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opthalmology > the lids and the lacrimal system > Flashcards

the lids and the lacrimal system Flashcards

1
Q

what are the muscles of the eye responsible for retraction ?

A

levator palpebral superiors
the superior tarsal muscles - Muller muscles

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2
Q

what muscles are responsible for the closure of thee eye ?

A

orbicularis occuli

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3
Q

what aree the different glands found in the tarsal of the eye ?

A

meibomian glands
glands of zeiss (sebaceous gland )
glands of Moll ( modified sweat glands )

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4
Q

what is blepharitis ?

A

inflammation of the lid and one of the most common conditions encountered

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5
Q

what is the course and nature of blepharitis ?

A

chronic condition with frequent remission and exacerbations

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6
Q

what are the anatomical divisons of blepharitis ?

A

anterior
posterior

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7
Q

what are the causes of anterior bleepharitis ?

A

staphylococcal
seborrheic blepharitis

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8
Q

what are the causes of posterior blepharitis ?

A

Meibomian gland dysfunction

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9
Q

what are the components of tear film ?

A

mucin component - goblet cells
aqueous component - lacrimal gland
lipid layer - meibomian gland

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10
Q

what is the clinical presentation of staphylococcal blepharitis ?

A

redness
oedema
scales
loss of lashes
eversion of lid margin

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11
Q

what is the clinical presentation of seborrheic blepharitis ?

A

sticky, glued together lashes
oily scales
foamy tear film

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12
Q

what is the presentation of posterior blepharitis ?

A

meibomian gland openings clogged with oil
tenelgectasia
multiple and recurrent chalazia

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13
Q

what is a common association and must be excluded with posterior blepharitis ?

A

rosacea

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14
Q

what is the management for blepharitis ?

A

eyelid hygienee
warm compresses and lid massage upwards
topical lubricants to manage dryness
topical ab +/- topical steroids
Oral antibiotiics ( doxycycline )

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15
Q

what are the contraindications for doxycycline drops ?

A

history of allergy
pregnancy
breast feeding
children under 8 years old

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16
Q

what are the differeent eyelid lesions and swellings ?

A

stye
hordeolum/Chalazion
molluscum contagiousum
xanthelasma

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17
Q

what are styes and hordeolums usually secondary toand what may they progress to ?

A

they are usually secondary to staphylococcal infections and may progress into preseptal cellulitis

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18
Q

what is the management associated with styes and chalazion ?

A

warm compresses
topical antibiotics ( tobramycin and dexamethasone combo )
oral ab only if preseptal cellulitis develops
chalazion may need excision

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19
Q

what is molluscum contangiousum ?

A

viral infectiion caused by pox virus
associated with follicular conjunctivitis
pale waxy nodule with an umbilical centre on the lid margin

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20
Q

what is the management associated with molluscum contagiousum ?

A

resolves spontaneously
if it causes conjunctivitis then it needs surgical excision

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21
Q

what is xanthelasma ?

A

lipid deposits around the eye associated with hyperlipidemia

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22
Q

what is the management of xanthelasma ?

A

surgical excision

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23
Q

what are the different lid malpositions ?

A

either entropion (lid inverted inwards ) or ectropion ( lid everted outwards)
or trichiasis

24
Q

what are the types of lid entropion ?

A

involutional ( laxity with age )
cicatricial ( scarring as with trachoma )
congenital

25
Q

what are thee types of lid ectropion ?

A

iinvoloutional
cicatricial
mechanical
paralytic
congenital

26
Q

what is trichiasis ?

A

malposition of thee eye lashes where they point towards the eye

27
Q

what is thee treatment for trichiasis ?

A

electrolysis

28
Q

what is the mode of prevention for eye lid malposition ?

A

treat cicatricial conjunctival disease

29
Q

when can we diagnose ptosis ?

A

when the upper eyelid covers more than 2mm of the superior limbus

30
Q

what are the different types of ptosis in adults ?

