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134 Cards in this Set
- Front
- Back
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What are the two main functions of the orbicularis?
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1) Raise upper lid
2) Works w/ orbicularis in both involuntary and forced blinking |
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What are the two main functions of Muller's muscle?
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1) Maint tonus of elevated upper lid
2) Maint tonus of opened lower lid |
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Orbicularis is innervated by CN __
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CN VII
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Palpebral portion of orbicularis is involved with (voluntary/involuntary) blinking.
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Involuntary
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Glands of Moll produces ____.
Glands of Zeis produces ____. |
Moll = sweat
Zeis = oils (sebaceous) |
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Posterior lid lymph drains ____.
Anterior lid lymph drains ____. |
Posterior = conj & tarsal glands
Anterior = skin & assoc skin structures |
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Lateral half of lid drains into ____ lymph node.
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Pre-auricular
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What disease has a congenital ptosis that is neurogenic?
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Neonatal myasthenia gravis
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What is the most prevalent type of congenital ptosis?
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Autosomal dominant
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Your patient presents with a ptosis that retracts when she opens her mouth. What is this called? Is it congenital or acquired?
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Marcus Gunn jaw winking - a Paradoxical CN III innervation ptosis
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When your patient looks downward, you notice that the lid retracts. What is this called?
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Psuedo Von Grafe sign
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Your patient has a ptosis with heterochromia iridies. What kind of ptosis do you suspect?
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Congenital Horner's syndrome
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T/F - trauma at birth can cause a ptosis.
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True
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Adhesion between upper and lower lid = Ankyloblepharon or Symblepharon?
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Ankyloblepharon
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T/F - Stevens-Johnson syndrome can result in Symblepharon.
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True
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T/F - Vitiligo is patchy depigmentation of the lashes.
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Patchy depigmentation of the SKIN. Alopecia = depigmentation of hair, tends to accompany Vitiligo.
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Cicatricial entropion is usually caused by _____.
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inflammation of the tarsal conjunctiva e.g. trachoma
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T/F - Spastic entropion = excessive contraction of the orbital portion of the orbicularis
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Excess contraction of the PALPEBRAL portion. Can also be caused by atrophy of lid retractors (rare).
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Name the types of entropion.
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Congenital, cicatricial, spastic, atonic (involutional, senile).
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Name the types of ectropion.
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Cicatricial, paralytic, involutional (atonic, senile).
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T/F - Opening the mouth widely will worsen an involutional ectropion.
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False. Opening wide will worsen a CICATRICIAL ectropion.
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T/F - Lagophthalmos can result in both sterile and infectious ulcers.
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True
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Name the types/causes of lagophthalmos.
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Paralysis of orbicularis (CN VII palsy), orbital, neurogenic, mechanical.
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What is the most common cause of neurogenic lagophthalmos?
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Grave's disease (HYPERthyroidism)
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What is tarsorraphy?
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Sew lids shut - used in lagophthalmos (severe?)
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Eyelid tic/twitch = Blepharospasm or Myokymia?
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Myokymia.
Blepharospasm = involuntary contraction of orbicularis. |
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T/F - Myokymia is associated w/ TMJ syndrome.
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False - Blepharospasm is assoc. w/ TMJ syndrome.
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Can you treat Blepharospasm with Botox?
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Yes
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What is blepharoclonus?
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Exaggerated reflex blinking (increased blink rate or increased lid closure time)
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Which tends to be more bilateral, Blepharospasm or Myokymia?
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Blepharospasm
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Name the treatments of myokymia.
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1. Topical antihistamines (Antazoline, Pheneramine)
2. Oral emetics (Promethazine, Tripelennamine) 3. Quinine |
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What is the most common cause of trichiasis:
1. Trachoma 2. Stevens-Johnsons syndrome 3. Blepharitis |
3. Blepharitis
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How fast to lashes grow back in children? Adults?
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Children = 2-4 wks
Adults = 4-8 wks |
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T/F - Vitiligo = whitening of the lashes due to staph blepharitis.
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False - POLIOSIS = whitening of lashes due to staph blepharitis.
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What is Madarosis? What is a common cause?
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Lash loss, commonly due to blepharitis. Also consider trichotellomania (neurotic pulling of lashes).
