the erosive/ ulcerative form
this is when the Epicanthal folds originate in the lower lid and extend upwards; see in blepharophimosis
epicanthus inversus
how do we manage hidrocystoma
no tx necessary unless pt is symptomatic ; supportive: avoid warm environments : medical : anticholinegic topical Ung or creams; drainage via stab incisions
this is a subtype of seborrheic keratosis ; presents as solitary nodule on the face ; asymptomatic and firm and white to pink in coloration
inverted follicular keratosis
whats management options for staph blepharitis
hyperthermia, lid margin cleansing, topical Ab and corticosteroids, oral Ab for secondary lid infections
this is characterized by loose, flaccid, easily everted upper eyelids ; association with obstructive sleep apnea
floppy eyelid syndrome
how does sebaceous gland carcinoma present
upper eyelid margin is common, redness and thickening and necrosis of the lid ( slide 75, dysplastic disorders) - management the same as for SCC and BCC
how do chalazia affect vision
can cause WTR astigmatism and deprivation amblyopia
how does atopic dermatitis present
hx of allergy, signs: scaling mainly slide 7 allergic disorders
mgt of milia
asymptomatic cases require no tx; no topical or systemic meds are effective for primary or secondary milia ; surgical care ie electrodessication
which glands are involved with external hordeolums
Zeiss
what happens with the eyes on true ocular hypertelorism
both the inner and outer canthi are abnormally far apart
what are some red flags for orbital cellulitis
high fever, recent hx of sinusitis or dental issues , proptosis / displaced eye , EOM restriction, chemosis of the globe, reduced vision, APD, increased WBC/ ESR
this is more commonly known as freckles ; NO malignant potential
ephelis
whats the main disorder Hypertelorism is assoc with
median cleft face syndrome ( frontonasal dysplasia) - slide 18, congenital )
how do we manage floppy eyelid syndrome
lubrication and protection from nocturnal damage,eyelid weights, sx for recalcitrant cases , refer for physical and sleep studies due to obstructive sleep apnea
how does seborrheic keratitis present
most common benign non infectious tumor of the elderly ; called “barnacles of aging” well circumscribed , rough surface round or oval lesions with uneven pigmentation ( slide 16 - dysplastic disorders)
what do you do in cases of Preseptal cellulitis that do not respond to oral Ab
consider alternate dx ( infectious disease) or consider surgical intervention ( oculoplastics)
this syndrome is characterized by genetic mutations in EDN3, EDNRB, MITF, PAX3, SNAI2,and SOX 10; have telecanthus and white forelock, variable hearing difficulties, light blue irides and/or heterchromia
Waardenburg Syndrome ( slide 18, congenital)
this is a soft tissue vascular sarcoma caused by human herpes virus 8
karposi sarcoma
this is the most common related sun growth ; reps dysplasis and architectural disorder of the epidermis ; risk factor is cumulative UV EXPOSURE ; precursor to SQUAMOUS CELL CARCINOMA
actinic keratosis
this type of anterior blepharitis results from dysfunction of the pilosebaceous glands ( too much sebum produced); related to fungal infection by Malassezia furfur
seborrheic blepharitis
relatively common low grade skin tumor; originates in the pilosebaceous glands ; resembles squamous cell carcinoma ; rapid growth followed by SPONTANEOUS REGRESSION; primary risk factor is UV EXPOSURE
keratoacanthoma
democidosis is really common in elderly, T or F
T
this is a hereditary degeneration of muscle fibers with variable age of onset ; characteristic muscle contraction w/o ability to relax “ myotonia”
myotonic dystrophy
this is the distance between the upper and lower eyelid : normal 7-10 mm in males and 8-12 mm in females
palpebral fissure
this type of nevus is the most common; occurs in older age ; papillomatous with little to no pigmentation l cells confined to dermis
intradermal
this is rare; when the Epicanthal folds arise above the brow and extend downward
epicanthus superciliaris
this is a rare condition where there is overriding of upper eyelids on lower eyelids ; congenital entropion of both lower eyelids ;
congenital eyelid imbrication syndrome
how is angular blepharitis managed
Dx made by classic appearance; lid hygiene ;broad spectrum Ab ( ie. FQL) - usually a self limiting disorder
