eyelids

Question 1

name the structures of the eyelid anterior to posterior

Answer 1

Skin

2. Orbicularis oculi
3. Fibrous layer
4. Levator palpebrae superioris muscle 5. Müller muscle

Question 2

what is the skin adnexa

Answer 2

ie deep in the dermis and includes the eyelashes and many types of glands:

Question 3

what type of glands are found in skin adnexa

Answer 3

• Eccrine glands: Sweat glands.

● Apocrine glands: Modified sweat glands (e.g. gland of Moll).

● Holocrine glands: Gland of Zeis, and meibomian glands. These glands
synthesize/secrete lipids and oily substances.

Question 4

sensory supply of the eyelid

Answer 4

● Lateral upper eyelid: Lacrimal nerve (CNV1).
● Upper eyelid: Supraorbital and supratrochlear nerves (branches of frontal
nerve of CNV1).
● Medial canthal area: Infratrochlear nerve (branch of nasociliary nerve of
CNV1).
● Lower eyelid: Infraorbital nerve (CNV2).

Question 5

role of the orbicularis oculi and the name of its components

nerve supply

Answer 5

A striated muscle arranged in concentric bands that functions in closing the eye. It has four parts: palpebral, orbital, lacrimal and ciliary parts. Nerve supply is via temporal and zygomatic branches of CNVII.

Question 6

role of LPS
nerve supply
orgination
type of muscle

Answer 6

A striated muscle responsible for eyelid retraction that originates at the lesser wing of the sphenoid to insert into the tarsal plate. Nerve supply is via the superior division of CNIII.

Question 7

role of the muller muscle
type of muscle
nerve supply

Answer 7

A smooth muscle innervated by the sympathetic nervous system which contributes to eyelid retraction. Originates from the aponeurosis of the levator to insert into the tarsal plate.

Question 8

what are the different stimulus for blinking reflex

Answer 8

● Corneal stimulus: CNV1 (afferent), CNVII (efferent)
● Light stimulus: CNII (afferent), CNVII (efferent)
● Auditory stimulus: CNVIII (afferent), CNVII (efferent)

Question 9

what is the bell’s phenomenon

Answer 9

upward and outward rotation of the globe on forced lid closure. This is particularly obvious in patients with CNVII palsy, as the lid remains open when patients are asked to close their eyes. This phenomenon is regarded as a defensive mechanism

Question 10

what is a chalazion and pathology

Answer 10

sterile lipogranuloma that occurs due to obstruction of the meibomian glands and occasionally the gland of Zeis

Question 11

presentation of a chalazion

Answer 11

it presents over several weeks as a painless round nodule in the eyelid. If infected, it may become red, swollen and painful.

Question 12

what is associated with chalazion

Answer 12

blepharitis

acne rosacea

Question 13

Mx of chalazion
conservative
medical
surgical

Answer 13

Management is mainly with hot compresses twice daily and use of oral
antibiotics if infected. Incision and curettage is also an option.

Question 14

pathology of port wine stain

Answer 14

A congenital capillary malformation of the dermis

Question 15

presentation of port wine

ass w what eye conditions

Answer 15

They present as pink/ purple well-demarcated patches that do not blanch on pressure and never cross the midline. Typically, they occur along the distribution of choroidal neovascularization (CNV)

overlying skin becomes hypertrophies and coarse

ass w ipsilateral glaucoma
episcleral haemangioma
iris heterochromia
diffuse choroidal haemangioma

Question 16

what is associated with port wine stain

Answer 16

It may be associated with Sturge-Weber syndrome.

Question 17

what is BCC

RFs

Answer 17

most common malignant eyelid tumour. They are slow growing and rarely metastasize.

fair skin
inability to tan
chronic exposure to sunlight

Question 18

histopathology of BCC

Answer 18

Clusters of darkly staining basaloid cells with peripheral palisading arrangement of nuclei.

Question 19

features of BCC

Answer 19

Centrally ulcerated pearly edged papules with associated telangiectasia

● Location (from most common to least common)
Eye: Lower lid > medial canthus > upper lid > lateral canthus Lips: Upper lip > lower lip

ulcerative is the most common type unlike nodular or sclerosing
non metastasizing

Question 20

Mx of BCC the name

Answer 20

Mohs micrographic surgical excision (layered excision of the tumour to allow better total clearance).

Question 21

features of SCC

Answer 21

Keratotic (e.g. scaly, crusty), ill-defined nodule that may ulcerate.

● Dome-shaped nodule with keratin-filled crater is typical in
keratoacanthoma.

20% metastise to regional lymph nodes

Question 22

Mx of SCC

Answer 22

Mohs surgery and radiotherapy

Question 23

what is sebaceous gland carcinoma

Answer 23

is tumour arises from meibomian glands or, less commonly, glands of Zeis

UNLIKE BCC or SCC it arises more commonly on the upper eyelid

Question 24

histopathology of sebaceous gland carcinoma

Answer 24

foamy vacuolated lipid-containing cytoplasm with hyperchromatic nuclei are seen

Question 25

features of sebaceous gland carcinoma

Answer 25

They are more common in elderly females and appear as a yellow nodule in the upper eyelid which may be mistaken for a chalazion.