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Your patient, a 75 year old male, has a bilateral, droopy skin flap, more pronounced on the temporal side. He has no history of edema, and no other remarkable findings. What's going on?
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Dermatochalasis.
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A 30 year-old female comes in complaining of a swollen lid that drapes over the lid margin. You notice that the skin around the orbit is loose and stretchy. There is history of recurrent edema and allergy. What lid disease is going on?
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Blepharochalaisis
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T/F - You can use steroids w/ blepharochalaisis.
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False - steroids usually not helpful
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Name the types of papilloma.
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Non viral
Viral (Verruca plana, verruca vulgaris, verruca digitala) |
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Viral papillomas grow (slow/fast), non-viral grow (slow/fast).
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Fast, slow
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T/F - Papillomas do not tend to have a vascular core.
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False - Papillomas do tend to have a vascular core.
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How do you treat a papilloma?
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Usually no Tx indicated, but document and observe. Excise if needed.
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You see a skin lesion that looks like it's "tacked on" to the surface of the skin. It is sharply defined, slightly elevated, and brown. What skin lesion do you suspect? Is this malignant?
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Seborrheic keratitis. Not malignant, nor pre-malignant.
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You see a lesion that is dome-shaped with a pit in the middle. It grew very quickly over the past few weeks. What is this skin lesion? Is it malignant? How do you treat it?
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Keratoacanthoma, non-malignant but must DDx vs BCC & SCC. Tx by reassurance, close follow-up. Excision if desired.
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What is a dermoid?
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A choriostoma arising during development. A cyst-like bump, usually superior temporal at the orbit. Assoc w/ Goldenhar's syndrome.
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Name the types of sebaceous gland cysts.
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Comedo (blackhead)
Milia (whitehead) |
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How do you treat sebaceous gland cysts?
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Normally just reassure, but can be removed for cosmetic reasons by needle puncture and gland expression.
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You notice a cystic type lesion at the lid margin, and when you shine your slit lamp you notice that it's translucent. The patient states that it's painless. What is this? How do you treat it?
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Sudoriferous cyst. Reassure, but lance if needed.
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Name the types of nevi.
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Junctional, Compound, Dermal.
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What is Xanthelasma? What systemic condition is it associated with?
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Slowly progressive skin growth, elevated yellowish discoloration of skin; plaque-like with slightly granulated surface. Seen bilaterally on medial aspect of upper lid. Assoc w/ blood lipid abnormalities (elevated cholesterol).
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What is the most common malignant neoplasm of the lids?
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Basal cell carcinoma
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T/F - Basal cell carcinomas grow rapidly.
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False - grows slowly, takes months to double in size
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Basal cell carcinomas are most often found where?
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On the lower lid
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Your patient complains of a lesion that has a dark, ulcerated center and said "it looks like it's bleeding." It originally looked like a small, translucent, waxy greyish-white nodule a couple of months ago. What do you suspect?
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Basal cell carcinoma
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T/F - Basal cell carcinomas tend to metastasize.
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False - does not usually metastasize (think slow growth).
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T/F - Squamous cell carcinomas grow rapidly.
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True
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T/F - Squamous cell carcinomas can metastasize.
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True
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What can a squamous cell carcinoma develop from?
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Actinic keratosis, cutaneous horns, or de novo.
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What is the most malignant skin tumor?
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Malignant melanoma
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T/F - Malignant melanomas can metastasize in the early stages.
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True
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Name the three types of malignant melanomas.
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1. Hutchinson's Freckle/lentigo malignant melanoma
2. Superficial spreading melanoma 3. Nodular malignant |
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Which type of malignant melanoma has the poorest prognosis?
1. Hutchinson's freckle 2. Superficial spreading 3. Nodular malignant |
3. Nodular malignant
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What is the most common melanoma?
1. Hutchinson's freckle 2. Superficial spreading 3. Nodular malignant |
2. Superficial spreading
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Which looks like a "blood blister?"
1. Hutchinson's freckle 2. Superficial spreading 3. Nodular malignant |
3. Nodular malignant
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An enlarging chalazion can signal what kind of skin lesion?
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Adenocarcinoma of the Meibomian Gland
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T/F - Adenocarcinomas of the Meibomian Gland can metastasize.
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True - likely to metastasize.