how do cysts of moll present
translucent pink in color , situated at the lid margin ; painless
this is the enlargement of an organ or tissue by the proliferation of cells of an abnormal type , as a developmental disorder or an early stage in the development of cancer
dysplasia
this represents chronic obstruction of the glands
MGD
this type of nevus occurs in younger people l cells at epidermial/dermal junction
junctional nevus
this disorder involves synkinesis of CN V3 -> CN III
Marcus Gun Jaw Winking SYndrome
this looks like a stroke but reps a peripheral lesion; sudden onset; more common in older pts; presents with relative ptosis, ectropion and facial paralysis ; ALWAYS unileratal ; self limiting
bells palsy
this is defined as a hereditary predisposition to allergy or hypersensitivity
atopy
this is a unique automated device that performs lid/gland hyperthermia in conjunction with focused gland expression
lipiflow:
how do we manage MGD
lid hyperthermia and gland expression, lid cleansing, and surface lubrication . Topicals : Ab ( azithromycin, erythromycin , cyclosporine) orals : tetracyclines ; surgical : Meibomian gland probing and lipiflow
neuro disorder; in upgaze the lids retract but motility restricted and a normal downgaze; light near dissociated pupils ( does not react to light but does to accommodation)
colliers sign in dorsal midbrain syndrome slide 34
this is muscular dystrophy with several variants ; pts in their 30s ; symmetrical bilateral, progressive ptosis followed by ophthalmoparesis in month to years
chronic progressive external ophthalmoplegia slide 22
this is a specific type of inflammation in which the antigen is some external ( rather than internal ) force
trauma
this is an abnormality of eyelid position b which the upper eyelid overrides the lower eyelid on closure, leading to chronic ocular irritation
eyelid imbrication; assoc with floppy eyelid syndrome
this is a condition where the eyelashes grow inwardly toward the globe ; can be associated with trauma ( cicatricial)
trichiasis ( slide 3, multifactorial ltrue )
how do we manage a nevus
BENIGN NEGLECT and surgery
how do we manage basal cell carcinoma
biopsy is critical, SX RESECTION : MOHS MICROGRAPHIC SX
how does blepharochalasis present
typically adolescents and younger adults; unilateral or bilateral on upper lids , hx of recurrent painless eyelid edema
how does karposi sarcoma present
as firm, palpable nodules or blotches that are red, purple, bronwn or black ( slide 92, dysplasia)
how does Phthiariasis Pubis present
with reddish black deposits, can be seen with lid eversion , blepharitis, PA lymphadenopathy, follicular conj, will have chronic redness and itching and irritation ( slide 84, infec disorders)
how does Preseptal cellulitis present
unilateral usually, pts usually AFEBRILE, no predilections ( see slide 23 , infect lids lecture )
how do we manage Phthiriasis Pubis
manual removal with forceps and topical therapy ( bland ointment to smother ) and pesticides applied to lid margin ; wash all clothes on high heat
how do cysts of Zeis present
opaque to transilllumination ( non translucent) ; painless ( slide 35, obstruct )
this results from direct skin exposure to allergens or other irritants ; type IV delayed hypersensitiviey reaction
contact dermatitis
how do we manage xanthelasma
dx by clinical appearance intervention is for cosmesis only , managed with chemocautery or sx if pt desires
this is the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells
hyperplasia
T or F: There is no proven therapeutic value for topical or oral antivirals in the acute phase of HSV blepharitis
T ( topical Antivirals are indicated if there is corneal involvement ) oral antivirals are helpful in reducing the frequency of recurrences ( acyclovir )
this represents a neurological condition characterized by forcible closure of the eyelids; etiology is multifactorial : females more than males; seen in older adults
blepharospasm
this was the first company to identify the potential for a prostaglanding analogue as a cosmetic eyelash enhancement
allergan
this is when the Epicanthal folds are symmetrically dist. between upper and lower lid ie. caucasians
epicanthus palpebralis ( slide 11 , congenital )
T or F; All prostaglandin analogues can cause hypertrichosis
