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OP3104- AOC- YR 3 > Eyelids > Flashcards

Eyelids Flashcards

1
Q

What is caruncle?

A

Part of the conjunctiva, takes fluid in the years from the punctum into the lacrimal sac and to the nose through nasal- lacrimal duct.

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1
Q

Role of orbicularis oculi?
How do they present?

A

Close the eye
Horizontal lines

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2
Q

Levator palpebrae role?

A

Open the eye
horizontal muscles

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3
Q

Meibomian glands are found in?

A

Tarsal plates

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4
Q

Tarsal plates are bigger in the lower or upper lids?

A

Upper

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5
Q

Function of eyelids?

A
  1. Sweep through the tear film to prevent drying.
  2. Protection from trauma.
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6
Q

Why do patients with extropian get watering?

A

Medial and lateral ectropian= no drainage, hence tears do not stay on the surface.

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7
Q

Why is there redness with ectropion?

A

Because the area is exposed.

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8
Q

Why do we get age related ectropion?

A

Tissue is lost with age, or excess tissue.

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9
Q

How to know if ectropion is caused by cicatrical vs age related?

A

More skin when you pull on lids= age related change. If cicatrical = eyelid skin doesnt move back to normal position when pulled on.

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10
Q

4 causes of ECtropion?

A
  1. Age related
  2. Cicatrical
  3. Paralytic (facial nerve palsy)
  4. Mechanical
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11
Q

Management of ECtropion?

A

Temporary- micropore tape horizontally along lower lid to provide lift. Definitative= surgery

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12
Q

ECtropion meaning?
Which lids are affected?

A

Eyelids turn out
Lower lids affected

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13
Q

What does ECtropian cause?

A

Tear outflow, red appearance of exposed conjunctiva.

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14
Q

What is ENtropion?

A

Age related change that affects the lower lids- inward turn. Constant rubbing of lashes on the cornea in long standing cases.

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15
Q

ENtropion signs?

A

The feeling that something is in your eye.
Eye redness.
Eye irritation or pain.
Sensitivity to light and wind.
Watery eyes (excessive tearing)
Mucous discharge and eyelid crusting.

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16
Q

Differential diagnosis to ENtropion?

A

Palpebral conjunctiva- The conjunctiva lining the inner eyelid of the lower lid may be inspected by gently pulling down the lid with a finger.

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17
Q

What happens in downgaze for ENtropion?

A

Movement of lower lid is reduced

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18
Q

What causes conjunctival scarring?

A

tarcoloma conjunctivitis

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19
Q

3 classifications of ENtropion?

A
  1. Age related
  2. Cicatrical
  3. Congenital - rare
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20
Q

Long & short term management of ENtropion?

A

Short term: Lubricants, bandage CLs for protection. Lid tapping as per ectropion. Botox used temporarily.
Definitive: Surgery

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21
Q

What are lower lid retractors?

A

They have a role in moving eyelids back to their normal position, if they do not work it causes entropion.

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22
Q

What is 7th nerve palsy?

A

The affected side becomes flat and expressionless, ability to winkle forehead and blink is limited and absent.

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23
Q

What are pxs with 7th nerve palsy going to report?

A

Sudden onset of facial droop, ocular discomfort, blurred vision.

