Lids notes Flashcards
1
Q
chalazion symptoms
A
- Subacute/chronic gradually enlarging painless nodule
- Acute: sterile inflammation or bacterial infection with localised cellulitis; differentiation may be difficult
- A secondary infected meibomian gland is referred to as an internal hordeolum
2
Q
chalazion signs
A
- Nodule within the tarsal plate, sometimes with associated inflammation
- Bulging inspissated secretions may be visible at the orfice of the involved gland
- There may associated conjunctival granuloma
- Lesion at the anterior lid margin – a marginal chalazion may be connected to a typical chalazion deeper in the lid or be due to isolated involvement of a gland on zeis
3
Q
chalazion treatment
A
- Oral antibiotics is significant bacterial infection
- At least 1/3 resolve spontaneously so observation may be appropriate
- Hot compress several times a day
- Expression
- Steroid injection – into or around lesion, preferred for marginal lesions or lesions close to structures such as the lacrimal punctum because of risk of surgical damage
- Surgery - following local anaesthesia infiltration, eyelid is everted, cyst is incised vertically through the tarsal plate and its contents curetted
- Prophylaxis – treating bleph
4
Q
SImple myogenic Ptosis
A
- Failure of neuronal migration or development with muscular sequelae secondary to this
- Unilateral or bilateral ptosis
- Problems with levator muscle causes no crease/small crease
- LPS does not work correctly, so doesn’t relax quick enough, causing lid lag – lag ophthalmos. In down gaze, ptotic lid is higher than normal because of poor relaxation of levator muscle
- Associated with SR dysfunction
- Levator resection is usually required
5
Q
BPES ptosis
A
- Autosomal dominant inheritance
- Blepharoptosis – reduction in vertical PAH
- Phimosis – reduction in horizontal PAH
- Epicanthus – fold of tissue at medial canthus
- Inversus – epicanthus is greater in the lower lid than the upper lid – only happens with BPES
6
Q
Neurogenic ptosis
A
- 3rd nerve palsies
o CN3 upper division supplies LPS and SR
o Lower division supplies MR, IR, IO
o Ptosis
o Eye down and out
o Pupil involved and lack of accommodation - Horner’s syndrome
o Mild ptosis (1-2mm)
o Miosis
o Anhydrosis
o Enophthalmos
7
Q
Myogenic ptosis
A
- At the level of the muscle
o Myotonic dystrophy
o CPEO - At nerve muscle junctions
o MG
Fluctuating ptosis
Reduced levator function
Cogan’s twitch
Anomalous flutter like eye movements
8
Q
Involutional ptosis
A
- Age related, usually bilateral
- Thinning/disinsertion of the levator aponeurosis
- Disinsertion from the tarsal plate caises the retraction of the levator aponeurosis
- More commonly seen in CL wearers
- Ps will have
o Thinned upper lid, deep sulcus
o Higher upper lid crease (8-10mm)
o Normal levator function
o Absent lid lag on downward gaze
o Eyelid drops on downgaze
o Fatigue of mullers muscle – worse at end of day
9
Q
Ptosis management
A
- Always 5 measurements
o PAH
o Marginal reflex distance
o Upper lid crease and fold
o Lid show - Levator muscle excursion
o 15mm – normal
o > 8 mm – good
o 5-7 mm – fair
o < 4 – poor - Surgical management depends on levator function
o Good – mullers muscle, conj resection
o Good – moderate – levator advancement
o Moderate – poor (child) – levator resection
o Poor – absent – frontalis brow suspension
10
Q
Lash disorders
A
DISORDERS OF THE LASHES
* TRICHIASIS
* DISTICHIASIS
* EYELASH PTOSIS
* TRICHOMEGALY
* MADAROSIS
* POLIOSIS
11
Q
Acute allergic oedema
A
- Usually caused by exposure to pollen or by insect bites, and manifests with the sudden onset of bilateral boggy periocular oedema
- Often accompanied by chemosis
- Treatment - Oral antihistamines are sometimes given
12
Q
contact dermatitis signs
A
- Lid scaling
- Angular fissuring
- Oedema
- Tightness
- There may be chemosis, redness and papillary conjunctivitis
- Corneal involvement is usually limited to punctate epithelial erosion
13
Q
contact dermatitis treatment
A
- Avoidance of allergen
- Cold compress
- Topical steroids and oral antihistamines can be used but are rarely required
14
Q
External hordeolum
A
- An external hordeolum (stye) is an acute staphylococcal abscess of a lash follicle and is associated with the glands of Zeis.
