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Ocular Disease > Lid Anatomy Pg 1 - 10 Ravi > Flashcards

Lid Anatomy Pg 1 - 10 Ravi Flashcards

1
Q

What is the outermost layer of the lids?

A

Dermal Layer

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2
Q

What is the innermost layer of the lids?

A

conjunctiva

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3
Q

the orbicularis muscle is under CN___ control

A

VII

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4
Q

the Levator is under CN___ control

A

III

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5
Q

Mueller’s is innervated by (Parasymp/sympathetics)?

A

sympathetics

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6
Q

we have apx 150-200 lashes on our __ lid, and 75-100 on our ___lid.

A

upper/ lower

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7
Q

Which glands are lipid/sebaceous in characteristics?

A

Zeiss/ meibomian

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8
Q

Which glands are sweat/sudor in characteristics?

A

Moll

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9
Q

What is cicatrization?

A

scarring

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10
Q

The lid has a ___ like closure for lubrication / protection

A

zipper

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11
Q

how many zeiss glands are there on each tarsal plate?

A

30

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12
Q

which layer of the lid has thin skin with loose sub-cutaneous (Q) tissue and prominent vascularization

A

Dermal layer

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13
Q

what is the involuntary bilateral spasm of orbicularis?

A

blepharospasm

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14
Q

which sex is blepharospasm more common in? what ratio, over what age?

A

females 3:1 in their 60’s (cumshot fear)

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15
Q

what tx can you get to reduce the muscle response seen in blepharospasm?

A

botox

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16
Q

Blepharoclonus is a condition where the patient ____ excessively leading to muscle spasm, it is believedd to be secondary to _____.

A

blinks/ ocular inflammation

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17
Q

____ is an eyelid twitch that is (unilateral/bilateral), and self limited

A

myokymia, unilateral

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18
Q

myokymia’s twitch can occur due to what 4 things? SEFM

A

Stress, Excess Alcohol, Fatigue, Medication

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19
Q

To treat myokymia you want to prolong the refractory period so muscles won’t quiver, using ____ compresses and topical ____, or even ___ which is found in tonic water

A

cold, antihistamine, quinine

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20
Q

What is the abberant regeneration of CNIII?

A

Pseudograefe

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21
Q

In a pseudograefe, following traumatic CNIII palsy, the MR fibers regrow and travel with the ___ fibers so when they elevate their eye, their eye also looks ___.

A

MR, IN

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22
Q

Marcus Gunn is congeintal in __% of patients.

A

5%

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23
Q

marcus gunn improves with ____ and is treated with ___

A

mouth opening/ surgery

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24
Q

angioedema with urticaria is secondary to ____ release (allergic response)

A

histamine

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25
Q

urticaria means the patient has ____

A

hives

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26
Q

what are some treatments for angioedema with urticaria?

A

oral antihistamines, cool compresses, possibly oral steroids

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27
Q

what are the 3 forms of anthrax?

A

cutaneous, respiratory, GI

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28
Q

anthrax is also known as ___ disease

A

wool sorters

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29
Q

who is at risk for anthrax?

A

people who handle wool/ veterinarians/ farmers / 3rd world countries

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30
Q

Which type of anthrax is seen on the eye?

A

cutaneous

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31
Q

when does cutaneous anthrax onset?

A

1-2 days, up to 8 weeks, most commonly within 1st 2 weeks of exposure

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32
Q

cutaneous anthrax may present as ____ with some differences

A

mild preseptal cellulitis

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33
Q

is the demarcation line seen with anthrax or preseptal cellulitis?

A

preseptal

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34
Q

is pain and tenderness and pus(suppuration) seen with anthrax or preseptal?

A

preseptal cellulitis

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35
Q

is itching seen seen in anthrax or preseptal cellulitis?

A

anthrax

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36
Q

anthrax can infect the body via infected wool through a ___ in the skin or in africa it can include an ____ vector

A

break, insect

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37
Q

anthrax starts with a painless _____ that looks like a spider bite

A

red macular rash

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38
Q

as anthrax progresses, it can develop vesicles and bullae which eventually ____ and ____

A

rupture/ ulcerate

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39
Q

eventually, the ruptured vesicles/ bullae from anthrax form a black necrotic ulceration called an _____

A

ESCHAR

40
Q

an Eschar is a brown to black ulcer that is __-__cm in size, surrounded by severe edema looking pearly white and this typically sloughs in __-__ weeks.

A

1-5/ 2-4

41
Q

Damage from the necrotic tissues in anthrax leads to _____

A

scarring, possibly gangrene

42
Q

The classic black eschar and a history of exposure to ___ or ____ is characteristic of diagnosing anthrax.

A

animals/ soil

43
Q

a ___ was given to all active duty military to prevent infection from anthrax.

A

vaccine

44
Q

how many sub-Q injections are given in prevention of anthrax?

A

3, 2 weeks apart

45
Q

boosters in prevention of anthrax are given at which month marks?

A

6,12,18 then annually

46
Q

what works as a good protective barrier against anthrax?

