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Ocular Disease > Lid Anatomy > Flashcards

Lid Anatomy Flashcards

(144 cards)

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1
Q

What nerve controls orbicularis muscle?

A

CN 7

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2
Q

What nerve controls levator palpebrae superioris?

A

CN III

Mueller is controlled by sympathetic

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3
Q

What glands are on tarsal plates?

A

Zeiss and approx 30

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4
Q

How many lashes on upper and lower lid?

A

150 lashes on upper and 100 on lower

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5
Q

What are the 2 sebaceous glands

A

zeiss and meibomian

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6
Q

What are the sweat glands?

A

moll

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7
Q

What is blepharospasm?

A

involuntary bilateral spasm orbicularis
(where eyes shut and can’t open them)
females develop in 60’s
has 3:1 ratio

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8
Q

What is Tx for blepharospasm?

A

botox every few weeks to decrease muscle response. This is because lids can close while driving

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9
Q

What is blepharoclonus?

A

where patients blink a lot.

secondary to inflammation

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10
Q

What is Tx for blepharoclonus?

A

treat inflammation

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11
Q

What is myokymia? (think of David when muslce twitches)

A

eye lid twitches (fasiculation of orbicularis)
refractory period is messed up
jumping eyelid

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12
Q

What is etiology of myokymia?

A

lack of sleep, stress, medication, excessive alcohol consumption

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13
Q

What is Tx for mykymia?

A

want to prolong refractory period, cool compress, topical anti-histamine, take quinine.
Quinine found in tonic water

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14
Q

What is Pseudograefe?

A

aberrant regeneration of CN III
follows CN III palsy
elevates eye and it goes in because of MR and LFP fibers
eye will elevate when it is adducted.

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15
Q

What is Entropion?

A

Lower lids turns inward
congenital
can be confused with epiblepharon

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16
Q

What is most common age related involutional disorder?

A

entropion

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17
Q

treatment for entropion?

A

surgery, epilation, glue

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18
Q

What is ectropion?

A

outward rolling of lid where cornea and conjunctiva exposed

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19
Q

What are the causes for ectropion?

A

cicatricial or mechanical

mechanical = burns, dermatoses, tumor, trauma

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20
Q

What is Tx for cicatricial/mechanical ectropion?

A

steroids , surgery

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21
Q

what causes paralytic ectropion?

A

bells palsy. Can be induced by botox

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22
Q

What is etiology of congenital ectropion?

A

associated with other lid problems

Tx: taping, lubrication, surgery

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23
Q

What is nocturnal lagophthalamos?

A

incomplete lid closure
can be diagnosed from NaFl from tonometry
patients have inferior morning SPK

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24
Q

Who has lagophthalmos more kids or adults?