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Which glands are associated with external hordeola? Internal?
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External = Moll, Zeiss, or associated follicle
Internal = Meibomian gland |
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How long does it take for an external hordeolum to drain?
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<1 week
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Which is at higher risk for preseptal cellulitis - internal or external hordeolum?
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Internal
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What is the primary Tx for hordeola?
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Warm compress
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Use ointment for internal or external hordeola?
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More for external
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T/F - Recommend use of oral antibiotic for external hordeolum.
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False - more so for internal
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Hordeola:
Externals resolve in ___. Internals resolve in ___. |
External = <1 week
Internal = 7-10 days or sooner |
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How long should you use oral antibiotics for an internal hordeolum?
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7-10 days
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How often should you dose antibiotic ointment for staph blepharitis?
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At least BID (one of them at least QHS), when controlled use alternating ointment types for first five nights of each month.
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Your patient presents with an internal hordeolum, but you also see diffuse tenderness and redness in the orbital area. You also see palpable and tender nodes. What's going on???
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Internal hordeolum, progressed into preseptal cellulitis.
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T/F - Chalazia are sterile.
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True
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Chalazia are (soft/hard) at first, then (soft/hard) later.
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Soft, hard.
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How do you Tx chalazia?
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Warm compress, digital massage, saline soak; antibiotics are variable since chalazia are sterile, but Tetracyclines may facilitate lipid breakdown. Can also use steroid injection.
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Blunt or penetrating trauma to lids most likely causes this bacteria type of preseptal cellulitis.
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Strep
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Eyelid infections tend to cause this bacteria type of preseptal cellulitis.
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Staph
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What is the most common cause of preseptal cellulitis?
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Sinusitis
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A 10 year-old female comes in with painful, swollen, red orbital tissue and tender, palpable nodes. EOMs are normal, eye movements are not painful. What is going on and what is the likely microbe?
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Preseptal cellulitis caused by H. flu.
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T/F - H. flu is more common in adults than in children with preseptal cellulitis.
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False - H. flu more more likely in children.
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T/F - Optic nerve edema and ischemia is associated w/ orbital cellulitis.
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True
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T/F - Orbital cellulitis is more often unilateral.
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True
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What Tx should you use for preseptal cellulitis caused by staph?
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Penicillins, Erythromycin, Cephalosporins, Bactrim
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What Tx should you use for preseptal cellulitis caused by strep?
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Penicillins, Cephalosporins (1st gen)
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What Tx should you use for preseptal cellulitis caused by H.flu?
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Penicillins, Cephalosporins (2nd gen)
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What Tx should you use for severe preseptal cellulitis?
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Vancomycin IV
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When should you follow up for preseptal cellulitis?
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1-2 days
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What are the causative agents of impetigo?
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Staph (more likely) or group A strep
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T/F - Impetigo more frequent in adults.
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False - more freq in newborns and children
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T/F - Impetigo typically occurs in cold weather.
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False - warm weather
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How does the lesion in impetigo develop?
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Macule - vesicle/pustule - rupture then ooze
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T/F - Impetigo lesions scar.
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False - they do NOT scar
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How do you Tx impetigo?
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Topical antibiotics ineffective without debridement; use Burow's soln, Hibiclens soln, then apply topical antibiotic. Also can use Muciprocin ointment and systemic Tx (oral antibiotics - more effective vs topicals).
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What is the most common causative agent of staph blepharitis?
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S. epidermidis - NOT S. aureus!!!
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T/F - Neovascularization can be seen in staph blepharitis.
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True
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What is the SPK pattern in staph blepharitis?
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Inferior 1/3 of cornea
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Staph blepharitis is worst at what time of the day?
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Upon awakening and end of day
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How do you Tx staph blepharitis (in general)?
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First line of Tx = lid hygeine. Remove scaling, then Tx w/ topical antibiotic and steroid - can use combo drops as well.
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Which of the following are NOT good for Tx staph blepharitis?
1. Bacitracin 2. Erythromycin 3. Sulfacetamide 4. Neomycin 5. Gentamycin 6. Tobramycin |
3. Sulfacetamide
4. Neomycin |
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What is seborrhea?
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A sebaceous gland dysfunction: Overproduction of secretion, retention of secretion, or unknown etiology.
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What ocular conditions can seborrhea cause?