- Presents as a tender swelling in the lid margin pointing anteriorly through the skin, usually with a lash at its apex
- Multiple lesions may be present and occasional an abscess may involve the entire lid margin
15
Q
external hordeolum management
A
- Topical (occasionally oral) antibiotics, hot compresses and epilation of the associated lash
16
Q
Necrotising fascitis
A
- Rare but commonly very severe infection involving subcutaneous soft tissue as the skin, with rapidly progressive necrosis
- Unless early aggressive treatment is instituted, in the form of surgical debridement and high-dose intravenous antibiotics, death may result
- Periocular infection is rare: redness and oedema are followed by the formation of large bullae and black discoloration of the skin due to necrosis
17
Q
Herpes simples
A
- Skin rash results from either primary infection or reactivation of herpes simplex virus
- Eyelid and periocular skin vesicles
- Commonly associated with papillary conjunctivitis, discharge and lid swelling, and dendritic corneal ulcers can develop.
18
Q
Herpes simplex management
A
- In many patients, things will gradually settle down without treatment within 1 week
- Topical antiviral treatment may be used – acyclovir
- Antibiotics may be required in px’s with secondary bacterial infections
19
Q
FES
A
- FES is uncommon unilateral or bilateral condition that is often overlooked as a cause of persistent ocular surface symptoms
- Typically affects obese older men who sleep with one or both eyes against the follow, leading to the lid pulling away from the globe
- Upper lid is extremely lax, often with substantial excessive loose upper skin
- Tarsal plate has a rubbery consistency
- The lid is very easy to evert, to fold and to full away from the eye
- Papillary of superior and tarsal conjunctiva may be intense
- Can be keratopathy, eyelash ptosis, ectropion and other findings
20
Q
Fes treatment
A
- Overweight patients encouraged to lose eight
- Mild cases – lubrication, eye shield wear or taping of lights at night
- Moderate/severe – horizontal shorting to stabilize the lid
21
Q
Coloboma
A
- Uncommon, unilateral or bilateral partial or full-thickness eyelid defect
- It occurs when eyelid development is incomplete, due to either failure of migration of lid ectoderm to fuse the lid folds or to mechanical forces such as amniotic bands
- Treatment of small defects involves primary closure, while large defects require skin grafts and rotation flaps
22
Q
Chronic blepth
A
- Very common cause of ocular discomfort and irritation
- Can be subdivided into anterior and posterior, or mixed:
23
Q
chronic blepth symptoms
A
- Symptoms are caused by disruption of normal ocular surface function and reduction in tear stability
- Discomfort, irritation
- Burning, gritty, itchy eyes
- Photophobia
- Crusting of eyelids
- Chronic and bilateral
24
Q
chronic blepth treatment
A
- non-pharmacological
- lid hygiene – once/twice a day initially, compliance an technique is highly varaible
o hot compresses – several minutes
o face cloth, hot spoon, steam,
o expression of glands – if posterior
o lid hygiene
diluted baby shampoo, sodium bicarbonate solution or dedicated lid cleaning solution
use a swab or cotton bud
twice daily and then once daily
o avoid cosmetics
o medicated shampoo if necessary - pharmacological
o artificial tears
o lubricants
o antibiotics (topical/oral systemic)
o manage complications (e.g. dry eye, chalazion)
o tea tree oil wipes
o clear advice
