Ophthalmology Quiz: Ectropion and Blepharitis

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following is NOT an acquired type of ectropion?

Congenital (correct)

Paralytic

Involutional

Cicatrical

Which medication is typically favored for treating blepharitis due to its prolonged contact with the eyelid margins?

Chloramphenicol eyedrops

Topical steroid eyedrops

Chloramphenicol ointment (correct)

Oral tetracyclines

What structural change is primarily associated with involutional ectropion?

Increased tone of the pre-septal/pre-tarsal orbicularis muscle

Tightening of the medial and lateral canthal tendons

Disinsertion of the upper lid retractors

Disinsertion of the lower lid retractors (correct)

What is a common recommendation for mild cases of ectropion?

Avoiding lid rubbing combined with lubrication Signup and view all the answers

What is the typical duration for oral tetracycline treatment in cases of meibomian gland disease associated with acne rosacea?

Three to six months Signup and view all the answers

In which situation are topical steroids most likely to be indicated in the treatment of blepharitis?

Complications such as marginal keratitis Signup and view all the answers

What is a potential treatment for ectropion that helps protect the cornea from exposure?

A therapeutic contact lens Signup and view all the answers

In cases of new-onset seventh nerve palsy, what temporary relief measure might be considered for ectropion?

Taping the lateral canthal skin supero-temporally Signup and view all the answers

What distinguishes an internal hordeolum from an external hordeolum in terms of its location?

An internal hordeolum is located within the tarsal plate Signup and view all the answers

Which surgical treatment approach is mentioned for ectropion?

Shortening of the lower lid and/or canthal plication Signup and view all the answers

What is the typical treatment approach for an internal hordeolum in its acute phase?

Broad-spectrum topical antibiotic Signup and view all the answers

What advice should be given to patients with chronic blepharitis regarding the long-term management of their condition?

They may have to maintain a long-term eyelid hygiene routine Signup and view all the answers

What age group is most commonly affected by pre-septal cellulitis?

Children under five years of age Signup and view all the answers

What is the primary defining characteristic of trichiasis?

Posterior misdirection of the eyelashes toward the globe Signup and view all the answers

Besides erythema and oedema, what other symptom/sign might be present in a child with pre-septal cellulitis?

Irritability Signup and view all the answers

What typically causes horizontal lid laxity?

Atrophy of the tarsus and canthal tendons Signup and view all the answers

Which of the following is LEAST likely to be associated with involutional entropion?

More frequent occurrence in men than women Signup and view all the answers

Which of the following findings is NOT typically associated with posterior blepharitis?

Crusting around the eyelash follicle Signup and view all the answers

A patient with ectropion is MOST likely to present with which of the following combination of symptoms?

Keratinisation of the palpebral conjunctiva and mucous discharge. Signup and view all the answers

What is the primary cause of the pathology seen in posterior blepharitis?

Bacterial colonization leading to toxins and inflammation Signup and view all the answers

Which of the following is a FALSE statement regarding paralytic ectropion?

It is typically associated with the eighth cranial nerve. Signup and view all the answers

What is the significance of 'inferior corneal punctate keratitis' in the context of blepharitis?

It suggests a poor tear film and short tear break-up time. Signup and view all the answers

Which surgical intervention is typically considered a temporary measure for ectropion?

Eyelid-everting sutures. Signup and view all the answers

What is the typical occurrence rate of ectropion in the population over 50?

Approximately 4% Signup and view all the answers

Which of the following is a characteristic feature of marginal keratitis?

Small white infiltrates near the limbus that generally do not stain with fluorescein Signup and view all the answers

What factor contributes to the mechanical form of ectropion?

Tumours that evert the lower lid. Signup and view all the answers

Which of the following is a feature typically associated with acne rosacea, that is also mentioned as being seen alongside blepharitis?

Rhinophyma (enlargement and thickening of the nose soft tissues) Signup and view all the answers

What does 'madarosis' refer to in the context of blepharitis complications?

