the lids and the lacrimal system

Question 1

what are the muscles of the eye responsible for retraction ?

Answer 1

levator palpebral superiors
the superior tarsal muscles - Muller muscles

Question 2

what muscles are responsible for the closure of thee eye ?

Answer 2

orbicularis occuli

Question 3

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

Answer 3

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

Question 4

what is blepharitis ?

Answer 4

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

Question 5

what is the course and nature of blepharitis ?

Answer 5

chronic condition with frequent remission and exacerbations

Question 6

what are the anatomical divisons of blepharitis ?

Answer 6

anterior
posterior

Question 7

what are the causes of anterior bleepharitis ?

Answer 7

staphylococcal
seborrheic blepharitis

Question 8

what are the causes of posterior blepharitis ?

Answer 8

Meibomian gland dysfunction

Question 9

what are the components of tear film ?

Answer 9

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

Question 10

what is the clinical presentation of staphylococcal blepharitis ?

Answer 10

redness
oedema
scales
loss of lashes
eversion of lid margin

Question 11

what is the clinical presentation of seborrheic blepharitis ?

Answer 11

sticky, glued together lashes
oily scales
foamy tear film

Question 12

what is the presentation of posterior blepharitis ?

Answer 12

meibomian gland openings clogged with oil
tenelgectasia
multiple and recurrent chalazia

Question 13

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

Answer 13

rosacea

Question 14

what is the management for blepharitis ?

Answer 14

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

Question 15

what are the contraindications for doxycycline drops ?

Answer 15

history of allergy
pregnancy
breast feeding
children under 8 years old

Question 16

what are the differeent eyelid lesions and swellings ?

Answer 16

stye
hordeolum/Chalazion
molluscum contagiousum
xanthelasma

Question 17

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

Answer 17

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

Question 18

what is the management associated with styes and chalazion ?

Answer 18

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

Question 19

what is molluscum contangiousum ?

Answer 19

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

Question 20

what is the management associated with molluscum contagiousum ?

Answer 20

resolves spontaneously
if it causes conjunctivitis then it needs surgical excision

Question 21

what is xanthelasma ?

Answer 21

lipid deposits around the eye associated with hyperlipidemia

Question 22

what is the management of xanthelasma ?

Answer 22

surgical excision

Question 23

what are the different lid malpositions ?

Answer 23

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

Question 24

what are the types of lid entropion ?

Answer 24

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

Question 25

what are thee types of lid ectropion ?

Answer 25

iinvoloutional cicatricial mechanical paralytic congenital

Question 26

what is trichiasis ?

Answer 26

malposition of thee eye lashes where they point towards the eye

Question 27

what is thee treatment for trichiasis ?

Answer 27

electrolysis

Question 28

what is the mode of prevention for eye lid malposition ?

Answer 28

treat cicatricial conjunctival disease

Question 29

when can we diagnose ptosis ?

Answer 29

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

Question 30

what are the different types of ptosis in adults ?

Answer 30

involutional / aponeurotic ptosis myogenic neurogenic mechanical

Question 31

what is the cause of involutional ptosis ?

Answer 31

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

Question 32

what are the causes of pseudoptosis ?

Answer 32

contralateral proptosis contralateral lid retraction blepharospasm dermatochalasis brow ptosis

Question 33

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

Answer 33

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

Question 34

what is tthe most common cause of ptosis in adults ?

Answer 34

aponeurotic ptosis/involutional

Question 35

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

Answer 35

myogenic ptosis

Question 36

what are thee causes of abnormal tear distribution ?

Answer 36

eye lid malposition tear film abnormalities like sebehrroic blepharitis

Question 37

what are the lacrimal system obstructions in newborns vs adults ?

Answer 37

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

Question 38

what is dacrocystitis ?

Answer 38

infection of thee lacrimal sac

Question 39

what is the workup for epiphora ?

Answer 39

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

Question 40

what are the lacrimal system investigations ?

Answer 40

dye disappearance test lacrimal probing and irrigation

Question 41

what is the management in adult NLDO ?

Answer 41

dacryocystorhinostomy management is always surgical newborns can resolve with conservative management

Question 42

what must be excluded in congenital epiphora ?

Answer 42

congenital glaucoma

Question 43

what are the types of periorbital infections ?

Answer 43

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

Question 44

what is the source of infection in preseptal cellulitis ?

Answer 44

local face or eye infection or due to trauma

Question 45

what are thee causative organisms in preseptal cellulitis ?

Answer 45

staph aureus strep. pneumonia strep. pyogens

Question 46

what is the presentation of preseptal cellulitis ?

Answer 46

* Tenderness, swollen, inflamed eye lids ,+/- fever * Normal pupil, ocular motility and VA, no Proptosis

Question 47

what is the treatment for preseptal cellulitis ?

Answer 47

* Oral antibiotics eg Amoxicillin/Clavulanic acid * Warm compresses

Question 48

what is the source of infection in orbital cellulitis ?

Answer 48

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

Question 49

what are the causative organisms in cases of orbital cellulitis ?

Answer 49

same as preseptal except no pyogens , h.influenza instead

Question 50

what is the clinical picture of orbital cellulitis ?

Answer 50

* Fever, periocular pain, inflamed eyelids * Proptosis, limited ocular motility, RAPD, conjunctival chemosis

Question 51

what are the complications associated with orbital cellulitis ?

Answer 51

CRAO,CRVO, cavernous sinus thrombosis

Question 52

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

Answer 52

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

Question 53

what are the investigations for orbital cellulitis ?

Answer 53

* CBC:Leucocytosis and neutrophilia * CT/MRI (Orbit and sinuses)

Question 54

what is the management for orbital cellulitis ?

Answer 54

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

Question 55

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

Answer 55

CT is the gold standard