Podcast
Questions and Answers
What information is crucial to gather when assessing a patient's condition?
What information is crucial to gather when assessing a patient's condition?
What condition should be excluded when assessing for ptosis?
What condition should be excluded when assessing for ptosis?
What must be excluded to rule out visual deprivation amblyopia?
What must be excluded to rule out visual deprivation amblyopia?
Why is a history of trauma important in patient assessment?
Why is a history of trauma important in patient assessment?
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Which of the following is NOT a factor to consider when taking a patient’s history?
Which of the following is NOT a factor to consider when taking a patient’s history?
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What is one visible effect of the frontalis muscle hyperaction when attempting to elevate a ptotic lid?
What is one visible effect of the frontalis muscle hyperaction when attempting to elevate a ptotic lid?
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What happens to the skin of the forehead when the frontalis muscle is overly active?
What happens to the skin of the forehead when the frontalis muscle is overly active?
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Which muscle is primarily responsible for the elevation of the eyebrow during attempts to elevate a ptotic lid?
Which muscle is primarily responsible for the elevation of the eyebrow during attempts to elevate a ptotic lid?
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What condition is indicated by the term 'ptotic lid'?
What condition is indicated by the term 'ptotic lid'?
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What does hyperaction of the frontalis muscle lead to besides eyebrow elevation?
What does hyperaction of the frontalis muscle lead to besides eyebrow elevation?
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What is trichiasis in relation to the eyelashes?
What is trichiasis in relation to the eyelashes?
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Which statement accurately describes the effect of trichiasis?
Which statement accurately describes the effect of trichiasis?
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In what way can trichiasis impact eye health?
In what way can trichiasis impact eye health?
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Which of the following is NOT a characteristic of trichiasis?
Which of the following is NOT a characteristic of trichiasis?
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What can be a potential consequence if trichiasis is left untreated?
What can be a potential consequence if trichiasis is left untreated?
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What is the goal of electrocautery punctures in treating mild ectropion?
What is the goal of electrocautery punctures in treating mild ectropion?
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Which treatment option is specifically mentioned for mild ectropion?
Which treatment option is specifically mentioned for mild ectropion?
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What is a potential outcome of electrocautery treatment for mild ectropion?
What is a potential outcome of electrocautery treatment for mild ectropion?
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How does electrocautery punctures work in the context of ectropion?
How does electrocautery punctures work in the context of ectropion?
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What is a common characteristic of ectropion that influences treatment choice?
What is a common characteristic of ectropion that influences treatment choice?
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What is a consequence of using too much soap when cleaning the eyes?
What is a consequence of using too much soap when cleaning the eyes?
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What technique can help in expressing oils from the meibomian glands?
What technique can help in expressing oils from the meibomian glands?
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Why is it important to avoid using an excessive amount of soap during eye care?
Why is it important to avoid using an excessive amount of soap during eye care?
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What is the purpose of the meibomian glands in the eyelids?
What is the purpose of the meibomian glands in the eyelids?
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What is a likely effect of insufficient oil expression from the meibomian glands?
What is a likely effect of insufficient oil expression from the meibomian glands?
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What is a characteristic symptom of a chalazion?
What is a characteristic symptom of a chalazion?
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When does pain typically occur in the case of a chalazion?
When does pain typically occur in the case of a chalazion?
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What sign is indicative of a non-infected chalazion?
What sign is indicative of a non-infected chalazion?
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Which of the following could indicate a progression of a chalazion?
Which of the following could indicate a progression of a chalazion?
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Which statement about multiple chalazia is true?
Which statement about multiple chalazia is true?
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Study Notes
Eyelid Anatomy and Diseases
- Eyelids are two mobile muco-cutaneous folds covering the orbital content.
- The edges of the eyelids meet when the eyes are closed; the anterior border has rows of lashes (100 upper, 50 lower).
- The posterior border is angled. Meibomian glands are anterior to the posterior border.
- Modified sebaceous (Zeis) and sweat (Moll's) glands secrete into lash follicles.
- The lid fits the globe about 2mm below the upper limbus (for the upper lid) and nearly on the lower limbus (for the lower lid).
- The lacrimal portion of the lid margin is small, medial to the puncta, and lacks lashes.
Eyelid Anatomy - Minute Anatomy
- The eyelid has several layers including skin, subcutaneous tissue, muscle, a fibrous tarsus, and the palpebral conjunctiva.
- The eyelids are supported by palpebral fascia (orbital septum), skin of the eyelid, superficial fascia, palpebral part of orbicularis oculi, lash follicles, Zeis glands, eyelashes, and Moll's glands.
- Skeletal muscle layer includes the palpebral part of the orbicularis oculi (which is innervated by the 7th cranial nerve), the insertion of the levator palpebrae superioris (3rd cranial nerve), and Muller's muscle (involuntary, sympathetic innervation).
- The submuscular areolar tissue contains vessels, nerves, and lymphatics, traversing the levator fibers, marked as a gray line on the lid margin.
- The tarsus is a condensed fibrous tissue forming the eyelid's skeleton, with meibomian glands arranged within it (30 lower, 40 upper). It connects to the orbital margins and the orbital septum both laterally and medially.
Congenital Anomalies of the Eyelid
- Ankyloblepharon: Adhesion between both eyelid margins.