A

gloves, long sleeves etc.

47
Q

what is the drug of choice in treating anthrax?

A

ciprofloxacin (flouroquinolone)

48
Q

what other drugs can be given to an anthrax patient to treat them?

A

doxycyclin, amoxicillin, penicillin G( if life threatening)

49
Q

what % of lesions will sponatenously heal with treatment?

A

80-90%

50
Q

10-20% of antrhax cases when left untreated can be ____

A

fatal

51
Q

Anthrax can be fatal because if bacteria gets into your systemic circulation, it leads to septicemia, ____, _____, and death

A

shock, Renal failure

52
Q

syphilis is on the rise because of its resistance to ____

A

penicillin

53
Q

what is the primary lid lesion in syphilis called?

A

Chancre

54
Q

some of the signs of syphilis include ____ chancre, ____ or loss of lashes, scleritis, and interstitial ____

A

conjunctival/ madarosis/ keratitis

55
Q

what is the treatment for syphalis?

A

penicillin

56
Q

what is a rare parasitic infection characterized as a severe allergic response leading to severe edema due to surge of lymphatic fluid in sub-Q tissue and facial tissue.

A

Elephantiasis

57
Q

Vaccinia is also known as ___pox, it is secondary to ____ vaccine.

A

cow, small pox

58
Q

vaccinia is contracted via ___ contact, and it is usually self limited meaning it will heal up and leave a scar.

A

direct

59
Q

cowpox mutant can lead to widespread ____, causing skin to slough off

A

dermatitis

60
Q

Leukoderma/ poliosis are signs characteristic of ____

A

vitiligo

61
Q

which syndrome is associated with vitiligo?

A

vogt koyanagi

62
Q

vitiligo is whitening with ____ esposure

A

sun

63
Q

poliosis refers to white ___

A

lashes

64
Q

Vitiligo can result in recurrent ____ or post inflammatory ____

A

uveitis, RD

65
Q

which disease is known as being allergic to the sun?

A

xeroderma pigmentosa

66
Q

Xeroderma P. is characterized by big patches known as ____ as well as scarring

A

macules

67
Q

there is an increased risk of ____ due to sunlight reaction with xeroderma P, and patients are usually monitored from a ___ age.

A

cancers, young

68
Q

what is an infectious condition with swelling, and well-defined expanding red line?

A

erysipelas

69
Q

erysipelas looks like ____ but hte patient is actually systemically ___, with fever, pus around eye, very fast progression. (You can see it get worse during their visit with you

A

angioedema, ill

70
Q

Erysipelas B-Hemolytic strep pyogenes is secondary to _____

A

skin trauma

71
Q

B-hemolytic strep pyogenes is sometimes referred to as ___ because it eats through the tissue and expands rapidly

A

flesh eating

72
Q

What is the tx for erysipelas?

A

systemic antibiotics/ hospitalization

73
Q

With erysipelas doctors mark the edges of the red lesions on a patients face and see how much the disease is slowed or reversed, and decide how much ___ to give.

A

antibiotics

74
Q

Erythema multiforme/stevens - johnson syndrome

A

DTH Type IV (allergic rxn) due to med, iatrogenic, 1st time is fine, but then pt allergic. red patches on hands, spreads rapidly. can cause skin to slough and kill pt. Flu symptoms 1st. bulls eye rash. starts at hands or feet and spreads. STOP the med. Targets mucous membranes. pseudomembrane formation, will bleed if pulled off. crusted lids.

Complications = fibrosis, severe scarring. dry eye(sicca) corneal perforation, iritis, symblepharon - lids fuse to conj. distichiasis - dry lid sticks to conj tx scleral lens. Epiphora.

Tx: electrolytes, topical steroids, bandage CL/ Scleral lenses, Tarsorraphy - suture lid shut, surgery

75
Q

Ocular Cictrical pemphigoid

A

Late onset. autoimmune mucous membrane disorder. like STVNJohnsons but in older women. 1-30,000 mostly F in 60’s. Bullae(rupture) fibrosis. conj shrinks, symblepharon, scarring. Lesions start in mouth. .25-.33 suffer vision loss.

complications - bacterial keratitis. ankyloblepharon no canthus lids fused. metaplastic lashes - growing in odd spots. scarring. obliteration of fornices/ severe symblepharon.

TX: bandage, CL, tears, epilation - remove lashes with lazers. punctal occlude, tarsorraphy (Lid suture). steroids, IV cyclophosphamide, restasis.

76
Q

impetigo

A

don’t scratch insect bites. bed bugs. or trauma. macular rash on lids and face, crusted over blister like lesions.spreads to face, lots of swelling, needs oral antibiotics. If it is localized on the face, then you only need topical antibiotics. staph or strep species. Rash like, yellow crusting. caused by picking scabs.

