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107 Cards in this Set
- Front
- Back
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What is the only muscle made of smooth muscle?
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Mueller's
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What CN innervates the levator?
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CN III
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What CN innervates the frontalis?
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CN VII
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What CN innvervates the orbicularis?
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CN VII
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What is the function of the palpebral portion of the orbicularis?
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It's used in blinking, voluntary winking, and keeps the lid tight to the globe.
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What is the function of the orbital portion of the orbicularis?
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It's used in forced lid closure.
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Define dermatome.
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It's the area of skin that is mainly supplied by one cranial nerve.
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Which CN causes the eyelid to close?
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CN VII
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Which CN causes the mouth and cheeks to smile and the forehead to furrow?
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CN VII
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What are possible causes of Bell's Palsy?
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Cold temperatures, idiopathic (unknown cause), trauma, stroke, or viral infection.
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How does Bell's Palsy cause DES?
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Orbicularis not working to blink and refresh tears
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What structure causes the eyelid to lift with the eyeball?
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Levator aponeurosis
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Where do the fibers of the levator aponeurosis pass to attach to the skin?
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Orbicularis
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Where does Muller's muscle originate?
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From the underside of the levator
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What two muscles open the lid?
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Levator and Muller's muscle
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What innervates Muller's muscle?
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Sympathetic system, epinerphrine, etc.
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Where is Muller's insertion?
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Superior tarsus
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Where is Muller's located in relation to the levator?
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Muller's is located below the levator.
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What type of tissue is the tarsal plate?
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Dense fibrous CT
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What's the function of the tarsal plate?
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Provides lid structure
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How many Meibomian glands are in the upper lid? Lower?
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14 in upper lid, 10 in lower lid
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What's the function of the Meibomian glands?
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It's SEBACEOUS. They secrete lipid sebum for the surface layer of the tear flim, which keeps it stable
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Where are Zeiss glands located? What are there purpose?
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Near the eyelash follicle so Zeiss can keep the lashes supple.
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What type of gland are Moll glands?
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They are modified apocrine sweat glands
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What's the thinnest skin of the body?
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Eyelid skin
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Centrally, what two structures does the orbital septum fuse with? (and specify upper/lower lid)
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Upper lid levator aponeurosis and lower lid tarsal plate
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What's the function of the orbital septum?
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It separates orbital from lid structures.
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Peripherally, where does the orbital septum attach?
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At the periosteum of the orbital margin
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What bacteria most commonly causes blepharitis?
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Staphylococcus: On lid margins S. aureus is the less common natural flora than S. epidermidis.
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What are possible causes of anterior blepharitis? Posterior? Angular?
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Anterior: Staphylococcus or Seborrheic
Posterior: Meibomian seborrheic or gland dysfunction Angular: Staphylococcal or Moraxella |
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How does staphylococcus cause blepharitis?
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Bacteria breaks the tear lipids into free fatty acids, trigging the inflammatory response.
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What are characteristics of an inflammatory response?
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Dilation of BVs (redness), increased vascular permeability, movement of PMNs from blood into tissues to fight infection
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The presence of pus indicates a bacterial infection. What is pus made of?
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Pus = dead PMNs + protein clot. It's a diagnostic sign.
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What are symptoms of staphylococcal blepharitis? Signs?
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Symptoms = chronic itching, FB sensation, tender lids, crusty lashes, red lids. Signs = Pus and crust along the lash lines. In severe cases, ulcers appear at the lash base.
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What is a collarette?
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Crust that encircles a lash
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What is madarosis? Cause?
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Lash loss due to follicles infected with Staphylococcus or due to tumor of the gland or skin
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What is trichiasis? Cause?
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"Tricky eyelash:" Misdirected eyelashes that scrape the cornea due to lash follicle damage.
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What is the name of the process of lash removal and what types of lashes would be removed?
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Epilation, especially of trichiasis
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What can happen to lid margins over time with Staphylococcal blepharitis?
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Lid margins may become indurated (hardened). Tylosis = thickened lid margin.
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How should mild Staphylococcus blepharitis be treated?
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Remove crusts, do lid scrubs, and use warm compresses to increase blood circulation
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How should severe Staphylococcus blepharitis be treated ST vs. LT?