- Coloboma: Full-thickness defect in the eyelid and lid margin that can cause exposure keratitis, requiring surgical repair.
- Epicanthus: Skin fold over the medial canthus and caruncle, sometimes causing a pseudo-convergent squint.
- Telecanthus: Increased distance between medial canthi, producing pseudo-convergent squint.
- Blepharophimosis syndrome: Narrowing of the palpebral fissure (25-30 mm to 18-20mm), often accompanied by ptosis, epicanthus inversus, and ectropion or telecanthus.
- Congenital ectropion: Outward turning of eyelid.
- Congenital entropion: Inward turning of eyelid.
- Distichiasis: Extra row of lashes in the site of meibomian gland ducts.
Ptosis
- Ptosis is the dropping of the upper eyelid below its usual level (usually covering the upper 1/6 of the cornea, 2 mm).
- Congenital ptosis often appears bilateral and is usually hereditary. It involves myogenic or neurogenic poor development of the levator palpebrae superioris muscle or nerve supply.
- Acquired ptosis can be neurogenic (e.g., oculomotor nerve palsy, Horner's syndrome), myogenic (e.g., myasthenia gravis, myotonic dystrophy), mechanical (e.g., lid swelling), or senile (involutional) (degenerative changes).
- Pseudo-ptosis results from a lack of lid support, such as in microphthalmos or enophthalmos.
- Hysterical ptosis can be associated with emotional distress in young women
- Traumatic ptosis is due to injury to the levator muscle or its nerve supply
Evaluation of Ptosis
- History (age of onset, trauma, family history)
- Exclude pseudo-ptosis through visual acuity and visual deprivation amblyopia diagnosis
- Frontalis muscle elevation measurement by marking the brow position & measuring the difference in the primary position.
- Observe for absence of eyelid crease, corneal sensation abnormality, or unusual head posture
- Measure marginal reflex distance and vertical fissure height.
- Assess levator function (measured in mm)
Surgical Repair of Ptosis
- Indications: Congenital or acquired ptosis (excluding hysterical, pseudo-ptosis, and myasthenic ptosis). Exclude any 3rd nerve palsy or corneal anesthesia.
- Timing varies based on severity, pre-school (mild) vs. younger age (possible amblyopia)
- Surgical choices include Fasanella-Servat operation (mild ptosis), Levator resection (moderate-severe ptosis), or Frontalis suspension (severe ptosis).
Disorders of Eye Lashes
- Trichiasis: Misdirected lashes rubbing against the cornea or conjunctiva
- Etiology: Entropion (most common), old age, bandaging, burn injuries, trachoma
- Polyosis: Whitening of lashes
- Madarosis: Permanent loss of lashes
Entropion
- Rolling of the eyelid margin & tarsal plate inward.
- Etiology: Cicatricial (scarring), spastic (muscle spasm), involutional (senile).
- Types: Cicatricial (post-inflammatory, post-traumatic), spastic (due to blepharospasm), senile (involutional), mechanical (empty socket, atrophic globe).
- Treatment: Varies by type but generally involves correction of the underlying cause (post-traumatic injury) & temporary (eg, collodion, adhesive strips), and permanent options.
- Causes: Scar tissue, burns, mechanical irritation/detachment issues, muscle spasm, and natural causes of aging.)
Ectropion
- Rolling of the eyelids outward, usually affecting the lower lid, due to gravity.
- Symptoms: Epiphora (excessive tearing), eczema, conjunctiva/corneal issues.
- Types: Cicatricial (scarring), spastic, senile (involutional), mechanical.
- Treatment: Varies by type. Some common treatments are correcting the underlying cause (scar tissue), temporary measures (eg, moistening eye drops), and surgical options (eg, grafting, wedge resection)
Other Eyelid Diseases
- Xanthelasma: Subcutaneous cholesterol deposits often in the medial canthus; treated by therapies or surgical removal.
- Dermatochalasis: Redundancy of eyelid skin in old age; treated by blepharoplasty.
- Blepharochalasis: Recurrent edema of the eyelid in young age.
Blepharitis
- Chronic inflammation of the eyelid margin often caused by external irritants(dust, wind, heat), metabolic issues, and or conditions affecting eyelid margin:
- Types: Squamous, Ulcerative, Parasitic, Angular.
- Etiology: Predisposing (external irritants, eye strain, etc.) & Excitatory (bacterial, seborrhea, parasites).
- Clinical picture: Vary by type, ranging from sebaceous discharge to redness and scales.
- Treatment: General (health, scalp care, diet) and local (cleaning, ointment, antibiotics).
Inflammation of Glands
- Stye (Hordeolum Externum): Acute infection of Zeis gland or eyelash follicle, usually causing pain, swelling, redness
- Hordeolum Internum : infection of the meibomian gland; more painful.
- Chalazion: Chronic inflammation of the meibomian gland.
References
- Wills Eye Manual
- Kanski's Clinical Ophthalmology
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Description
This quiz focuses on key elements of patient assessment related to ocular conditions, particularly ptosis and trichiasis. Participants will test their understanding of history-taking, visible effects of muscle hyperaction, and potential impacts on eye health. Ideal for healthcare professionals in ophthalmology or optometry.
