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Question 1

What is the definition of ptosis?

Answer 1

Drooping of the upper eyelid to cover more than 2mm (1/6) of the cornea while the patient is looking forward.

Question 2

What are the different causes of acquired ptosis?

Answer 2

Aponeurotic (most common acquired cause)

Neurogenic (Horner’s syndrome and 3rd nerve palsy)

Myogenic (myasthenia gravis)

Mechanical (large chalazion)

Question 3

How is the degree of ptosis assessed?

Answer 3

Judged by the lid margin-corneal distance (MRD), which decreases in ptosis. Normal MRD is 4-5mm.

Question 4

What are the different types of ptosis and their respective causes?

Answer 4

-Congenital (simple): Due to dystrophy of the levator muscle, poor levator contraction, and poor relaxation. Associated with anomalies such as weak superior rectus muscle and Marcus Gunn phenomenon.

-Neurogenic: Associated with 3rd nerve palsy and Horner’s syndrome.

-Myogenic: Associated with myasthenia gravis.

-Trauma can cause aponeurotic, myogenic, or neurogenic ptosis.

Question 5

What are the suitable surgical procedures for ptosis with good and poor levator action?

Answer 5

• Good levator action: Resection
• Poor levator action: Frontalis sling

Question 6

What are the complications of unilateral severe ptosis?

Answer 6

Amblyopia and squint

Question 7

Why can mild bilateral ptosis be managed conservatively until the age of school?

Answer 7

Full development of muscles can lead to spontaneous improvement.

Question 8

How can trauma cause ptosis?

Answer 8

Trauma can cause aponeurotic, myogenic, or neurogenic ptosis.

Question 9

What type of ptosis can be mistaken with myogenic (myasthenia gravis) ptosis?

Answer 9

Involutional (senile) ptosis, which worsens at the end of the day due to fatigue of Muller’s muscle.

Question 10

What is the most important extraocular muscle to be examined during EOMs examination and why?

Answer 10

Superior rectus, because it shares a common embryological origin with the levator, they both share the same common sheath, and have the same nerve supply.

Question 11

What is squamous blepharitis?

Answer 11

Chronic inflammation of the lid margin characterized by scales

Question 12

What is ulcerative blepharitis?

Answer 12

Chronic inflammation of the lid margin characterized by ulcers.

Question 13

Etiology

Answer 13

The cause or set of causes of a disease or condition.

Question 14

Organism

Answer 14

The specific microorganism responsible for causing a disease.

Question 15

Predisposing factors

Answer 15

Factors that make an individual more susceptible to a disease or condition.

Question 16

Symptoms

Answer 16

Subjective evidence of a disease or condition as perceived by the patient

Question 17

Signs

Answer 17

Objective evidence of a disease or condition as observed by a healthcare professional.

Question 18

Complications

Answer 18

Additional medical conditions or adverse effects that arise from a primary disease or condition.

Question 19

Why should we rub antibiotic ointment well into the lid margin?

Answer 19

Because the organism is hidden in the lash root.

Question 20

Entropion

Answer 20

Rolling in of the lid margin

Question 21

Ectropion

Answer 21

Rolling out of the lid margin

Question 22

Which lid is more affected by all types of entropion & ectropion?

Answer 22

Lower eye lid

Question 23

Congenital, Cicatricial (conjunctival fibrosis)

Answer 23

Causes of entropion

Question 24

Causes of ectropion

Answer 24

Congenital
Cicatricial (fibrosis of skin)

Question 25

Types of Cicatricial causes for entropion

Answer 25

Trachoma (most common) Post-operative Chemical injuries Ocular cicatricial pemphigoid

Question 26

Types of cicatricial causes for ectropion

Answer 26

Burns, Post-operative (blepharoplasty)

Question 27

Causes of Involutional (senile) entropion

Answer 27

Horizontal laxity of lid tissue, vertical laxity

Question 28

Causes of Involutional (senile) ectropion

Answer 28

Horizontal laxity of lid tissue

Question 29

Causes of Mechanical ectropion

Answer 29

Large chalazion

Question 30

Causes of 7th nerve palsy leading to ectropion

Answer 30

Paralysis of orbicularis oculi

Question 31

Symptoms of entropion and ectropion

Answer 31

Foreign body sensation Lacrimation Photophobia Blepharospasm Disfigurement

Question 32

Complications of entropion and ectropion in conjunctiva

Answer 32

Ulceration Keratinization Chronic conjunctivitis

Question 33

Complications of entropion and ectropion in cornea

Answer 33

Corneal ulceration (most dangerous) Vascularization and opacification Conjunctival exposure Corneal exposure >> ulceration in lower 1/3

Question 34

Treatment for Cicatricial entropion

Answer 34

Replacing the shortened conjunctiva by a mucus membrane graft

Question 35

Treatment for Cicatricial ectropion

Answer 35

Replacing the shortened skin by skin graft from behind the ear

Question 36

What is a Hordeolum extremum?

Answer 36

A style

Question 37

What is a Hordeolum Internum?

Answer 37

An infected chalazion

Question 38

Hordeolum extremum def

Answer 38

Acute suppurative infection of zies gland

Question 39

Hordeolum Internum def

Answer 39

Acute suppurative infection of meibomian gland

Question 40

Complications of chalazion

Answer 40

Infection (hordeolum Internum) ptosis (if large chalazion on upper lid) ectropion (if large chalazion on lower lid) astigmatism (if pressing on globe), malignant transformation

Question 41

Hordeolum

Answer 41

Acute suppurative infection of hair follicle or zies gland (extremum or style)

Question 42

Chalazion

Answer 42

Chronic lipo-granulomatous infection of meibomian gland

Question 43

Symptoms of Chalazion

Answer 43

Painful, red swelling at lid (for chalazion) painless lid swelling (painful if infected), cosmetic disfigurement

Question 44

Treatment of Chalazion

Answer 44

Rarely surgical drainage is needed, oral and systemic antibiotics + hot foments, control of diabetes, rarely spontaneous resolution, incision and cottage from conjunctival side (vertical)

Question 45

What are the predisposing factors for Hordeolum?

Answer 45

Malnutrition & hypo-vitaminosis old age diabetes mellitus

Question 46

What are the local predisposing factors for Hordeolum?

Answer 46

Eye strain due to uncorrected errors of refraction, lack of sleep

Question 47

What are the general treatment options for Hordeolum?

Answer 47

Systemic antibiotic topical antibiotics horizontal incision

Question 48

What is the related organism to lash root?

Answer 48

Staph aureus

Question 49

What are the signs of Chalazion?

Answer 49

Localized lid swelling, not tender, not attached to skin (firm, well defined)

Question 50

What is the extra information about Chalazion?

Answer 50

Chalazion is better palpated than seen, less attached to skin, firm and well defined

Question 51

What are the complications of Hordeolum?

Answer 51

Madarosis (loss of eyebrows or eyelashes) cavernous sinus thrombosis orbital cellulitis