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ST use steroids like Tobradex to decrease redness. LT use oral antibiotics effective on gram positive bacteria like Bacitracin, Erthromycin, Tobramycin, and Gentamicin.
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What is PEE? What do you stain it with?
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Punctate epithelial erosions (dry areas) due to reactions to bacterial exotoxins. Fluorescein stain pools in the epithelial divots where superficial and wing cells are lost.
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How should an at-home lid scrub cleaner be prepared?
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Diluate baby shampoo ten to one, then apply in gental oval scrubs with clean fingertips or washcloth or Qtip for 1 minute.
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If dry eye occurs secondary to Staphylococcal Blepharitis, what's the treatment?
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Artificial tears for mild DES and for severe DES oral antibiotics like Doxycycline (inhibits exotoxin-induced cytokines).
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What is an associated marginal infiltrate?
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WBC that infiltrates the cornea between the epithelium and stroma near the limbus and after dying, released enzymes damage the epithelium
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How are associated marginal infiltrates created by bacteria?
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Hypersensensitivity to Staph toxins trigger the Ag-Ab-complement which triggers C3a and C35a which attracts WBCs from limbal BVs.
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Does a marginal infiltrate stain?
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No
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How do you treat Staphylococcal blepharitis associated marginal infiltrates?
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Treat the blepharitis and add topical steroids (Prednisolone, Dexamethasone, Loteprednol) or a topical combo like Tobradex (tobramycin + dexamethason) or Zylet (tobramycin + loteprednol)
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What type hypersensitivity is a Staphylococcal blepharitis associated phlyctenule?
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A type IV hypersensitivity reaction to staph toxins that appears as a raised white lesion on conj, limbus, or cornea.
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What happens if a Staph associated Phylctenule moves across the cornea?
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It pulls blood vessels and causes scarring as it moves
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How do you treat Staphylococcal blepharitis associated phlyctenule?
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Treat the blepharitis and add a topical combo like Tobradex (tobramycin + dexamethason) or Zylet (tobramycin + loteprednol)
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Many years ago, what was the primary cause of phlyctenules?
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TB
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Today, what is the primary cause of phlyctenules?
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Staphylococcus
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What causes Seborrheic blepharitis?
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Unknown cause
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What condition is Seborrheic dermatitis associated with?
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Seborrheic dermatitis: chronic skin disorder where sebaceous glands are abundant, can cause dandruff/scurf
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What's the most common symptom of Seborrheic blepharitis?
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Nothing. Seborrheic blepharitis is frequently asymptomatic, but possible morning mattering or DES.
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What are the signs of Seborrheic blepharitis?
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Waxy, dandruff-like scales at lash base and greasy lids
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How do you treat Seborrheic blepharitis?
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Lid hygiene and lubricants
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What is Meibomian Seborrheic blepharitis?
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Excess and abnormal oil production
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What is the primary symptom of Meibomian Seborrheic blepharitis?
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DES is the primary symptom
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What is the cause of Meibomian Seborrheic blepharitis?
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Unknown cause
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What are the signs of Meibomian Seborrheic blepharitis?
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Tear frothing, oily tear film, reduced TBUT, conj injection, normal lid
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How do you treat Meibomian Seborrheic blepharitis?
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Lid hygiene and lubricants
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What is Angular blepharitis?
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A localized eczematoid inflammation, usually at the outer lid at lateral canthus
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How does Staphylococcus affect Angular blepharitis?
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It makes the lid dry and scaly
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How does Moraxella affect Angular blepharitis?
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It makes the lid wet and macerated with frothy discharge
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How do you treat Angular blepharitis?
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Use oral antibiotics effective on gram positive bacteria like Bacitracin, Erthromycin, Tobramycin, and Gentamicin.
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How is meibomian gland dysfunction connected to rosacea?
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Thickened meibomian secretions block the opening and allow for a stagnant surface for bacteria...lipase...FFAs...inflammation = rosacea
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For what population is rosacea common?
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Celtic, 30-60 year olds
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What are signs of rosacea?
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Erythema with papules and pustules, telangiectasia, and rhinophyma
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What dietary restrictions help diminish rosacea?
