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Duke Elder exam > Eyelids > Flashcards

Eyelids Flashcards

(69 cards)

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1
Q

3 layers of eyelid skin

A

epidermis
dermis
skin adnexa

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2
Q

what do the skin adnexa include (lie deep in the dermis)

A

eyelashes

glands (eccrine, apocrine, holocrine)

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3
Q

example of eccrine glands

A

sweat glands

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4
Q

example of apocrine glands

A

modified sweat glands (e.g. gland of Moll)

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5
Q

2 examples of holocrine glands

A

gland of Zeis
meibomian glands

secrete/synthesise lipids and oily substances

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6
Q

sensory supply to lateral upper eyelid

A

lacrimal nerve (CNV1)

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7
Q

sensory supply to upper eyelid

A

supraorbital and supratrochlear nerves (branches of frontal nerve of CNV1)

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8
Q

sensory supply to medial canthal area

A

infratrochlear nerve (branch of nasociliary nerve of CNV1)

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9
Q

sensory supply to lower eyelid

A

infraorbital nerve (CNV2)

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10
Q

what type of muscle is orbicularis oculi

A

striated

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11
Q

4 parts of orbicularis oculi

A

palpebral
orbital
lacrimal
ciliary

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12
Q

nerve supply to orbicularis oculi

A

tempral and zygomatic branches of CNVII

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13
Q

2 things the fibrous later of the eyelid consists of

A

tarsal plates - provide structural support, upper tarsal plate thicker than lower
orbit septum

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14
Q

function of levator palpebrae superioris

A

striated muscle responsible for eyelid retraction - originates at lesser wing of sphenoid to insert into tarsal plate

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15
Q

nervous supply of levator palpebrae superioris

A

superior division of CNIII

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16
Q

function of Müller muscle

A

smooth muscle, sympathetic nervous system, contributes to eyelid retraction - originates from aponeurosis of levator to insert into tarsal plate

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17
Q

3 pathways which activate the blinking reflex

A

corneal stimulus - CNVI (afferent), CNVII (efferent)
light stimulus - CNII (afferent), CNVII (efferent)
auditory stimulus - CNVIII (afferent), CNVII (efferent)

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18
Q

what is Bell’s phenomenon

A

upward and outward rotation of the globe on forced lid closure - obvious in those with CNVII palsy as the lid remains open when patients are asked to close their eyes

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19
Q

what is a chalazion

A

sterile lipogranuloma due to obstruction of meibomian glands/sometimes gland of Zeis

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20
Q

2 conditions associated with chalazion

A

blepharitis

acne rosacea

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21
Q

3 ways to manage a chalazion

A

hot compresses twice daily
oral antibiotics if infected
incision/curettage

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22
Q

what is a port wine stain (naevus flammeus)

A

congenital capillary malformation of the dermis

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23
Q

how does a port wine stain present

A

pink/purple well-demarcated patches that don’t blanch on pressure

never cross the midline

typically occur along the distribution of choroidal neovascularisation (CNV)

