L3 Adnexa, Lids, Lashes: Mechanical Signs & Conditions

Jessica

BCL abreviation means

bandage contact lens

which portion of the orbicularis oculi does voluntary forced closure

orbital portion

which portion of orbicularis oculi does contraction leading to blinking and lacrimal drainage?

preseptal portion

which portion of orbicularis oculi does contraction leading to blinking and eyelid apposition to globe

pretarsal portion

eyelid myokymia and blepharospasm are both _____ muscle contraction

involunatary

eyelid myokymia is usually _____ (uni or bilateral) and localized with ____ twitches

unilateral, fine

eyelid myokymia is assoicated with stress, fatigue and ____

caffeine

blepharospasms can be either unilateral or ____ including orbicularis oculi, corrugator supercilli, and _____ muscles

bilateral, procerus

which 3 facial muscles are involved in blepharospasm

corrugator, procerus, and depressor supercilli

is benign blepharospasm associated with systemic disease or syndrome?

no

is benign blepharospasm uni or bilateral presentation

bilateral

can secondary blepharospasm be either uni or bilateral presentation?

yes

which systemic diseases are associated with secondary blepharospasm(6)

1. meige syndrome- dystonia

2. tourette syndrome- tics

3. infections

4. palsies

5. seizures

6. ocular irritant- dry eye

best tx options for eyelid myokymia

lifestyle changes to avoid triggers

best tx options for blepharospasms conservatively (2)

tx underlying cause

consider glasses or lubricant

best tx options for blepharospasms with meds(2)

1: botox injection for tempoary fix

2. oral meds- benzodiaepines

best tx options for blepharospasms with when nothing else works

surgery

what 3 conditions can cause lowering of the upper lid

dermatochalasis, blepharochalasis, & blepharptosis

entropion is

the inward rotation of the lid

ectropion is

the outward rotation of the lid

blepharoptosis is an droopy lid condition affecting which age group

any ages

blepharoptosis is bi or unilateral weakness of the ___ muscles

levator

t/f blepharoptosis can be congential - cn3 palsy, horners, & marcus gun jaw winking

true

t/f blepharoptosis can be acquired- aponeuronetic, myogenic, neurogenic, mechanical or traumatic

true

dermataochalasis affects which age group

middle age/ elderly

bilateral involutional change of CT or skin elasticity against gravity describes

dermatochalasis

blepharochalasis affects which age group

any ages

blepharochalasis is bi or unilateral transient drooping of eyelid due to recurrent ____ & ____

swelling and inflammation

dermatochalasis

blepharochalasis

reverse ptosis is common in

horners

1. ptosis of upper lid

2. reverse ptosis of lower lid

dx: blepharoptosis

what are the tx options for blepharoptosis (3)

1. address underlying issue

2. oxymetalzoline(upneeq)

3. surgery

what are the tx options for dermatochalasis(2)

1. oxymetazoline(upneeq)

2. surgery

what are the tx options for blepharochalasis(3)

1. address underlying problem

2. anti-inflammatories/anti-histamines

3. surgery

oxymetazoline (upneeq) mechanism of action

alpha adrenergic agonist triggering the levator muscle to lift

oxymetazoline (upneeq) dosing

1 gtt qd to affected eye

side effects for oxymetazoline (upneeq)

dry eye

pain

irriation , redness

headaches

contraindications for oxymetazoline (upneeq)

heart disease/ HTN

how is the snap back test done

pull lower lid down

& count long it takes for it to return

longer it is the worse

inward rotation of the lashes rub against the ocular surface. what does that do to the tears?