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Restrict spicy, alcohol, hot drinks, chocolate, tomatoes, citrus
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How is rosacea treated?
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Oral Doxycycline and topical metrodiazole gel
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Name some ocular manifestations of rosacea.
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Meibomian dysfunction, blepharitis, hordeolum/chalazia, lid infection, poor tear film, conj injection, PEE/SPK, corneal vascularization or thinning causing keratitis
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How do you clinically diagnose meibomian dysfunction?
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Forced expression of the meibomian glands.
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How do you treat mild meibomian gland dysfunction? Severe?
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For mild cases, warm compresses and digital massage toward margin. For severe cases, Doxycycline but taper off. There's no cure, just management.
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What causes impetigo?
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Staph aureus or Strep pyogenes causes the contagious skin infection.
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For what population is impetigo common?
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Kids, the elderly, and those living in poor hygiene questions.
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What are the symptoms of impetigo?
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Crusty rash, usually on face or distal extremities
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How do you treat impetigo?
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Oral antibiotics Cephalosporin, Macrolide, or Dicloxacillin. Wash areas with antibacterial soap then apply topical Bacitracin or Mupirocin.
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What causes Erysipelas?
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Strep pyogenes infects the superficial lymphs
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What's the Erysipelas differential against rosacea?
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Erysipela usually has a sudden onset of fever and chills. Erysipela also is asymmetric.
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How do you treat Erysipelas?
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Treat with antibiotic injection of Penicillin G or take Penicillin V by mouth.
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A 39-year-old woman presents with painless eyelid edema, bilateral proptosis, and conjunctival injection overlying the horizontal rectus muscle tendons. What disease does this patient most likely have?
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Grave’s disease
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Dacryoadenitis is an inflammation of the ____ and is usually a ___ condition.
a. lacrimal sac, bilateral b. lacrimal gland, bilateral c. lacrimal sac, unilateral d. lacrimal gland, unilateral |
d. Dacryoadenitis is an inflammation of the lacrimal gland and usually presents as a unilateral condition.
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Profound loss of vision and APD associated with thyroid orbitopathy are usually a result of:
a. exposure keratitis b. compressive optinc neuropathy c. lid inflammation d. secondary uveitis e. chronic dry eye |
b. Loss of vision associated with Graves’ ophthalmopathy most often results from compression of the ON within the orbit, that is compressive optic neuropathy.
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The reference points for exophthalmometry measurements are the ___ and the ___.
a. nasal orbital rim, corneal apex b. outer canthus, limbus c. outer canthus, corneal apex d. temporal orbital rim, limbus e. temporal orbital rim, corneal apex |
e. In all exophthalmometry measurements, the primary reference points are the temporal orbital rim posteriorly and the corneal apex anteriorly.
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A 64-year-old woman has a left lower lid ectropian as a surgical complication after the removal of a basal cell carcinoma. This ectropian would be classied as being _____ in nature.
a. cicatricial b. congenital c. tarsal d. paralytic e. involutional |
a. Cicatricial ectropian is defined as ectropian caused by shortening of the anterior lamella of the eyelid, most frequently as a result of lid surgery.
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An acquired condition in which eyelashes are misdirected toward the cornea or conjunctiva is:
a. blepharitis b. trachoma c. trichiasis d. entropion |
c. Trichiasis is an acquired condition in which eyelashes are misdirected posteriorly toward the conjunctiva or cornea.
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Which of the following refers to removal of the globe, while leaving the remaining contents of the orbit intact?
a. evisceration b. exenteration c. enucleation d. exoneration |
c. Enucleation
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During administration of the primary Jones dye test, dye is recovered following the application of a cotton-tipped applicator under the inferior turbinate. This MOST likely indicates:
a. complete obstruction of the lacrimal drainage system b. tearing due to primary hypersecretion c. partial obstruction of the lacrimal drainage system d. poor function of the valve of Hasner |
b. Tearing due to primary hypersecretion
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Stratified squamous epithelium that lacks a normal pattern of maturation and contains an increased number of mitotic figures is:
a. neoplastic b. metaplastic c. hypoplastic d. dysplastic e. all of the above |
D. Dysplasia means disordered growth.
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A generalized inflammation of the eyelid anterior to the orbital septum is a(an):
a. chalazion b. hordeolum c. primary meibomianitis d. preseptal cellulitis |
D. Preseptal cellulitis
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Which of the following antibiotics would be an appropriate treatment for Meibomian gland dysfunction?