A

adults because of decreased tear production

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25
What are the 4 types of lagophthalmos?
nocturnal, orbital, mechanical, paralytic?
26
What is orbital lagophthalmos?
caused by graves ophthalmopathy
27
what is mechanical lagophthalmos?
occurs because of facial or ocular scarring?
28
What is paralytic lagopthalmos?
caused because of paralysis of CN 7 because of Bell's Palsy cannot close lids properly vascular association you must rule out stroke for Bell's Palsy the flat side is the diseased side
29
What is Tx for paralytic lagophthalmos?
lubrication, taping, tarsorrhaphy ( where you stitch the lid shut)
30
what is congenital ptosis?
autosomal dominant | in down gaze the lid is higher than normal
31
what is blepharophimosis?
``` autosomal dominant characterized by severe bilateral ptosis lateral ectropion telecanthus (wide bridge) normally the epicanthal folds in asian children cause a slight entropian but with this condition, the epicanthus is inverted and fold the opposite way. ```
32
what is horners?
ptosis, miosis, anhydrosis | congenital or aquired
33
What is congenital horners?
associated with heterochromia
34
what is acquired horners?
no heterochromia
35
what is pre-ganglionic horners?
associated with chest trauma and tumors
36
what is post-ganglionic horners?
will be benign and NOT have a loss of sweating
37
What are 3 tests for horners?
cocaine 10% solution, hydroxyamphetamine, PE (phenylephrine)
38
How do you use cocaine?
will dilate normal eye but not horners
39
how do you use hydroxyamphetamine?
will not dilate post ganlionic because not enough norepinephrine
40
how do you use phenylephrine?
elevates side affected by muellers | IMPORTANT TO RULE OUT MALIGNANCY
41
what is myotonic dystrophy?
characterized by muscle wasting patient has mournful expression will have difficulty relaxing muscle once contracted Ptosis, Cataract, Retinal changes: retinopathy, near light reflex dissociation, low IOPs, similar to bells, but it is bilateral.
42
what is myastenia gravis?
loss of receptors giving rise to muscle fatigability and weakness 90% will present with ocular signs
43
what is the DX for myastenia gravis?
tensilon test | use edrophonium will improve ptosis
44
what is the Tx for myastenia gravis?
steroids, immunosuppresives, anticholinesterases, thymectomy
45
What is floppy eyelid syndrome?
obese middle age men get this where lids are easily everted and cornea drys associated with sleep anea and keratoconus
46
What is Tx for floppy eyelid syndrome?
lid taping or surgery
47
What is Dermatochalasis?
bilateral conditions in elderly patients | redundancy of the skin
48
What is the Tx for dermatochalasis?
can send for blepharoplasty | affects visual fields
49
What is a lid coloboma?
deals with children and the embryonic tissue that didn't close can get a cleft lid
50
What is the Tx for lid coloboma?
surgical repair for 3 - 6 months of age
51
What is cryptophtalmia?
skin is over the eyelids (fusion) | no Tx
52
what is the Tx for ablephara and Micorblephron?
Ablepharon = absence of the eyelid Microblepharon = shortening of the eyelid Tx: surgery
53
What is a contusion?
ecchymosis = black eye | can cause a hemorrhage that can cause IOP rise that can damage sight
54
What are the 3 common types of thermal burns?
flame, flash and scalding
55
What happens if you get a chemical burn from acid?
it is self limited and you will get a very red eye
56
What if you get alkali in your eye?
can cause greater destruction due to capillary closure. | IF EYE TURNS WHITE = BAD!!!
57
What is the Tx for burns?
irrigation for 1 - 2 mins with neutral irrigation 5 - 10 minutes of non-neutral then you place anti-biotic and cycloplege the pt
58
What is an adhesive lid trauma?
This is crazy glue in your eye.
59
What is the Tx for adhesive lid trauma?
mineral oil soaks and a pressure patch with forceps later
60
What is Molluscum contagiosum?
viral skin infection | Sx: yellow nodules with follicular conjuctivitis and SPK
61
What is the Tx of Molluscum contagiosum ?
excision by cautery
62
What is a xanthelasma?
plaque like lesions occurring in the middle-age pts occurs in younger pts with hyperlipidemia this is higher in females than males
63
What is the Tx for xanthelasma?
excision by cosmesis
64
What is seborrheic keratoses?
a papilloma that looks like a mole growth
65
What is actinic keratoses?
a pre-cancerous skin lesion found in elderly fair skinned people with h/o skin exposure will see it on tips of ears
66
What is treatment of actinic keratoses?
biopsy with cryo
67
What is a sudoriferous cyst?
form from gland of moll | typically asymptomatic but can lead to trichasis (inward turning of eye lashes)
68
What is the Tx for sudoriferous cyst?