T ( ie Latanoprost “ Xalatan” and Travaprost “Travatan” ) -
how does blepharospasm present
increased blinking frequency, forceful eyelid closure; dystonic movements of other facial muscles, interference with “ Activities of Daily Living” slide 39
how does demiodicosis present
more common in anyone > 50 YO ; red inflamed lid margins, crusty debris, burning/irritation. secondary dry eye ; key feature is cylindrical dandruff ( slide 95, infec, disorders)
this is single or multiple bands of tissue joining the upper and lower eyelids ; can be unilateral or bilateral ; congenital defect assoc. with iridogoniodysgenesis and juvenile glaucoma
ankyloblepharon ( slide 35)
how do the squamous papilloma present
more common in obese and old people ; assoc with diabetes and pregnancy; asymptomatic; painful if inflamed ; pedunculated ( slide 7 , dysplastic disorders), benign and non infectious
how do we manage squamous papilloma
lesions are treated if they display bleeding or irritation and for cosmesis ; tx includes cryotherapy, chemical cautery, surgical removal
how does actinic keratosis present
usally older, noted in fair skinned ppl, more in men , SCALY REDDISH BROWN LESIONS ( slide 41, dysplastic disorders); considered a pre malignancy
this is a hypersensitivity reaction to an allergen
Type I- driven by mast cells
this is the distance bw the pupillary light reflex and the lower eyelid margin with eye in primary gaze
marginal reflex distance 2 : normal > 5 mm
which vaccine is indicated for the prevention of shingles for anyone 50 and older who have had chickenpox but not yet shingles
Zostavax
how can we manage trichiasis
lubricants, bandage CL, epilation , follicle destruction
this is a dysfunction affecting innervation to the muscles of the eyelid : Horners syndrome “ ptosis , miosis , anhydrosis”
neurogenic blepharoptosis
how do acquired melanocytic nevi present
as a flat or slightly raise papule - evenly pigmented - usually soliary - commonly seen on eyelid margin
this is diffuse , subcutaneous inflammation of ocular tissue secondary to infection anterior to the orbital septum
Preseptal cellulitis
this type of anterior blepharitis is not infectious - results from bacterial overgrowth ( staph, epidermis and staph aureus )
staph blepharitis
this is an extremely rare inherited disorder; physical abnormalities affecting the craniofacial region, skin , fingers, and genitalia- “fish like mouth” and low set ears
ableparon- macrostomia syndrome ( slide 32)
how do we manage comedones
open comedones are removed via minor sx ; closed comedones are more difficult to tx surgically bc of their deep nature
these represent multiple, tiny hidrocystomas; caused by proliferation of intraductal epithelium in eccrine and /or apocrine glands ; appear as small, skin colored or yellowish dermal papules; common on cheeks and lower lids , appear at puberty; associated with down syndrome and diabetes
syringoma ( slide 49, obstruct)
how does molluscum contagiosum present
in children
how do we manage ectropion
conservative:
this occurs when the lashes of the upper lid begin pointing in a more more horizontal to inferior orientation ; can be congenital or acquired;
eyelash ptosis
this is a rare and highly aggressive tumor ; caused by a virus ) merkel cell polyomavirus) ; color varies from flesh colored , red, violet or blue
merkel cell carcinoma ( slide 88, dysplastic disorders)
what are some associations to eyelid coloboma
Goldenhar syndrome, Treacher Collins Syndrome
this is cutaneous deposit of fatty material ; assoc with elevated serum cholesterol
xanthelasma
how do we manage epidermoid cyst
asymptomatic cysts don’t require tx; intralesional triamcinolone injection may hasten resolution ; surgical removal of the cyst and wall
this is an inward turning of the eyelid ; reps an abnormal inversion of the lid margin toward the globe ; involves mainly the lower lid
entropion
this is an alternative tx for demodex and is an antihelminthic agent - two 200 mcg doses given 7 days apart
oral ivermectin
what are the stages of the varicella zoster infection
- varicella infection 2. latency period 3. VZV Reactivation in trigeminal ganglion 4. chronic pain phase
what is the diff between classic vesicular herpes simplex and erosive /ulcerative simplex