Loss of eyelashes Signup and view all the answers

Which of these is TRUE about the bilaterality of ectropion?

It is bilateral in approximately 50% of cases. Signup and view all the answers

Besides horizontal lid laxity, what is another commonly associated problem in patients with ectropion?

Constant wiping of the eyes. Signup and view all the answers

Which of the following is considered a direct complication of blepharitis?

Conjunctivitis Signup and view all the answers

What causes the 'rounding' effect of the posterior lid margin in blepharitis?

Swelling and inflammation of the meibomian glands. Signup and view all the answers

Which of the following is the least likely cause of eyelid swelling?

Bacterial orbital cellulitis Signup and view all the answers

A patient presents with eyelid swelling and is found to have normal ocular motility, visual acuities, and pupillary reactions. Which of the following conditions is MOST likely to be ruled out?

Bacterial orbital cellulitis Signup and view all the answers

Which of the following is NOT a typical pathogen associated with bacterial orbital cellulitis?

Escherichia coli Signup and view all the answers

What feature is characteristic of the 'ulcerative' type of basal cell carcinoma?

A lesion with a 'pearly' indurated border and an excavated center. Signup and view all the answers

Which of the following groups is at the HIGHEST risk of developing basal cell carcinoma?

Immunocompromised individuals in their early sixties Signup and view all the answers

In the context of orbital cellulitis, which sinus is most commonly the source of infection spread?

Ethmoid sinus Signup and view all the answers

Which of the following clinical features is LEAST likely to be observed with nodular basal cell carcinoma?

Prominent telangiectasia on the surface Signup and view all the answers

A patient with a history of previous sinus infections develops bacterial orbital cellulitis. Which of the following is the most crucial step for managing their care?

Intravenous antimicrobial therapy. Signup and view all the answers

Which characteristic is MOST indicative of a basal cell carcinoma (BCC) rather than a squamous cell carcinoma (SCC)?

Presentation as a non-healing ulcer with pearly white borders. Signup and view all the answers

A patient presents with a lesion on their lower eyelid, and the pathology report confirms the cells originated from the deepest layer of the skin. What is the MOST likely diagnosis?

Basal cell carcinoma (BCC). Signup and view all the answers

What is the typical location for basal cell carcinoma (BCC) on the eyelid, in decreasing order of frequency?

Lower eyelid, medial canthus, upper eyelid, lateral canthus. Signup and view all the answers

Why is intraoperative frozen section analysis, especially Mohs‘ micrographic technique important in the surgical management of eyelid squamous cell carcinoma (SCC)?

To ensure complete removal of the tumour by examining the margins. Signup and view all the answers

Which of the following is considered the MOST aggressive characteristic of squamous cell carcinoma, compared to basal cell carcinoma?

The higher chance of metastasis to regional lymph nodes. Signup and view all the answers

A patient with a history of chronic sun exposure and several actinic keratoses presents with a suspected eyelid malignancy. Which factor would MOST strongly suggest a potential for squamous cell carcinoma (SCC) over basal cell carcinoma (BCC)?

The presence of existing ultraviolet-related lesions. Signup and view all the answers

A patient who has been exposed to oils and tar presents with a lower eyelid lesion. Other than sun exposure, which diagnosis should also be considered?

Squamous cell carcinoma. Signup and view all the answers

What is the primary surgical approach regarding margin size to ensure complete removal of cancerous cells in a suspected Squamous cell carcinoma (SCC)?