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24
How is Lagopthalmos measured?
Ask px to close eyes, sclera should not be visible when eyes are closed.
25
CN 7 supplies which gland?
lacrimal gland
26
What is checked for px's with a 7th nerve palsy?
Corneal sensation, bell's phenomenon, corneal staining, lagopthalmous
27
7th nerve palsy must be differentiated to?
Bells palsy Hunts syndrome, lyme disease, ramsay, trauma.
28
What is Bell's phenomenon and how is it checked?
Ask px to close squeeze lids tight, when they open them- cornea not vissible, only sclera. Bell's phenomenon describes the reflex upward movement of the front of the eyeball when the eyelids close (or blink).
29
Complications of 7th nerve palsy?
Exposure keratopathy and corneal perforation.
30
Treatment options for 7th nerve palsy?
Temp: lubrication (Day), ointment (night). Tape at night. Botox into upper lid including ptosis. Lower lid tightening, upper lid lowering.
31
What is ptosis and what causes it?
Droppy lids, caused by overaction of frontalis muscle
32
Causes of ptosis?
1. Involuntary 2. Neurogenic- Horner's 3rd nerve palsy 3. Myasthenia gravis 4. Mechanical 5. Congenital
33
How is ptosis managed?
Depends on cause 1. Abnormal eye movement (consistent with 3rd nerve palsy) = refer to ophthalmology. 2. Tumour= emergence refferal 3. Myasthenia gravis = emergence referal
34
Ptosis needs to be differenitated from?
pseudoptosis
35
How is levator function tested?
Open eyelids on the top using the thumb (blocking action of frontalis muscle), ask px to look all the way down vs up, and measure how much lid moves.
36
What must be checked in ptosis?
EOM Pupils
37
Risk of using steroids on skin?
Pigmentation
38
Chalazion- how does it look?
Eyelid bump- same colour as skin.
39
What causes chalazion?
Blocked meibomian glands.
40
chalazion px's may also have?
Rosacea and seborrheic dermatitis.
41
Treatment of chalazion?
Hot compress and surgery is non-resolving.
42
Cyst of Moll- how does it look?
Small, clear fluid filled cysts. Transilluminates when light is shone. (Clear= due to sweat)
43
Cysts of Moll treatment?
Treated surgically if cosmesis is bad and px is uncomfortable. Sac is removed to prevent it from reforming.
44
Cyst of Zeis - how does it look?
White cyst Contains oily secretion hence not translucent.
45
Cyst of Zeis treatment?
Hot compression and expression. Surgery if non-resolving, irritating and cosmesis is bad.
46
How does pyogenic granuloma look like?
Red lump on the lids- can bleed.
47
What causes pyogenic granuloma?
After trauma at wound site, occurs due to abnormal wound healing. Caused by proliferation of immature capillaries.
48
Treatment of pyogenic granuloma?
Lubrication, tropical steroids, excise surgically.
49
What is basal cell carcinoma (BCC), and how does it look?
Malginant lid lession. Ulceration, shiny/ pearly appearance, blood vessels run on the surface, gets bigger with time, common with sun exposure.
50
BCC is more common in fair skin individuals- true or false?
True
51
Common position of BCC?
Lower lid and medial canthus
52
Red flags in patients with BCC?
Lash follicle destruction, raised pearly edge with telangiectasia, cysts forming, bleeding
53
BCC or SCC- which one is more common?
BCC
54
Squamous cell carcinoma (SCC)- how does it look?
Scaly, hyperkeratosis, irregular margins, ulceration, crusting.
55
Why is SCC concerning?
Risk of metastasis- risk of the cancer spreading to other parts.
56
Risk factors for SCC?
age, white skin, X-ray, chemical exposure, immunosuppression, xeroderma pigmentosa.
57
BCC and SCC- Similarity and differences?
Both usually occur on sun-exposed areas. Differences: BCC- Most common skin cancer, shiny pearly nodule, umbricalted centers of telangiectasias, grows slowly. SCC- Most common in immunosuppressed or transplant px's, hyperkeratotic lesions with crusting and ulceration, can be more aggressive than BCC.
58
How does malignant melanoma look?
Pigmented lessions.
59
malignant melanoma affect lids?
No
60
What must you consider in any pigmented lesion?
Melanoma
61
What is the ABCD rule followed in malignant melanoma?
Asymmetry Border Colour heterogeneity Dunamic (Change in colour, elevation or size)
