Lids

epicanthus

fold of skin found on medial portion of the eye

epiblepharon

extra horizontal row of skin across lid margin + lashes point vertically

congenital entropian

skill pulls down and lid pulls away from the globe

entropian

involution (age-related)

extropian

involution, can be 7th CNP, congenital, mechanical

Blepharophimosis

epicanthus inversus - lower lid folds larger than upper

telecanthus - inc distance to medialcanthi

poorly developed nasal bridge

rare and congenital

blepharospasm

involuntary excessive twitching

aetiology blepharospasm

post stroke, drug induced, ocular irritation, post encephalitis, hysterical

lagophathalmos

inability to close eye

enopthalmos

sunken eye

simple congenital ptosis

absence of upper lid crease + poor levator function when assessing the macula

double elevator paly/monocular elevation deficiency

1 eye can't elevate, giving a true or pseudoptosis due to hypertropia

symptoms of a congenital horner's

slight ptosis

u/a of muller's muscle

heterochromia

constricted puple

symptoms of an acquired horner's

ptosis

anhydrosis

constricted pupil

enophthalmos

defective accommodation

pupil re-dilation slow

what lesion damaged in an acquired horner's

sympathetic nerve supply at any point in pathway, 1st, 2nd, 3rd order neurons

what can cause a 1st order lesion?

brain stem disease - demyelination

spinal cord disease - tumours, syringomyelia

what can cause a 2nd order neuron

intaorthic lesions - aneurysm, tumour

neck lesion - gland, trauma

what can cause a 3rd order lesion

ICA disease, cavernous sinus mass

list acquired myogenic cause of ptosis?

MG

CPEO

common look in MG

asymmetric bilateral ptosis

MG signs and symptoms

limitaiton of OM and diplopia

variability + fatigue

CPEO (chronic progressive external ophthalmoplegia)

mitochondria disease, causing progressive, symmetrical, ophthalmoplegia - paralysis of muscles and bilateral ptosis and obicularis weakness

marcus gunn

congenital misdirection of nerve supply to LPS and pterygoid muscles (mastication)

with a partial ptosis which inc on opening jaw + movement to affected side

list neurogenic ptosis

3rd CNP

horner's

cyclic oculomotor palsy

cyclic oculomotor palsy

complete or partial 3rd NP alternates with spasm of the 3rd nerve function

aberrant regeneration/misdirection syndrome

regrowth of fibres following 3rd NP, but fibres misdirected causing weird clincial features

clincial features of aberrant regeneration

elevation/adduction of upper lid on downgaze

adduction of eye on upgaze

constriction on adduction

globe retraction on up/down gaze

7th NP

bell's - cant close eye + obicularis weakness causing ectropian

TED

o/a of muller's muscle

lid retraction

lagophthalmos

collier's sign

lid retraction

secondary to BT

post BT leakage

secondary to over liberal ptosis surgery

lid retraction