Surgery with broad margins to ensure complete removal. Signup and view all the answers

Study Notes

Disorders of the eyelids and orbit

Blepharitis is eyelid margin inflammation, often chronic and recurring. Two main types are anterior and posterior, potentially coexisting.
Anterior blepharitis is typically associated with bacterial (often staphylococcal) colonization, toxicity from bacterial exotoxins, or allergic reactions to staphylococcal antigens. Seborrhoeic blepharitis arises from seborrhoeic dermatitis.
Symptoms include ocular discomfort, soreness, burning, itching, mild photophobia, and dry eye symptoms. There may also be associated signs, including aqueous tear deficiency, lid margin hyperaemia, lid margin swelling, crusting/desquamation around lashes, madarosis (loss of lashes), secondary signs like inferior punctate epithelial erosion, marginal keratitis, mild papillary conjunctivitis, greasy deposits on lid margins, and conjunctival/lid margin hyperaemia.
Posterior blepharitis involves meibomian gland dysfunction, characterized by retention of secretions and blockage of gland orifices. Possible causes include bacterial colonisation, immune-mediated damage, and toxin production.
Complications may include epiphora, dry eyes, conjunctivitis, chalazion formation, trichiasis (misdirected lashes), ectropion (eyelid turning outward), entropion (eyelid turning inward), and corneal disease.

Hordeolum

A hordeolum (stye) is a localized eyelid infection or inflammation.
External hordeolum affects the eyelash follicle and associated glands.
Internal hordeolum affects the meibomian glands.
Staphylococcus aureus is often implicated.
Management usually involves warm compresses and possible topical antibiotics. Systemic antibiotics may be considered in severe cases or if there's a pre-septal cellulitis (a spread to surrounding tissue). Referral to a general practitioner for systemic antibiotics may be required in certain cases.

Trichiasis

Trichiasis is a misdirection of eyelashes towards the globe.
Underlying conditions include chronic lid margin disorders (blepharitis), epiblepharon (misfolding of eyelid), past herpes zoster ophthalmicus, trachoma, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, and vernal keratoconjunctivitis.
Causes eyelash irritation, ocular pain, and foreign body sensation. Symptoms can include conjunctival injection, posterior lamellar scarring, involutional entropion, corneal abrasions (punctate epitheliopathy), and microbial keratitis.
Management involves epilation (removal of lashes) and addressing the underlying cause. Temporary relief can include taping the eyelids.

Entropion

Entropion is the inversion of the eyelid margin toward the globe.
Types include involutional, cicatricial, congenital, and spastic.
Involutional entropion is the most common type associated with aging.
Management options that may be available are epilation, taping, bandage contact lenses, surgical correction, and sometimes lubrication and tear supplements.

Ectropion

Ectropion is the outward rotation of the eyelid margin.
Types include involutional, cicatricial, paralytic, and mechanical.
Involutional ectropion is the most common type which is often associated with aging.
Management involves treating underlying causes, and possibly lubrication, therapeutic contact lenses (depending on the severity), and potentially surgical correction.

Pre-septal cellulitis

A pre-septal cellulitis is a superficial eyelid and periorbital infection, most common in children.
Characterized by acute eyelid erythema and oedema.
Often preceded by a respiratory tract infection, especially paranasal sinusitis. Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus species, and anaerobes are common culprits.
It must be differentiated from orbital cellulitis, which is a more severe infection involving structures behind the orbital septum.

Tumors (Basal Cell Carcinoma and Squamous Cell Carcinoma)

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are cancers of the eyelid with BCC being more common.
BCC often presents as a non-healing ulcer with a pearly white border. SCC typically presents as a roughened, scaly red, elevated area, or ulcer-like lesion, with crusting and/or bloody margins.
Management usually involves surgical removal (excision) with careful margin assessment to prevent recurrence.

Thyroid Eye Disease

Thyroid eye diseases often present with proptosis (bulging eyes), lid retraction and lag, and occasionally vision loss.
The condition is frequently associated with Graves' disease (an autoimmune hyperthyroidism condition).
Management typically includes supportive measures like frequent lubrication if corneal dryness is a problem. Urgent referral to an ophthalmologist is key for significant proptosis, or loss of vision, or double vision (diplopia).

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on the diagnosis and treatment of ectropion and blepharitis. This quiz covers various topics including types of ectropion, treatment recommendations, and surgical approaches. Perfect for medical students and professionals in ophthalmology.