62
Risk factors of malignant melanoma?
1. Age 2. Complexation 3. UV
63
What is the key examinations for lids abnormality?
1. Loss of normal architecture 2. Lash loss 3. Ulceration 4. Irregular border or contour 5. Telagietasia or pearly appearance 6. Alternated sensation
64
Drainage system starts from?
Canaliculi's
65
Role of lacrimal gland?
Produce tears and aqueous component of tears.
66
Role of lacrimal sac?
Drain tears away from ocular surface
67
2 systems of lacrimal?
1. Production system 2. Drainage system
68
What happens when lacrimal drain is blocked?
Infection
69
3 components of lacrimal system?
Tear lake Lacrimal sac Nasal cavity
70
Important clinical assesments in px's with watery eyes?
1. VA 2. Observe for any surgical scars? trauma? related sag? lacrimal swelling? 3. Lids- MG? Malposition? lid laxity? 4. Puncta- position? scarring? patency? 5. Cornea and conjunctiva- signs of irritation? inflammation? 6. Tear film- meniscus height? TBUT? dry eyes? 7. Flurosecein dye disappearance test?
71
Lacrimal sac blockage causes high tear film, why?
Beacause tears do not drain
72
What causes medial spillage and lateral spillage - what is 1 underlying cause for watery eyes?
Medial spillage = due to impaired drainage. Lateral spillage = due to lower lid laxity
73
State 2 causes of overproduction vs 2 causes of impaired drainage ?
Overproduction- FB, Conjunctivitis. Impaired drainage- Pump failure, laxity
74
How is blockage investigated?
1. Dye recovery- Jones 1 & 2 dye test. 2. Syrnging- commonly used 3. Imaging- DCG, CT
75
With a Jones 2 dye test no dye is detected on cotton bud, what does this suggest about underlying cause?
Suggests blockage is in the canalicular system, or lacrimal duct, fluroscein doesnt go through.
76
Is ultra sound used as an imaging technique for lacrimal drainage system?
No - doesn't penetrate through bones.
77
What does meibomian gland dysfunction lead to?
Increased tears production
78
Lacrimal pump failure is due to?
Lid laxity and punctal eversion
79
How to deal with small punctum?
Enlarge surgically
80
Is it alarming to have swelling above medial tendon? What is this swelling called?
YES- could cause cancer of px's nasal mucosa. Acute dacryocytitis
81
What is canaliculitis? Cause?
Infection of caniculus CAUSE: Due to obstruction of nasal lacrimal system. Needs urgent referral to prevent celluitis.
82
What causes congenital nasal lacrimal duct obstruction (NLDO)? Signs? Tx?
Valve of Hasner doesn't open. Child complains of watering with no other cause found. TX: nothing is done for 12 months- just massage over lacrimal system. However, need to check for congenital glaucoma.
83
What are the 7 P's for orbital history examination?
1. Pain 2. Proptosis 3. Progression- mins/ days/ weeks 4. Past medical history 5. Perception 6. Palpable mass 7. Periorbital abnormalities- sensory changes, weakness, redness, watering.
84
What 4 clinical conditions affect the orbit?
1. Infection 2. Inflammation 3. Vascular 4. Tumour
85
Are orbital infections life threatening?
yes
86
Optic nerve dysfunction is a feature of orbital or pre-septal cellulitis?
Orbital
87
What is Thyroid Eye Disease (TED)?
TED is an autoimmune disease in which the eye muscles and fatty tissue behind the eye become inflamed.
88
TED Presentation?
This inflammation can push the eyes forward (“staring” or “bulging”) or cause the eyes and eyelids to become red and swollen.
89
TED Management?
Blood check- for antibodies Imaging- CT Orthoptic review MDT Educate px about smoking, chronic nature of disease, supportive groups
90
Risk factors for TED?
1. Older age of onset 2. Males 3. Smokers 4. Diabetes 5. Reduced VA 6. Rapid progressive onset 7. Longer duration of active disease
91
Which muscles are involved in TED?
Inferior rectus, medial rectus, superior rectus, lateral rectus.
91
Carotid Cavernous Fistula (CCF) - how does it look?
RAPD, Pulsatile proptosis, orbital oedema, injected conj, raised IOP, Wiggly arteries and veins (Engorgmenet)
91
Which muscles are first affected by TED?
Inferior Rectus

OP3104- AOC- YR 3 (8 decks)

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