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Duke Elder Revision > Eyelids > Flashcards

Eyelids Flashcards

(79 cards)

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1
Q

Eyelid tissue layers from anterior to posterior

A
  1. Skin
  2. Orbicularis muscle
  3. Tarsal plate
  4. Levator muscle
  5. Muller muscle
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2
Q

How is the eyelid anatomically divided into the lamellae?

A

Gray line - outermost margin of the orbicularis muscle

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3
Q

contents of anterior lamella

A

skin and orbicularis

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4
Q

contents of posterior lamella

A

tarsal plate and conjunctiva

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5
Q

what is the normal position of the eyelids in comparison to the limbus?

A

the upper lid is 2mm below the superior limbus and the lower lid is level with the inferior limbus

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6
Q

muscles of eyelid retraction

A

levator palpebrae superioris
Mullers muscle
frontalis

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7
Q

innervation of levator palpebrae superioris

A

CN III

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8
Q

innervation of Mullers muscle

A

sympathetic innervation

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9
Q

innervation of frontalis

A

CN VII

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10
Q

muscle of eyelid closure

A

Orbicularis oculi

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11
Q

innervation of orbicularis oculi

A

CN VII

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12
Q

Muscle involved in lacrimal pump mechanism

A

orbicularis muscle

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13
Q

afferent limbs of the blink reflex

A

Corneal stimulus via CNV1
Light stimulus via CN II
Auditory stimulus via CN VIII

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14
Q

Efferent limb of blink reflex

A

CN VII to the orbicularis oculi muscle

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15
Q

Bell’s phenomenon

A

where the globe rotates up and out during forced lid closure

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16
Q

where does the lacrimal sac lie?

A

between the limbs of the medial canthal tendon

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17
Q

palpebral fissure

A

gap between the upper and lower eyelid margins

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18
Q

presentation and mechanism of thyroid eye disease

A

Retraction due to muller contraction

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19
Q

presentation and mechanism of horner syndrome

A

ptosis due to muller relaxation

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20
Q

presentation and mechanism of CN VII palsy

A

lagophthalmos due to orbicularis spasm

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21
Q

presentation and mechanism of CN III palsy

A

ptosis due to levator relaxation

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22
Q

Lagophthalmos

A

inability to fully close the eyelids

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23
Q

priority order of skin graft sites for eyelids

A
  1. Other lid
  2. Preauricular
  3. Post auricular
  4. Under arm
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24
Q

Can you repair both lamellae with grafts?

A

No because there would be no blood supply

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25
Anterior lamella advancement
incise and stretch tissue over laceration
26
Anterior lamella transposition
move tissue from the other lid
27
Anterior lamella rotation
rotated skin from the cheek
28
anterior lamella glabella
rotated diamond-shaped forehead skin
29
posterior lamella hughs flap
flap taken from the upper lid
30
posterior lamella free tarsal graft
tissue taken from the other eye
31
blepharitis
chronic inflammation of the eyelid typically associated with staphylococcus aureus infection
32
blepharitis classification
Anterior (seborrheic or staphylococcal) and posterior
33
Guess the condition: bilateral crusting of the lids and foamy tear film
blepharitis
34
recurrent unilateral blepharitis should be investigated for which condition?
sebaceous cell carcinoma
35
Blepharitis type associated with atopic dermatitis
staphylococcal
36
Blepharitis type associated with seborrheic dermatitis
seborrheic
37
Blepharitis type associated with acne rosacea
posterior
38
blepharitis management
lid hygiene, warm compress, topical lubrication and tetracyclines
39
function of tetracyclines in blepharitis
limit fatty acid production which can decrease inflammatory secretions
40
meibomian gland dysfunction
chronic disorder of meibomian glands that overlaps with posterior blepharitis. Characterised by duct obstruction and abnormal glandular secretions.
41
pathophysiology behind meibomian gland dysfunction
secretion of meibomian oil is obstructed -> stagnation within glands leads to inflammation -> staphylococcal colonisation leads to chronic inflammation and scarring
42
Guess the condition: foamy tear film, crusty eyelashes and gritty irritated eyes, TBUT < 5s
Meibomian gland dysfunction
43
Management of MGD
1. dietary increase in omega 3 and lid hygiene and warm compress 2. topical lubricants, increase humidity and lysosomal sprays 3. Oral tetracycline 4. Anti-inflammatory therapy for dry eye
44
Trichiasis
inward misdirection of the eyelashes
45
Distichiasis
congenital abnormality where there are 2 rows of eyelashes Can be associated with Meige syndrome
46
Acquired metaplastic lashes
Abnormally positioned lashes due to inflammation such as meibomitis and scarring
47
Pseudotrichiasis
Inwardly projecting lashes due to entropion
48
Management of trichiasis
1. Epilation 2. Lash destruction by electrolysis/laser/cryotherapy 3. Surgery
49
external hordeolum
abscess of Zeis or Moll glands
50
internal hordeolum
abscess of Meibomian gland
51
Management of hordeolum
hot compress and oral antibiotics
52
pathology of chalazion
obstruction of meibomian or Zeis glands leads to sterile lymphogranuloma formation
53
management of chalazion
hot compress surgical incision and curettage
54
Cyst of Moll
Chronic translucent cyst arising from blockage of Moll glands
55
Cyst of Zeis
Chronic non-translucent cysts arising from blockage of Zeis glands
56
commonest cancer in ophthalmology
basal cell carcinoma
57
Vismodegib
medication that works through the hedgehog pathway for BCC non-resectable cases
58
ophthalmology cancer associated with HPV and immunocompromise
Squamous cell carcinoma
59
Vemurafenib
kinase inhibitor with FDA approval for unresectable melanoma tumours
60
Where do ophthalmology melanoma?
most likely arise from the choroid inside the eye can spread to the liver
61
commonest type of ectropion
involutional
62
involutional ectropion
Caused by horizontal lid laxity and often seen in the elderly.
63
cicatrical ectropion
Shortening of the anterior lamella by inflammation and scarring. It is caused by underlying conditions such as burns and dermatitis.
64
paralytic ectropion
Orbicularis weakness caused by facial nerve palsy.
65
congenital ectropion
Typically due to a shortage of skin. Can be seen in Down syndrome and prematurity.
66
management of horizontal lid laxity
lateral tarsal strip
67
management of vertical lid laxity
diamond excision
68
management of cicatrix
skin gaining procedures such as grafts and flaps
69
involutional entropion
commonest type caused by lower retractor weakness/dehiscence
70
cicatrical entropion
caused by shortening of the posterior lamella by vertical scarring Most commonly caused by trachoma
71
management of entropion
Retractor weakness → Everting sutures, transverse tarsotomy, or Jones procedure Scarring → Membrane graft or posterior lamella reconstruction
72
involutional ptosis
The most common type. Caused by dehiscence of the levator palpebrae superioris from its attachment to the levator aponeurosis.
73
treatment of involutional ptosis
anterior levator advancement surgery
74
neurogenic causes of ptosis
CN III palsy Horner Syndrome Myasthenia Gravis
75
management of ptosis due to horner syndrome
levator resection or mullerectomy
76
management of isolated congenital ptosis
Poor function → frontalis suspension. Preserved function → anterior levator resection.
77
blepharophimosis syndrome
Characterised by a shortened horizontal palpebral fissure and telecanthus. AD inheritance
78
Marcus Gunn Syndrome
Characteristic elevation of the ptotic lid whilst chewing. Thought to be caused by developmental CN5 misdirection to the levator palpebrae superioris.
79
causes of pseudoptosis
Blepharochalasis Dermatochalasis Brow Ptosis

Duke Elder Revision (12 decks)

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