excision because lancing will increase recurrences
69
What is a sebaceous cyst?
occurs from hair follicles or sebaceous glands | pts are asymptomatic
70
What is a Tx for a sebaceous cyst?
superficial - lance | subcuteneous - let it drain
71
What is verrucae vulgaris or plana?
HPV viral wart most common benign tumor of lids Vulgaris - crusted on a stalk plana - flat pitted appearance
72
what is the Tx for verrucae vulgaris or plana?
chemical cautery | do not want to lance or drain because can lead to conjunctivitis
73
what is a basal cell carcinoma?
most common malignant tumor slow growing and eats away it requires excision with biopsy followed by radiation
74
what is the Tx for a basal cell carcinoma?
requires excision with biopsy followed by radiation
75
What is a squamous cell carcinoma?
5 to 10% malignancies more aggresive occurs in elderly people with fair skin
76
what is a sebaceous gland carcinoma?
VERY RARE usually a meibomian gland may be present as a chalazion
77
What is a melonoma?
RARE
78
What is Karposi's sarcoma?
vacular tumor associated with AIDS | rapid growing
79
What is the Tx for Karposi's sarcoma?
radiation
80
What is the episclera?
dense vascular connective tissue | provides nutrition cornea
81
What is the vasculature for the episclera?
superficial episcleral plexus with Tenon's capsule
82
What is episcleritis?
benign and sudden onset | involves 3 layers!!
83
what 3 layers does episcleritis involve?
conjunctival vessels deep episcleral plexus superficial scleral plexus (tenon's vessels) there are no scleral or muculature involvement
84
What are the symptoms for episcleritis?
MILD pain in 1 or both eyes but NOT painful | acute onset of redness
85
What are the clinical signs of episcleritis?
vision normal mild tenderness nodule that can be moved slightly 70 to 75% NO associated systemic disease
86
Does episcleritis affect males or females more?
occurs in females 20 to 40 years old
87
How to differentiate episcleritis from scleritis?
scleritis pain is deep, severe, and occurs on ipsilateral side of head/face
88
how to differentiate episleritis from iritis?
cells and flare in anterior chamber
89
how to differentiate episleritis from conjunctivitis?
discharge | need to differentiate from contact lens over wear
90
what is the cause of episcleritis?
it is idiopathic | if not it is a connective tissue disease
91
What is the history for someone with episcleritis?
someone with a rash, venereal disease, arthritis, recent viral illness
92
What is the work up for episcleritis?
you would look for bluish hue externally | You would drop phenylephrine 2.5% in each eye and examine the vascular pattern
93
Most people have simple or nodular episcleritis?
simple! and can have sectorial or diffuse
94
What is simple episcleritis?
has greyish infiltrates generalized and moderate swelling resolves quickly
95
What is nodular episcleritis?
nodule of localized edema takes longer to resolve than simple has a moveable nodule
96
what is the Tx for episcleritis?
none Mild: iced artificial tears, topical decongestants Moderate to Severe: steroid drops or oral NSAIDS
97
what is the follow up for scleritis?
if on steroids check IOP weekly | check in 2 to 3 weeks if on artificial tears
98
what is chronic (stubborn) episcleritis?
RARE NO necrosis bluish color never develops to scleritis
99
tell me about the anatomy of the sclera?
rich nerve supply avascular low metabolism
100
What is scleritis?
inflammatory disease that affects the sclera
101
What is anterior scleritis?
patient has redness in the eye | severe eye pain
102
what is posterior scleritis?
patient will NOT present redness and MAY NOT present eye pain
103
Tell me about scleritis?
uncommon, chronic can lead to blindness and eye loss tissue destruction 50% is due to systemic cause
104
Who does scleritis mostly affect?
females more than males from 40 to 60 years old
105
What happens in scleritis?
inflammation of deep episcleral plexus its dark red with a bluish tint affects choroidal vasculature
106
what are the symptoms for scleritis?
severe ocular pain, may wake up from sleep, recurrent episodes common, decreased VA leading to blindness
107
what are the signs of scleritis?
inflammation of scleral, episcleral, and conjunctival vessels, sclera will have bluish hue
108
how to tell difference from episcleritis?
episleritis does NOT have the sclera involved. Episleritis is more acute, patients are younger with episcleritis and with milder symptoms
109
what are conditions that cause scleritis?
``` collagen disease metabolic disease granulmatous disease infectious disease ocular condition ```
110
What systemic disease is scleritis associated with?
connective tissue diseases and others
111
what is anterior scleritis?