A

involutional / aponeurotic ptosis
myogenic
neurogenic
mechanical

31
Q

what is the cause of involutional ptosis ?

A

dehiscence of levator muscle aponeurosis
good levator function
with a high lid crease

32
Q

what are the causes of pseudoptosis ?

A

contralateral proptosis
contralateral lid retraction
blepharospasm
dermatochalasis
brow ptosis

33
Q

what are thee types of surgeries for different types of ptosis ?

A

good levator function - levator resection
poor levator function - frontalis suspension
for aponeurotic ptosis - aponeurosis advancement

34
Q

what is tthe most common cause of ptosis in adults ?

A

aponeurotic ptosis/involutional

35
Q

what is the most common type of ptosis in congenital ptosis ?

A

myogenic ptosis

36
Q

what are thee causes of abnormal tear distribution ?

A

eye lid malposition
tear film abnormalities like sebehrroic blepharitis

37
Q

what are the lacrimal system obstructions in newborns vs adults ?

A

newborns : membranous obstruction of hasner valve
adults : naso-lacrimal duct obstruction

38
Q

what is dacrocystitis ?

A

infection of thee lacrimal sac

39
Q

what is the workup for epiphora ?

A

sit lamp examination and anterior segment examination
in newborns congenital glaucoma must be excluded
lacrimal system investigations

40
Q

what are the lacrimal system investigations ?

A

dye disappearance test
lacrimal probing and irrigation

41
Q

what is the management in adult NLDO ?

A

dacryocystorhinostomy
management is always surgical
newborns can resolve with conservative management

42
Q

what must be excluded in congenital epiphora ?

A

congenital glaucoma

43
Q

what are the types of periorbital infections ?

A

preseptal cellulitis - ant to orbital septum
post septal cellulitis - post to orbital septum
orbital cellulitis

44
Q

what is the source of infection in preseptal cellulitis ?

A

local face or eye infection
or due to trauma

45
Q

what are thee causative organisms in preseptal cellulitis ?

A

staph aureus
strep. pneumonia
strep. pyogens

46
Q

what is the presentation of preseptal cellulitis ?

A
  • Tenderness, swollen, inflamed eye lids ,+/- fever
  • Normal pupil, ocular motility and VA, no Proptosis
47
Q

what is the treatment for preseptal cellulitis ?

A
  • Oral antibiotics eg Amoxicillin/Clavulanic acid
  • Warm compresses
48
Q

what is the source of infection in orbital cellulitis ?

A
  • Direct spread: Sinusitis( Most common) Spread from face or teeth infection(Less common)
  • Hematogenous spread: Immunocompromised patients and children
  • Complication of trauma or surgery
49
Q

what are the causative organisms in cases of orbital cellulitis ?

A

same as preseptal except
no pyogens , h.influenza instead

50
Q

what is the clinical picture of orbital cellulitis ?

A
  • Fever, periocular pain, inflamed eyelids
  • Proptosis, limited ocular motility, RAPD, conjunctival chemosis
51
Q

what are the complications associated with orbital cellulitis ?

A

CRAO,CRVO, cavernous sinus thrombosis

52
Q

why is there a risk off infection spreading intracranially in orbital cellulitis ?

A

Orbital venous system drains into cavernous sinus therefore there is a risk of infection spreading intracranially

53
Q

what are the investigations for orbital cellulitis ?

A
  • CBC:Leucocytosis and neutrophilia
  • CT/MRI (Orbit and sinuses)
54
Q

what is the management for orbital cellulitis ?

A

medical emergency
hospital admission
Iv antibiotics - 3rd generation Cephalosporin (Ceftriaxone ) +/-Glycopeptide ( Vancomycin), Metronidazol
regular assessment of visual function
if no improvement repeat CT

55
Q

what is the gold standard for differentiating between pre septal or orbital cellulitis ?

A

CT is the gold standard

opthalmology (14 decks)

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