77
Q

HZV - Shingles Varicella zoster

A

causes chicken pox/ shingles. herpes zoster opthalmicus occurs in the elderly. if it happens under age 50, pt is prolly immunocompromised (MS) or pt has HIV(young). Harbored in nerve roots, spreads along dermatome that root innervates.spreads along frontal nerve to forehead, upper lid, superior conj. If opthalmic of CNV then it is HZ opthalmicus. if Nasociliary nerve involved the rash will move down to tip of nerve = hutchinson’s sign. . Respects midline. very painful. One side of head and nose is involved. both sides are swollen. can cause keratitis and pannus = imune mediated blood vessels encroaching on cornea. Living neurologic virus, lives in nerves, causes deep nerve pain. extremely painful. patient can get trigmeinal neuralgia - results in high suicide rate. ptosis, madarosis, retraction.

TX: acyclovir Valtrex for 7-10 days. analgesics, prednisone, antidepressants, TCA/ gabopinton, drying lotions like calamine, steroid creame, and antihistamines.

78
Q

Herpes simplex virus (HSV)

A

feber blister, encephalopathy. 20% of ocular HSV lid cases. vesicular looking rash will clear up eventually. there is a hereditary component. disease of children kissed by adult with virus. Vesicles, rupture, crust over, and then heal. 10-14 day duration of virus. Concerned with swellingand conjunctiva. tiny little cold sores. vesicles right on lid. Lid edema, follicular response = clear blister like lesion on the conj.

TX: aggressive tx to stop spreading. prophylaxis, ACV creme. GCV gel, antibiotics prevent 2 degree bacterial infection. calamine lotion.

79
Q

tools like lipiflow and mastrota paddle can be used to ____ the lids.

A

express

80
Q

Lid margin disease occurs in apx __% of the population

A

40

81
Q

What are the types of Blepharitis?

A

staphyloccal, seborrheic, mixed staph/seb, meibomian keratoconjunctivitis (MKC), and MGD.

82
Q

with bleph, a corneal stain can lead to _____

A

SPK

83
Q

with bleph, curvilinear corneal lesions occur at __,___,___, and __ oclock

A

10, 2, 4, 8

84
Q

with bleph you can have lid margin stains where the entire lid margin will stain _____

A

lissamine green.

85
Q

you will definately see ___glands with bleph. there can also be ____, where the tears produce FFA’s and sterols similar to soap, bubbly tears.

A

capped, frothing

86
Q

with bleph you will see poliosis, madarosis, and ____ which is a thick eyelid, the eyelid margins get thick and scalloped for chronic inflammation.

A

Pachyblepharon

87
Q

Blepharitis symptoms

A

itching, burning, dryness, foreign body sensation, mattered lids, redness, watery eyes, puffiness, scratchiness, lash loss, bumps on lid hordeolum.

88
Q

Assessment of bleph. you will see a lot of ___ and find that the ___ is low due to stasis

A

debris, TBUT.

89
Q

stasis reduces ___ in the tear film and increases evaporation

A

oils

90
Q

Bulbar conjunctival stain

A

appears long before corneal stain in patients with ocular surface disease. Best seen with yellow(wratten)filter. NaFl is more cost effective. filter removes blue and you see green. Lissamine green stains dead devitalized cells. Lissamine green staining will emerge over the regions of NaFl

91
Q

Rose Bengal staining

A

burns like hell, very few use it. indicates dry eye. stains dead cells. not used at IEI.

92
Q

Cornea Stain

A

we don’t examine entire cornea. we lookat where the bad lid is in apposition with the cornea, mostly the inferior cornea because this is where eyes closeand cornea and lid are in closest apposition.

We use flouresce for SPK. associated with bleph via staph exotoxin. worse in morning, staph stays concentrated in one place.

Rose Bengal - emerges over regions of NaFl. can find conjunctival rose staining from associated K. Sicca.(dry eye)

93
Q

digital expression in normal patients will show

A

clear oily liquid, vs an MGD or MKC pt, they have thicker opaque gelatinous pus like matter come out. if you can’t express the contents when you mash lids, you have stenosis at the orifice. turbid, inspissated

94
Q

Forceful expressions will show toothpaste-like string like expressions with No____

A

discharge, due to stenosis

95
Q

palepbral conjunctival signs -

A

we want the classic healthy corkscrew look. injection, concretions = calcified material. yellow, corkscrew appearance of glands. deep plugging looks like they blend all together. papillae, follicles, telangiectasia = tortuous vessels (Deep Plugging)

96
Q

MGD or meibomian seborrhea

A

over production of sebaceous materials. rapid turnover of epi cells. overproduction of sebum = lid margin stains well. clogged glands have frothing. precursor for MKC? 43% of population gets it. Responsible for up to 30% of unexplained CL intolerance. associated with roscea and generalized seborrhea.

TX: lid hygene = warm compresses. restasis, Azasite.

Grading MGD
0- all glands present
1 - 1-2 partially obstructed glands, still clear fluid
2 - 3 or more partially obstructed glands. expresses opaque fluid
4 - 3 or more blocked, remainder partially obstructed. expels toothpaste with pressure

Ocular Disease (1 decks)

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