disrupts the spread

what are signs that would be seen if the lashes are inward rotated

hyperemia

spk

corneal scarring

what are symptoms that would be seen if the lashes are inward rotated

redness

foreign body sensation

irriatation

epiphora

blurriness

what are the 4 types of entropion

congenital, involutional/senile, cicatricial, and acute spastic

what is epiblepharon

hypertrophic fold of the lower lid and orbicularis oculi overriding the lower lid margin

what is trichiasis

misdirected lashes

what is distichiasis

additional row of eyelashes from MG

epiblepharon

trichiasis

distichiasis

congenital entropion affects who

pediatric population

conservative tx for congenital entropion

lubricant and taping of lower lid

medical tx for congenital entropion

botox to orbicularis m

involutional (senile) entropion affects who

geriatric population

conservative tx for involutional (senile) entropion

lubricant, taping lower lid, bandage SCL

other option beside conservative for involutional (senile) entropion

surgery

who does cicatricial entropion affect the most

any age with chronic ocular condition with scarring

how does cicatricial entropion pathogenesis occur

postererior lamella contraction due to cicatrix formation leading to inward turning of the eyelids

what is the conservative tx for cicatricial entropion

lubricants, taping lower lid and bandage SCL

what is alternative tx for cicatricial entropion if conservative tx doesnt work

surgical repair

who does acute spastic entropion affect

any age with chronic ocular condition that can cause irritation

how does acute spastic entropion present

irrirant leads to blepharospasm and temporary inward rotation

what is the conservative treatment for acute spastic entropion

adress underlying issue, bandage SCL, or self resolving

what is the medical treatment for acute spastic entropion

botox to orbicularis m

what is the last option for tx if meds or conservative tx does not work for acute spastic entropion

surgery

cicatrical entropion

if eyelashes are turned outward what happens to the ocular surface

it is exposed

what are some signs of ectropion

hyperemia, SPK, corneal scarring

what are some symptoms of ectropion

redness, foreign body sensation, irriation, blurriness

eyelid malignancy, floppy eyelid syndrome, and nocturnal lagophthalmos are all differential diagnoses of

ectropion

what is eyelid malignancy

misdirected lashes (primary or secondary)

what is floppy eyelid syndrome

when the laxity of tarsal plate results in easy eyelid manipulation (esp during sleep)

what is nocturnal lagophthalmos

incomplete eyelid closure at night (may or may not be with pathology)

eyelid malignancy

floppy eyelid syndrome

nocturnal lagophthalmos

floppy eye lid is associated with (3)

obese males with sleep apnea, kerataoconus, or sleeping facing the pillow

do floppy eyelids present with mucous disharge, tearing, or corneal involvement

yes

what is the management of floppy eyelid syndrome conservatively

ocular lubricant, BCL, tape eyes lids or eye cover

what is the alternative tx to floppy eyelid tx when the conservative way doesn't work

surgery and management of sleep apnea

congenital ectropion affects who

pediatrics (may or may not be with genetic malformations)

what is congenital ectropion pathogenesis

absence or atrophy of tarsal plates with skin shortage and refraction

which group of people does involutional (senile) ectropion affect

getriatric population

what is the pathogenesis of involutional (senile) ectropion

horizantal laxity of medial first and continues to the lateral canthal tendon

tarsal degeneration

what is the conservative tx for involutional (senile) ectropion

lubricants, lower lid taping, band SCL

what is the nonconservative tx for involutional (senile) ectropion affect

surgery

cicatricial ectropion affects which age group of people

any age witch ocular condition with scarring from face or eyelid sx, truama or infilitrative conditions

pathogenesis for cicatricial ectropion

posterior lamella contraction leading to outward turning of the eyelids

conservative tx for cicatricial ectropion

lubricant, lower lid taping, bandage SCL

non conservative tx for cicatricial ectropion

surgery repair

who does paralytic ectropion seen in

any age with facial nerve paralsis from bells palsy, stroke, or sx/trauma

paralytic ectropion pathogenesis

decreased contraction or tone of orbicularis oculi from facial n palsy

tx for paralytic ectropion conservatly

lubricant, taping of lower lid, BCL

nonconservative tx for paralytic ectropion

surgery repair

who is mechanical ectropion seen in the most

any age with presence of mass or periocular swelling that results in outward rotation of lids

pathogenesis of mechanical ectropion

mechanical displacement of lids due to mass or swelling of the periocular region

conserative tx for mechanical ectropion

lubricant, taping of lower lid & BCL

nonconservative tx for mechanical ectropion

surgery repair

inflammatory ectropion affects who the most

any age associated w inflammation or allergies

presentation of inflammatory ectropion

facial inflammation causing outward rotation of eyelids

can be concurrent with cicatricial ectropion