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24
Q

what might port wine stain be associated with

A

Sturge-Weber syndrome

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25
histopathology of BCC
clusters of darkly staining basaloid cells with peripheral palisading arrangement of nuclei
26
features of BCC
centrally ulcerated pearly edged papules with telangiectasia
27
most and least common location of BCC in the eyelid
``` most = lower lid least = lateral canthus ```
28
management of BCC
Mohs micrographic surgical excision (layered excision)
29
3 features of SCC
keratotic, ill-defined, may ulcerate
30
features of keratoacanthoma (type of SCC)
dome-shaped nodule with keratin-filled crater
31
2 treatments for SCC
Mohs surgery | radiotherapy
32
where does sebaceous gland carcinoma arise from
meibomian glands | glands of Zeis (less commony)
33
histopathology of sebaceous gland carcinoma
foamu vacuolated lipid-containing cytoplasm with hyperchromatic nuclei
34
what might sebaceous gland carcinoma be mistaken for
chalaazion - appear as a yellow nodule on the upper eyelid
35
what is trichiasis
misdirected growth of eyelash follicles - grow towards cornea or sclera
36
2 most common causes of trichiasis
herpes zoster ophthalmicus | blepharitis
37
what is distichiasis
formation of a pesterior row of eyelashes
38
4 causes of distichiasis
congenital (AD inheritence) chemical injury Stevens-Johnson syndrome ocular cicatricial pemphigoid
39
2 types of blepharitis
anterior | posterior
40
what is anterior blepharitis
inflammation of the skin around the base of the eyelashes - staphylococcal or seborrheic
41
what is posterior blepharitis
inflammation of meibomian gland around the eyelid margins due to gland dysfunction
42
what might posterior blepharitis be associated with
ocular rosacea
43
4 rish factors for blepharitis
dry eyes seborrheic dermatitis dermodex folliculorum (associated with ocular rosacea) long-term contact lens wear
44
4 clinical features of blepharitis
bilateral and symmetric dry/gritty crusted red
45
what is staphylococcal anterior blepharitis associated with
atopic dermatitis
46
2 signs of staphylococcal anterior blepharitis
lid hyperaemia and swelling | hard scales and crusting of the bases of the lashes
47
3 things that might develop from staphylococcal anterior blepharitis
tear film instability dry eye syndrome trichiasis
48
what is seborrhoeic anterior blepharitis associated with
seborrheic dermatitis
49
2 signs of seborrhoeic anterior blepharitis
soft scales | oily lid margins
50
what is posterior blepharitis associated with
acne rosacea
51
3 signs of posterior blepharitis
foamy and unstable tear film | posterior lid margin hyperaemia and telangiectasia
52
3 forms of treatment for blepharitis
eyelid hygiene antibiotics tea tree oil for demodex infestation
53
type of antibiotics for blepharitis
tetracyclines (inability to inhibit fatty acid oxidation and lipase production)
54
4 types of causes of ptosis
neurogenic (Horners syndrome, CNIII palsy) myogenic (myasthenia gravis, myotonic dystrophy) involutional (age-related) congenital (levator muscle)
55
what is Marcus Gunn jaw-winking syndrome
in 5% of patients with congenital ptosis - ptotic lid that retracts when the ipsilateral pterygoid muscle is stimulated
56
4 things that pseudoptosis includes
dermatochalasis blepharochalasis microphthalmus phthisis bulbi (atrophic, non-functioning eye that occurs as a result of severe ocular disease)
57
what is dermatochalasis
excessive skin of upper eyelid = sagging (lateral hooding) - in elderly
58
what is blepharochalsis
bilateral, from abnormal elastic eyelids = recurrent episodes of painless oedema of upper eyelids leads to stretching and atrophy of skin = skin folds and ptosis
59
what is floppy eyelid syndrome
in middle aged men with obstructive sleep apnoea - upper eyelid lax which may lead to papillary conjunctivtis and keratopathy
60
7 causes of lid retrction
``` graves ophthalmopathy parinaud syndrome (collier sign) third nerve misdirection marcuss gunn jaw-winking syndrome progressive supranuclear palsy down syndrome congenital hydrocephalus (bilteral downward devciation of the globes with upper lid retraction) ```
61
what is lid coloboma
incomplete development of the eyelid due to failure of lid fold fusion, either upper or lower lid
62
where does lid coloboma on the upper lid form and what is it associated with
forms at the junction of the middle and inner thirds of the upper eyelid Goldenhar syndrome
63
what is goldenhar syndrome characterized by (5 things)
``` upper lid coloboma microphthalmia optic disc coloboma maxillary and mandibular hypoplasia limbal dermoids ```
64
what are limbal dermoids
smooth yellow subconjunctival mass typically at inferotemporal limbus with hair protrusion
65
what may limbal dermoids be associated with
Duane retraction syndrome
66
where does lid coloboma on the lower lid form and what is it associated with
forms at the junction of middle and outer thirds of lower eyelid Treacher collins syndrome
67
what is a hordeolum
stye - external or internal
68
causes of external vs internal hordeolum
external = infection of glands of Zeis/Moll internal = infection of meibomian gland usually staph
69
3 treatments for stye
hot compresses topical antibiotics eyelid hygiene

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