classic- vesicles form, ulcerate , or harden , assoc redness and swelling , resolve without scar erosive - involves larger but fewer focal lesions, erosions at the gray line and/or ulcers along lid margin; assoc redness and swelling ( pics slide 38, infec disease)
how can Preseptal cellulitis happen
puncture wound, insect bite, secondary to acute infection, surgical complication
how do we manage eyelid contusions
cold initially , heat thereafter, avoid/limit blood thinning agents , rule out orbital fracture with X ray and CT scan
how will contact dermatitis present
photo contact dermatitis “ photoallergic or phototoxic
this is a closed sac that contains liquid or semisolid material
cyst
management options for chalazion
conservative: hyperthermia with gentle digital massage tid- qid ; anti inflammatory therapy ( topicals ineffective ) use Kenalog steroid injection; you can do an incision and cut it out as well
this is a sweat filled cyst
hidrocystoma aka eccrine hidrocystoma, apocrine hidrocystoma
what is nocturnal lagopthalmos
lagopthalmos mainly upon wakening ; may be related to CPAP / BiPAP for sleep apnea
which type of herpes infection is mainly corneal
secondary
how can we manage nocturnal lagopthalmos
gels or ung for overnight therapy, lid taping, protective eyewear
this is a related condition to squamous papilloms which is seen in African american pts but is benign
dermatosis papulose nigrans
how do we manage herpes simplex blepharitis
self limiting condition, supportive therapy ( warm saline compresses, drying agents )
how do we manage cysts of moll
treated same as hidrocystoma; refer to oculoplastics for marsupialization or excision of the lesion
this is a focal acute infection of the canthal region caused by mainly Moraxella Lacunata
Angular Blepharitis
this is removal of the eye from the orbit while preserving all other orbital structures ( lids , EOMS, fat are all left in place) ; indicated for malignant intraocular tumors, in congenital anophthalmia or severe microophthalmia
enucleation
this results from proliferation of epidermal cells within a circumscribed space In the dermis
epidermoid cyst
this refers to a los of pigment in the lashes “ whitening” ;
poliosis ( slide 12)
these are eyes that are far apart; increased distance between the medial canthi ; occurs in Waardenburg syndrome and FAS
telecanthus ie. Oprah haha
what are the 5 categories of blepharoptosis
aponeurotic, mechanical, myogenic, neuromuscular junction disorder, neurogenic
what is the management for squamous cell carcinoma; same as BCC
biopsy critical, surgical resection is treatment of choice : Mohs micrographic sx
how do we distinguish hordeola and chalazia
discomfort: hordeola are painful and chalazia are painless timing: hordeola are acute and chalazia are chronic
this drug treats hypotrichosis of the eyelashes; made with bimatoprost “ Latisse”
Latisse
this is a dysfunction of message signaling between motor neurons and muscle fibers : “ myasthenia gravis” and Lambert Eaton myasthenic syndrome
neuromuscular junction disorders
how can we manage blink lagopthalmos
ocular lubricants and blink training
how is actinic keratosis managed
pt education about sun exposure, FLOUROURACIL ( medical therapy ) , chemical peels or dermabrasion
how does lagophthalmos presnet
variable, unilateral and bilateral, concurrent lid retraction, incomplete blink on slit lamp exam ; assoc with exposure keratoconjunctivitis slide 39
what are the palpebral fissure mesaurements in blepharoptosis
mild - up to 2 mm, moderate - 3 mm severe- 4 mm or greater
this the most common virus found in humans; systemic transmission via secreted fluid in close contact with mucosal tissues
herpes simplex virus
how does floppy eyelid syndrome present
typical pt : Male, middle aged and obsese can be unilateral or bilateral ; will have ocular irritation, itching, and stringy mucuous discharge ( slide 59)
how do we manage bells palsy
supportive mgmt. like oral acyclovir
how does a Hordeolum present
as one or more focal, firm, painful nodules in the eyelid ; More common in younger pts ; concurrent findings -> anterior/posterior blepharitis, bleparoconjunctivitis, general hygiene issues ( see slide 14, inf lid disorders)
how do we manage trichomegaly/ hypertrichosis
not overtly symptomatic , mainly cosmesis; can use eflornithine cream ( slide 10)