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Seborrheic blepharitis, MGD, Ocular rosacea; seborrheic blepharitis can overlap with staph blepharitis and MGD.
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What is the typical patient of seborrheic blepharitis?
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Older patient with poor nutrition and poor hygeine
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What is the difference between staph scales vs scurf?
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Staph scales = impaled on lash
Scurf = stick to greasy lashes |
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T/F - In seborrheic blepharitis, changes in lid margins are primarily due to seborrheic processes.
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False - changes are due to staph and/or MGD
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T/F - Scurf is typically asymptomatic.
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True; however, moderate to heavy SCALING can be asymptomatic or symptomatic
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How do you Tx Seborrheic blepharitis?
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Lid hygeine essential, treat staph and MGD; no cure therefore typically failure to Tx (patient frustration, non-compliance)
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Cells sloughing off the epithelium lining tubule of meibomian glands, then causing an obstructive mass which results in a creamy/cheesy substance is characteristic of...
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Meibomitis
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Name the types of meibomitis.
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Meibomian seborrhea, Secondary meibomitis, Primary meibomitis
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T/F - Meibomian seborrhea has normal gland orifices and lid tissue.
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True - Secondary and Primary meibomitis have swollen and inflamed orifices
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T/F - Meibomitis can result in photophobia for no good reason.
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True - slick oily surface therefore increased light scatter
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What type of meibomitis results in frequent chalazia and/or hordeola?
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Primary meibomitis
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Which types of meibomitis results in hyperemia?
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All types
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What is the general Tx of meibomitis?
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Warm soak, digital massage of lids, lid hygeine, ORAL Tetracycline, artificial tears; no cure, management only, lifelong condition.
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What are the causative agents of Angular blepharitis?
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Moraxcella lacunata, Staph aureus, Staph epidermidis (more common)
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Your patient has an eczematoid reaction at lateral canthi with maceration; you also see red lid margins at the outer canthi as well. The patient complains of chronic lid irritation, itching, and dry skin. What is this?
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Angular blepharitis
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How do you Tx angular blepharitis?
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Staph = bacitracin or erythro ung
Moraxella = sulfacetamide, neomycin, erythro, polymyx B ung Unknown = bacitracin, polymyx B ung Can also use Zinc Sulfate soln |
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When is it best to inject steroid into a chalazion?
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<6 months (when the chalazion is "young")
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What is the first line of treatment for chalazions?
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Warm compress, digital massage after, and saline soak
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Your patient has a chalazion that won't go away after doing the first line treatment for two weeks. Is it appropriate to go with injected steroid or surgery at this point?
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No, continue therapy (warm compress, digital massage, saline soak) for another two weeks; if not working at that time, then consider steroid injection or surgery.
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What is the dosage for Augmentin in preseptal cellulitis?
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250-500 mg PO TID
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If your patient has severe blepharitis, would it be appropriate to use oral antibiotics?
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Yes - but it is NOT a first line Tx.
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T/F - Seborrheic Keratitis is pre-malignant.
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False - NOT pre-malignant
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This skin lesion appears like it's stuck or tacked onto the surface of the skin. It's slightly elevated and brownish in color. What is this?
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Seborrheic keratitis
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You see frothing of the tear film at the outer canthi is very characteristic of...
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Meibomian seborrhea
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Too much meibomian gland secretion results in ___.
Too little results in ___. |
unstable tear film, aqueous evaporation
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What is inspissation? What condition is this seen in?
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Pouting of the meibomian gland orifice due to retained plug of dried secretion - seen in secondary meibomitis.
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What is serration? What condition is this seen in?
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Area of obstruction in the meibomian gland, which may be enlarged with pinpoint swelling of the lid - seen in secondary meibomitis.
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What type of meibomitis is the most severe?
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Primary meibomitis
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Dr. Tong recommended a special treatment for meibomitis...what is it?
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Doxycycline, less dose than normal (less than 250 mg - i.e. 100 mg, etc) to avoid long term cumulative toxicity effects
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How exactly do you conduct tetracycline therapy for meibomitis (dose, course of therapy)?
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1 gram/day, 4 divided doses, x3 weeks or more; then slow tapering to maintenance dose of 250 mg QD or more; course of therapy = 4-6 weeks
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