Eyelid Malpositions

Front 1

Ptosis- define, causes

Back 1

1.droopy upper lid
2.Involutional-attenuation of the levator aponeurosis causing levator to have poor function, most common type
3.mechanical- caused by tumor/mass,or scarring
4. Myogenic-weak levator superioris of NMJ like mytonic dystrophy,external ophthalmoplegia
5.Neurogenic-poor innervation of CN3, mueller's muscle, MG
6.Congenital-often unilateral, fibrosis/fat infiltration of levator, poor connection btw CN5 & levator, congenital horner's

Front 2

Ptosis- S&S, DDx, Tx

Back 2

1.VF defect, brow ache, poor stereo, eye looks smaller on ptotic side, Hering's law: downgaze the ptotic lid is higher(congenital) and lower(acquired),high astigmatism or amyblopia
2.Dermatochalasis, lid swelling, enophthalmos, hypotropia, small eye, contralateral lid retraction
3.Tx- rule out Horner's, MG, Palsies, then consider surgery

Front 3

Dermatochalasis-define

Back 3

1.lax upper lid causing skin/subcutaneous tissue redundancy.
2.if severe may cause superior VF defect
3.fix with surgery

Front 4

Cicatricial Ectropion- define, S&S, Tx

Back 4

1.turning of eyelid out dur to burns, trauma, or chronic inflammation
2.tearing, eyelid irritation, keratinized conj, injection, redness, SPK, dermatitis
3.treat corneal problems, horizontal lid tightening, skin graft/cheek lift, lamellar spacer

Front 5

Congenital Ectropion- define, S&S, Tx

Back 5

1.turning out of eyelid due to short anterior lamella (skin)
2.tearing, eyelid irritation, keratinized conj, injection, redness, SPK, dermatitis
3.if severe may be treat with skin graft or horizontal lid tightening

Front 6

Inflammatory Ectropion-
define, S&S, Tx

Back 6

1.turning out of eyelid due to chronic inflammatory conditions
2.tearing, eyelid irritation, keratinized conj, injection, redness, SPK, dermatitis
3.treat corneal & dermatology conditions, eyelid taping

Front 7

Involutional Ectropion-
define, S&S, Tx

Back 7

1.turing out of eyelid due to horizontal lid laxity, lid elongation, sagging, hypertropy of conj
2.tearing, eyelid irritation, keratinized conj, injection, redness, SPK, dermatitis
3.treat corneal conditions, horizontal lid shortening, spindle procedure if punctal, lower lid retractor reinsertion

Front 8

Mechanical Ectropion-
define, S&S, Tx

Back 8

1.turning out of eyelid due to edema, tumors, fat herniation, or glasses
2.tearing, eyelid irritation, keratinized conj, injection, redness, SPK, dermatitis
3.treat corneal conditions, treat or remove mechanical force

Front 9

Paralytic Ectropion-
define, S&S, Tx

Back 9

1.turning out of eyelid due to CN7 palsy
2.tearing, eyelid irritation, keratinized conj, injection, redness, SPK, dermatitis
3.treat corneal conditions, often resolves spontaneously if related to Bell's, if chronic may consider tarsorrhaphy or horizontal lid tightening

Front 10

Cicatricial Entropion- define, S&S, Tx

Back 10

1.turning in of the lid due to tarsal/conj shortening.
2.Causes rubbing of lashes on globe, may be caused with Steven-Johnson Syndrome, ocular pemphigoid, HZV, surgery, trauma.
3.Redness, tearing, FBS, inturned lid margin, keratinized margins, SPK, enopthalmos, symblepharon
4.treat corneal conditions, surgery on tarsus, scar removal, and conj grafts if severe

Front 11

Congenital Entropion-
define, S&S, Tx

Back 11

1.turning in of lid due to structure defect of tarsal plate, lamellae, or retractor dysgenesis
2.Redness, tearing, FBS, inturned lid margin, keratinized margins, SPK, enopthalmos, symblepharon
3.surgical treatment

Front 12

Involutional Entropion-
define, S&S, Tx

Back 12

1. most common cause in older adults, turning in of lid due to laxity, atrophied lid retractors, enophthalmous
2.Redness, tearing, FBS, inturned lid margin, keratinized margins, SPK, enopthalmos, symblepharon
3.thermal cautery, lid taping, tightening tarsal plate, lid retractor with blepharoplasty

Front 13

Spastic Entropion-
define, S&S, Tx

Back 13

1.turning in of lid due to inflammation, common post-surgery
2.Redness, tearing, FBS, inturned lid margin, keratinized margins, SPK, enopthalmos, symblepharon
3.taping lid, thermal cautery, treat underlying condition.