multiple dysplastic nevi may be a sign of _________
FAMMM ( familial atypical multiple mole and melanoma syndrome)
how does dermatochalasis present
sagging of upper and lower lids ; bilateral ; symptomatic pts are > 50 YO ; no gender biased ; “hooding effect” slide 68; visual field may be impacted in severe cases
when do the lids begin to differentiate during embryogenesis
at week 6
how does angular blepharitis present
unilateral, focal redness and excoriation at the inner and outer canthus ; symptoms: itching, dryness, irritation, tenderness, crusting, sticking of the lids “ frothy “ presentation ; No predilections ( slide 6, infec.t disorders lecture for pic)
this is the distance the lid travels from downgaze to upgaze while the frontalis muscle is held inactive at the brow
levator function normal > 15 mm good 12-4 fair 5-11 poor
how does myogenic blepharoptosis present
slow onset, progressive, bilateral ; assoc with diplopia; poor levator function
this is the distance between the pupillary light reflex and the upper eyelid margin with eye in primary gaze
marginal reflex distance 1: normal is 4-4.5 mm
this is small and malformed globe and eyelids ; may be unilateral or bilateral ; assoc with colobomas
micropthalmos ( slide 48)
this is aka skin polyp; benign HYPERPLASIA of normal epithelium with variable keratinization and pigmentation; arise as part of the aging process or due to skin fold
squamous papilloma
this is the most common inflammatory lesion of the eyelid ; lipogranulomatous inflammation of the Meibomian gland ; this is painless
chalazion
how does basal cell carcinoma present
translucent raised nodule with PEARLY MARGINS , INVOLUTION AND ULCERATION at the center ( slide 50 dysplastic )
how do comedones present
rasied thickened nodule with central pore, multiple in appearance seen mainly in teens and young adults ; ( slide 40, obstruct)
this is a def. or absence of eyelids assoc with congenital anomlaies
ablepharon ( slide 31)
how do we manage HZO
Oral Antivirals ( Acyclovir, Valacyclovir, Famciclovir ) must be initiated within 72 hours to minimize risk of postherpetic neuralgia; oral corticosteroids for edema ( prednisone), pain management ( cool compresses, CIMETIDINE); topical Ab for lesiosn
how do we manage cysts of Zeis
asymptomatic- no tx required; warm compresses and massage ; surgical intervention for larger or symptomatic lesion
what are some systemic associations with Epicanthal folds
Cri du Chat Syndrome , Klinefelter Syndrome, Turner Syndrome, and Ehlers Danlos Syndrome
what are the two phases of initial insult of the herpes virus
initial infection ( mild) and reactivation ( more symptomatic)
how does xanthelasma ppresent
pts > 40 YO, women more than men; cosmetic concerns ; typically non painful; characterstic yellow plaques
this denotes manifestations primarily affecting the lashes and their assoc pilosebaceous glands : types are staph blepharitis and seborrheic blepharitis
anterior blepharitis
how does mechanical blepharoptosis present
variable acuity, no pupil involvement
how do epidermoid cysts present
can occur at any time in life; males more than females; foul smelling “ cheese like” material ( slide 26, obstructive )
in blunt ocular trauma what is the “ tip of the iceberg”
the lids
how does the eyelid contusion present
with pain and tenderness
how does pilomatricoma present
small, hard lump under the skin on palpation ; asymptomatic, occurs in head and neck, more common in Caucasian females , solitary ( slide 29, dysplastic disorders)
these are obstructive lesions of the hair follicle with a potential for inflammation/infection ; retention of sebum and keratin; involves skin of faced, back and chest, class feature of acne vulgaris ; open “ blackheads” and closed ( white heads)
comedones
this is the distance from upper lid margin to the eyelid crease
margin crease distance ( 7-8 mmm in males and 9-10 mm in females)
what is hutchinsons sign
during HZO , when nasociliary nerve involvement induces inflammation involving the anterior segment
this is the prolapse of extraconal orbital fat into the upper and lower eyelids due to a lax orbital septum
steatoblepharon- slide 17
how does blepharophimosis present
abnormal narrowing of the palpebral fissures, absence of levator fold, lateral ectropion, hypoplasia of superior orbital rims, low nasal bridge, amblyopia ( slide 21)