a. doxycycline b. Augmentin c. dicloxacillin d. Keflex |
a. doxycycline
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What is dacryoadenitis?
a. infectoin/inflammation of the lacrimal sac b. infection/inflammation of the lacrimal gland c. infection/inflammation of the canaliculus d. swelling of the lacrimal sac |
b. Lacrimal gland
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If pressure on the lacrimal sac results in an outflow of mucus from the puncta, the patient most likely has:
a. dacryoadenitis b. dacryocystitis c. internal hordeolum d. meibomianitis e. chronic dry eye |
b. Dacryocystitis.
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The most common symptom of a disorder in the function or anatomy of the lacrimal drainage system is:
a. pain b. mucus discharge c. tearing d. photophobia e. asthenopia |
c. Tearing
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Which of the following is not an appropriate management option for dacryocystitis?
a. oral antibiotics b. warm compresses with massage c. topical antibiotics d. dilation and irrigation of the puncta and lacrimal system |
d. It is inappropriate to dilate and irrigate in the presence of active infection because it may spread.
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Which of the following oral medications would be most appropriate for treating a child with dacryocystitis?
a. tetracycline b. oral prednisone c. amoxicillin d. vanocmycin e. acyclovir |
c. Amoxicillin is an antibiotic approved for use in children.
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Appropriate long-term therapy for severe, chronic dry eye might include:
a. topical prednisolone acetate b. topical gentamicin c. oral prednisone d. Vigamox e. topical cyclosporine |
e. Topical cyclosporine
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A 46-year-old woman presents with complaints of ocular irritation, dryness, and redness. Telangiectasa of the facial BVs and facial erythema are noted on gross examination of the adnexa. The likely underlying cause of her ocular discomfort is:
a. systemic lupus erythematosus b. acne rosacea c. herpes zoster d. Graves’ disease e. herpes simplex |
b. Acne rosacea
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An inability to full close one eye is frequently caused by which of the following?
a. CNIII palsy b. CNVI palsy c. Bell’s palsy d. Diabetes |
c. Bell’s palsy
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The outer layer of the tear film is composed of ___ and originates primarily from the ___ of the lids.
a. mucin, goblet cells b. lipid, goblet cells c. mucin, Meibomian glands d. lipid, Meibomian glands e. aqueous, lacrimal gland |
d. lipid, Meibomian glands
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What condition commonly presents with a classic triad of dry eys, dry mouth, and arthralgia?
a. rosacea b. Sjogren’s syndrome c. Steven’s-Johnson syndrome d. keratoconjunctivitis sicca |
b. Sjogren’s syndrome
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Evaporative loss of aqueous tears is associated with dysfunction of the ___.
a. lipid tear layer b. mucin tear layer c. lacrimal gland d. lacrimal drainage system |
a. Lipid tear layer
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Which of the following should be ordered first when investigating the functional status of the thyroid gland?
a. T4 level b. T3 level c. TSH level d. fine-needle aspiration of thyroid gland e. radioiodine scan/scinigraphy |
C. TSH level is indicative of whether a primary disease involves the thyroid gland and is the 1st step in the functional assessment of thyroid dysfunction
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An ocular effect associated with the underlying defect in osteogenesis imperfecta is:
a. optic nerve atrophy b. blue sclera c. ptosis d. weakness of EOM |
B. Synthesis of type I collagen is abnormal in osteogenesis imperfecta. Besides bone, other tissues that normally are rich in type I collagen are affected. THe sclera appears blue bc the decreased amount of collagen makes it translucent and allows the dark choroid to show through it.
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Orbital cellulitis, which may be characterized by the acute onset of unilateral proptosis and chemosis, and painful diplopia:
a. is an ocular emergency b. is treated with topical antibiotics c. is not vision threatening d. never requires surgical intervention |
a. Is an ocular emergency.
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