Question 26

what is trichiasis

Answer 26

Misdirected growth of eyelash follicles, in which eyelashes grow towards the cornea or sclera

Question 27

common causes of trichiasis

Answer 27

Herpes zoster ophthalmicus and blepharitis.

Question 28

what is distichiasis

Answer 28

Refers to the formation of a posterior row of eyelashes.

Question 29

causes of distichiasis Mx

Answer 29

1. congenital (AD inheritance) - thinner and shorter after 5 years maybe ass w lymphoedema of the legs upper eyelide Mx - crytotherapy and lammelar eyelide divsion 2. acquired from chemical injury 3. Stevens-Johnson syndrome 4. ocular cicatricial pemphigoid. epilation eclectrolysis cryotherapy

Question 30

what is anterior blepharitis

Answer 30

inflammation of the skin around the base of the eyelashes and is divided into 1. staphylococcal or 2. seborrheic.

Question 31

what is posterior belpharitis

Answer 31

Inflammation of the meibomian gland around the eyelid margins due to gland dysfunction. May be associated with ocular rosacea.

Question 32

RFs of blepharitis

Answer 32

Dry eyes ● Seborrheic dermatitis ● Demodex folliculorum: Associated with ocular rosacea ● Long-term contact lens wear

Question 33

symptoms of blepharitis

Answer 33

Bilateral and symmetric, dry, gritty, crusted and red eyes

Question 34

signs of staphylococcus anterior blephariits

Answer 34

– Associated with atopic dermatitis – Lid hyperaemia and swelling – Hard scales and crusting of the bases of the lashes – Tear film instability, dry eye syndrome and trichiasis may develop

Question 35

signs of seborrhoeic anterior blepharitis

Answer 35

– Associated with seborrheic dermatitis | – Soft scales and oily lid margins

Question 36

signs of posterior blepharitis | ass w

Answer 36

– Associated with acne rosacea – Foamy and unstable tear film (due to abnormal meibomian gland secretion, leading to excess lipid in tear film) – Posterior lid margin hyperaemia and telangiectasia

Question 37

Mx for blepharitis

Answer 37

● Eyelid hygiene is the most important management. ● Antibiotics (e.g. tetracyclines, due to their ability to inhibit fatty acid oxidation and lipase production). ● Tea tree oil may be used for demodex infestation.

Question 38

causes of ptosis

Answer 38

neurogenic (e.g. Horner syndrome, CNIII palsy) myogenic (e.g. myasthenia gravis, myotonic dystrophy) involutional (age-related) congenital (due to failure of development of the levator muscle).

Question 39

what is marcus gunn jaw-winking syndrome

Answer 39

congenital ptosis. It presents as a ptotic lid that retracts when the ipsilateral pterygoid muscle is stimulated (e.g. chewing).

Question 40

what is dermatochalasis

Answer 40

Excessive skin of the upper eyelid leading to sagging, classically described as lateral hooding. This condition occurs in the elderly.

Question 41

what is blepharochalasis

Answer 41

This bilateral condition results from abnormal elastic eyelids causing recurrent episodes of painless oedema of the upper eyelids. This leads to stretching and atrophy of the skin and subsequent skin folds and ptosis.

Question 42

what is floppy eyelid syndrome

Answer 42

middle-aged obese men with obstructive sleep apnoea. sleep facedown to pillow The upper eyelid is extremely lax, which may lead to papillary conjunctivitis and keratopathy.

Question 43

causes of lid retraction

Answer 43

``` ● Graves ophthalmopathy ● Parinaud syndrome (Collier sign) ● Third nerve misdirection ● Marcus Gunn jaw-winking syndrome ● Progressive supranuclear palsy ● Down syndrome ● Congenital hydrocephalus (setting-sun appearance: bilateral downward deviation of the globes with upper lid retraction) ```

Question 44

what is lid coloboma

Answer 44

Incomplete development of the eyelid due to the failure of lid fold fusion. It can occur in either the upper or lower eyelids.

Question 45

what is goldenhar syndrome

Answer 45

A sporadic condition characterized by upper lid coloboma, microphthalmia, optic disc coloboma, maxillary and mandibular hypoplasia, and limbal dermoids (smooth yellow subconjunctival mass, typically at the inferotemporal limbus with hair protrusion). May be associated with Duane retraction syndrome.

Question 46

lower eyelid coloboma ass w

Answer 46

middle and outer thirds of the lower eyelid. Can be associated with Treacher Collins syndrome.

Question 47

what is hordeolum (stye)

Answer 47

stye is an External hordeolum is an infection of the glands of Zeis or Moll. Internal hordeolum is an infection of the meibomian gland.

Question 48

features of a stye cause ass w

Answer 48

due to a staphylococcal infection and presents as a painful, erythematous swelling of the eyelid. ass w staphylococcal blepharitis

Question 49

Mx of a stye

Answer 49

hot compresses, topical antibiotics and eyelid hygiene.

Question 50

signs of keratoanthoma

Answer 50

hyperkeratotic nodule regressing a keratin filled crater may develop

Question 51

causes and Mx of impetigo erysipselas necrtosing fascitis

Answer 51

staph aureues - erythromycin or flucox strep pyogenes - oral abx same - benzylpenicillin

Question 52

examples of pseudoptosis

Answer 52

dermatochalasis, blepharochalasis, microphthalmus and phthisis bulbi (atrophic, non-functioning eye that occurs as a result of severe ocular disease).