how does hidrocystoma present
prevalent in 30-70 YO; asymptomatic, signs : Translucent ; lesions grow slowly and persist indefinitely ; exacerbated in warmer climates
what are the ABCs of suspicious dermatologic lesions
asymmetry, borders, bleeding, color , circulation, diameter, and elevation
this is a type of basal cell carcinoma that account for
sclerosing or morpheaform BCC
how is the herpes virus mainly contracted
via orofacial contact ie kissing
how do we manage distichiasis
lubricants, bandage Cl, epilation, follicle destruction
this is an abnormally increased distance between two organs
Hypertelorism ( ie in the eyes)
how does basal cell carcinoma present
usually older and seen more in men than women
T or F: recurrent or atypical chalazia warranty BIOPSY
T
this is an infestation by demodex; most common age dependent ectoparasite ; cant see with naked eye ; they inhabit hair follicles and are not parasitic by nature ( feed on sebaceous oils and dead skin cells ) their overpopulation causes inflammation
demodicosis
eyelashes of increased length, thicknes and pigmentation ; can be congenital or acquired ( ie prostaglandin analogues)
trichomegaly or hypertrichosis
this is when the Epicanthal folds originate in the lateral aspect of the upper lid and dissipate medially ie Asians
epicanthus tarsalis
how does eyelid retraction present
uncommon; can affect pts of any age ; seen mostly in adults ; bilateral or unilateral slide 31
T or F: recurrent hordeolas are not as ominous as recurrent chalazia but still warrant concern
T : there could be possible assoc with selective IgM def. or Hyperglobulinemia E, possible malignancy
T or F: immunocompromised pts present with larger, more numerous , multicentric molluscum as compared to immunocompetent pts
T
how do we manage hordeola
they are usually self limiting; hot compresses tid-qid with gentle massage, antibiotic therapy ( cephalexin, amoxicillin, tetracyclines) ; surgical therapy for EXTERNAL hordeola , surgery not recommended for INTERNAL
this is removal of the contents of the globe while leaving the sclera and EOM intact; indicated for endophthalmitis
evisceration
what are the most common organisms to cause Preseptal cellulitis
staphylococcus and streptococcus, H. Influenzae, and klebsiella pneumonia
how does staph blepharitis present
bilateral, itching, burning, grittiness, Foreign body sensation, heaviness, and tearing ; crustiness around base of lashes, collartes conj injection,
what are some commercially available TTO tx for demodex
CLIRADEX, blephadex, and oust demodex
mgt of karposi sarcoma
best managed by infectious disease specialist
this condition is not well understood for etiology ; mainly caused by CHRONIC UV EXPOSURE; MOST COMMON NON MELANOMA SKIN CANCER IN THE US
basal cell carcinoma
this is drooping or slack eyelids; rare condition that involves recurrent episodes of eyelid edema ; subsequent damage to levator aponeurosis resulting in ptosis ; considered idiopathic
blepharochalasis
how do we manage contact dermatitis
remove the offending agent , topical steroids , supportvie therapy
this is an outward turning of the eyelid; reps an abnormal eversion of the lid margin away from the globe ; involves lower lid mainly ; uncommon ; no predilections but mainly in older people ; unilateral or bilateral
ectropion- slide 25
what is Iliff’s sign
when you evert the eyelid and ask the pt to look up- failure of the eyelid to return to its normal position when the pt looks up indicates poor levator function
how does squamous cell carcinoma present
usually in older fair skinned peeps, often looks like a scab that wont heal ( slide 69, dysplastic disorders); SCC more aggressive than BCC
this is really radical and involves removal of the eye, adnexa, and part of the bony orbit; indicated for invasive lid tumors
exenteration
rare condition where the lashes grow from the meibomian orifices ; can be congenital or acquired and complete or partial
distichiasis
what are some risk factors for post herpetic neuralgia
older age, severe shingles, severe acute pain, presence of prodrome
how do you manage pilomatricoma
do not regress spontaneously, requires surgical management if symptomatic or cosmetically undesirable ; POTENTIAL FOR INFLAMMATION
how is dermatochalasis managed