most people have this one non-necrotizing and vision is maintained is diffuse and nodular
112
what is the Tx for anterior scleritis?
take oral NSAIDS oral prednisone immunosuppressive therapy
113
what is anterior scleritis necrotizing?
most severe form, vision threating complications, pain is extreme, collagen vasculature problems occur THIS IS AN OPHTHALMIC EMERGENCY!!
114
Can secondary complications occur with anterior necrotizing with inflamation scleritis?
yes like staphyloma and ectasia
115
What is a staphyloma?
thinning of the sclera, bulging of the uvea,
116
what is ectasia? (POSSIBLE TEST QUESTION)
bulging of the sclera without uveal lining
117
what is anterior necrotizing without inflammation (scleromalacia perforans)?
occurs in patients with long standing rheumatoid arthritis, NO PAIN, older females
118
What is the Tx for Necrotizing scleritis?
oral prednisone, immunosuppressive agents, eye surgery may need to be performed
119
What is posterior scleritis?
can occur with anterior scleritis, restricted EOMS, proptosis, pain, tenderness, decreased vision (permanent), usually unrelated to systemic disease
120
What is worse anterior or posterior scleritis? (Isaac made up this question)
probably posterior
121
what are the ocular signs for posterior scleritis?
disc swelling, macular edema, choroidal folds or detachment
122
what is the Tx for posterior scleritis?
asprin, NSAIDS, steroids, immunosuppressive therapy
123
What is Tx for scleritis?
if infections then use anti-biotic if foreign body the remove it glasses or eye shield should be worn at all times TOPICAL STEROIDS NOT EFFECTIVE sub-conjunctival steroids are contraindicated
124
what is the work up for scleritis?
examine sclera everywhere do slit lamp with the green light do a physical exam
125
what do you use to diagnose scleritis?
10% phenylephrine test will blanch conjunctival vessels and superficial episcleral vessels WILL NOT blanch deep scleral plexus
126
what are pigment cuffs?
very common short anterior ciliary arteries associated with axonfeld's loop
127
What is a blue sclera?
tissue color due to scleral thinning and exposed uvea | NORMAL for infants
128
what is osteogenesis imperfecta?
inherited condition permanent blue sclera affects skeleton, joints, teeth, skin, and eyes
129
what are the 3 signs for osteogenesis imperfecta?
blue sclera, deafness, and bone fractures
130
What is melanosis oculi?
congenital bilateral hyperpigmentation of conjunctiva, episclera, sclera, uvea, and choroid seen in darker colored patients (LIKE GANESH but that's messed up but hey you are going to remember it now lol)
131
what is the nevus of ota?
pigmentation of the periorbita skin | will distribute along ophthalmic and maxillary division of CN V
132
What is senile hyaline plaque?
older patients over 50 will get this it is localized non-inflammatory thinning reassure patient it is not cancerous
133
What is icterus/jaundice?
yellow pigmentation of the sclera or skin because of high concentrations of bilirubin in the blood NEEDS A MEDICAL EXAM
134
What is scleral perforations?
``` can be due to high velocity projectiles like BB gun, fireworks, metal hammerings varying pain sight may not be detectable will have decreased IOP NO MRI for patient ```
135
What is the Tx for scleral perforations?
``` immediate hospitalization Fox shield (eye shield) given to patient ```
136
What is a blue sclera?
tissue color due to scleral thinning and exposed uvea | NORMAL for infants
137
what is osteogenesis imperfecta?
inherited condition permanent blue sclera affects skeleton, joints, teeth, skin, and eyes
138
what are the 3 signs for osteogenesis imperfecta?
blue sclera, deafness, and bone fractures
139
What is melanosis oculi?
congenital bilateral hyperpigmentation of conjunctiva, episclera, sclera, uvea, and choroid seen in darker colored patients (LIKE GANESH but that's messed up but hey you are going to remember it now lol)
140
what is the nevus of ota?
pigmentation of the periorbita skin | will distribute along ophthalmic and maxillary division of CN V
141
What is senile hyaline plaque?
older patients over 50 will get this it is localized non-inflammatory thinning reassure patient it is not cancerous
142
What is icterus/jaundice?
yellow pigmentation of the sclera or skin because of high concentrations of bilirubin in the blood NEEDS A MEDICAL EXAM
143
What is scleral perforations?
``` can be due to high velocity projectiles like BB gun, fireworks, metal hammerings varying pain sight may not be detectable will have decreased IOP NO MRI for patient ```
144
What is the Tx for scleral perforations?
``` immediate hospitalization Fox shield (eye shield) given to patient ```

Ocular Disease (1 decks)

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