no tx required for asymptomatic pts ; surgical mgmt. is blepharoplasty
how does MGD present
bilateral ; any age but most are > 40YO , will complain of itching, burning, stinging sensation
can SCC arise from actinic keratosis
Yes
this is a papillomatous skin response to viral infection by HPV; produces fibrovascular, epithelial projections with vascularized cores , covered by hyperkeratotic epithelium
verruca ( slide 72, infect. disorders)
how do we manage eyelash ptosis
lubricants, bandage CL, epilation ( temporary) and blepharoplasty ( definitive)
etiology of this condition not understood may be due to chronic UV exposure; second most common melanoma skin cancer in the US
squamous cell carcinoma
how do we manage atopic dermatitis
stress control, avoidance of allergens and irritants, medial therapy: topical steroids ( Arisocort, Lidex, and Elocon ) and topical immunomodulatory agents for recalcitrant cases ( Elidel and Protopic)
this is characterized by a horizontal fold of skin stretching across the border of the eyelid ; normal eyelid margin position ; Entropion posture; common in Asians ; comorbities = keratophy secondary to trichiasis ; may resolve spontaneoulsy
epiblepharon ( slide 24)
how do we manage Epicanthal folds
mgt is surgical if pt symptomatic;
how do we manage keratoacanthoma
SURGICAL ; for poor surgical candidates we can do methotrexate. 5- FU, Bleomycin, and corticosteroids
what are the signs of Preseptal cellulitis
mechanical ptosis, red-purple skin coloration, swelling and firmness, involvement of connunctiva, pain on palpation, cant open eye, tearing
whats the mgt for ankyloblepharon
amblyogenic if untreated ; surgical mgt warranted
this type of nevus occurs in middle age- the cells extend from the epidermis into the dermis
compound
T or F: 90 % of adults harbor the HSV-1 virus
T- typically as fever blisters and cold sores
this is usually present at birth and is bilateral ; common in African american and down syndrome children ; when the upper eyelid everts
congenital upper eyelid eversion “lamellar ichythyosis”
condition where the upper and lower eyelid is position significantly more open;
eyelid retraction- this is a sign NOT a diagnosis
if nevus cells are derived from dermal melanocytes what are they called
blue nevi
what are some differentials for hordeola
cysts of zeis or moll, pyogenic granuloma, Kaposi’s sarcoma, Preseptal cellulitis
management for seborrheic blepharitis
hyperthermia, lid margin cleasning, topical Ab NOT necessary and topical steroids are CI, orals unnecessary
this is a rare congenital anomaly where you have vertical shortening of the eyelids ; managed with ocular lubricants and sx in severe cases
microblepharon
how do we manage verruca
benign neglect; intervention only for cosmesis ( keratolytic agents: KOH, Salicylic acid, cantharidin) imiquimod cream , electrocautery , chemical cautery or cryotherapy
this is drooping or slack skin; reps a normal involutional change due to decrease in laxity and gravity ; blinking and photochemical stress contribute
dermatochalasis
how does entropion present
uncommon; mainly in older pts; can be unilateral or bilateral- slide 33
this results from a defect in closure of the optic fissure during embryogenesis ; most common position is at junction of the medial and middle third of upper lid
eyelid coloboma ( slide 27)
this is an infestation by Phthiriasis ( aka crabs) ; organisms infest where adjacent hairs are within grasp such as eyebrows and lashes; transmission by direct contact ; they burrow in at lash base and feed off blood of host ; fecal deposits visible
Phthiriasis Pubis
how do chalazions present
one or more focal and firm and painless!; affects men more may follow an acute infection slide 9 ( inflamm. disorders)
this condition involves proliferation of epidermal cells ; assoc with gene mutation coding for FGFR3
seborrheic keratitis
what are some potential complications of MGD
hordeola, chalazia, Preseptal cellulitis, and marginal keratitis ; if untreated can result in Meibomian gland atrophy and dropout
this disease involves development of molluscum bodies ( aka Henderon Patteron bodies )- large round or oval cytoplasmic inclusions containing molluscum virions, eosinophils, and basophils; produces an acanthosis; forms a central cavity and will appear umbilicated
molluscum contagiosum
