Term
| What does each letter of S.O.A.P. stand for? Include example |
|
Definition
S- Subjective: What the patient tells you
O- Objective: What I see. ex: retinoscopy
A- Assessment: Your diagnosis
P- Plan: How you plan to manage the diagnosis
E- Education: Educate your patient |
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|
Term
| Describe the word: ectropion |
|
Definition
| Abnormal eversion of the lower lid margin away from the globe |
|
|
Term
| Which lid is normally involved when a patient presents with ectropion? |
|
Definition
|
|
Term
| A patient comes into your office with an ectropic lid, what are some subjective symptoms your patient would notice? |
|
Definition
-tearing
-eye or eyelid irritation
-constantly wiping eyes
-history of burns, surgery or trauma around lid
-concurrent Bell's Palsy
-Asymptomatic |
|
|
Term
| Patient with ectropic lid: What objective signs would you notice? |
|
Definition
-Outward turning of the eyelid margin
-Punctate Epithelial Erosions (PEE)
-Exposure keratopathy
-Conjuctival injection
-Keratinization (2' to conj drying) |
|
|
Term
| What is punctate epithelial erosion (PEE)? |
|
Definition
-corneal epithelium loss
-caused by a variety of conditions (tear abnomalities, exposure) |
|
|
Term
| What is exposure keratopathy? |
|
Definition
| inflammation of the cornea caused by irritation |
|
|
Term
| What is conjuctival injection? |
|
Definition
| dilated blood vessels, which give a red appearance to the conj/sclera |
|
|
Term
| List some of the causes for ectropion? |
|
Definition
Acquired:
-Involution (lid laxity due to age)
-Paralytic (nerve issues)
-Cicatricial (due to scarring)
-Mechanical (something pushing it)
Congenital |
|
|
Term
| What is another word that is often used interchangably with PEE? What makes it different? |
|
Definition
| SPK or superficial punctate keratopathy- used specifically for Thygeson's |
|
|
Term
| What is the most common form of ectropion? |
|
Definition
Involutional
-horizontal lid laxity
-typically begins medially
-usually due to age-related weakness |
|
|
Term
| What are the 4 ways to describe ectropion? |
|
Definition
1)Punctal- can see puncta w/o manipulation
2)Medial- can see everted medial aspect of lid
3)Lateral- can see everted lateral aspect of lid
4)Tarsal- can see entire lower lid everted |
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|
Term
| An example for ectropion due to paralysis? |
|
Definition
| seventh-nerve palsy ex: Bell's Palsy |
|
|
Term
| How do you test a patient for orbicularis dysfunction? |
|
Definition
| -tested by asking patient to show teeth and comparing elevation of lip angles |
|
|
Term
| What are some causes for cicatricial or scarring that can result in ectropion? |
|
Definition
-chemical burn
-surgery
-eyelid laceration scar |
|
|
Term
| What are some causes for mechanical ectropion? |
|
Definition
-herniated orbital fat
-eyelid tumor |
|
|
Term
| What is the result of allergy induced ectropion? |
|
Definition
|
|
Term
| Is congenital ectropion common? |
|
Definition
No. It is rare and rarely an isolated anomaly
- |
|
|
Term
| List any diseases or conditions that may be associated with congenital ectropion? |
|
Definition
-Blepharophimosis syndrome (horizontal narrowness of palpebral fissure)
-Microphthalmos (small globe)
-Buphthalmos (enlarged globe)
-Orbital cyst
-Down syndrome
-Occasional paralytic cause |
|
|
Term
| An abnormal narrowness of the palpebral fissure in the horizontal direction is known as. . |
|
Definition
| Blepharophimosis syndrome |
|
|
Term
| A congenital or developmental anomaly where the globe is abnormally small is known as. . . |
|
Definition
|
|
Term
| An enlarged globe that results from increased IOP and is seen in pts w/ congenital glaucoma is known as. . . |
|
Definition
|
|
Term
| Where is an orbital cyst located? |
|
Definition
| It is a cyst around the orbit, which can cause pseudo-ptosis |
|
|
Term
|
Definition
| uncommon group of skin disorders characterized by excessive amounts of dry surface scales |
|
|
Term
| What are some differentials for ectropion? |
|
Definition
-Bell's Palsy
-Floppy Eyelid Syndrome
-Basal Cell Carcinoma
-Squamous Cell Carcinoma
Ichthyosis |
|
|
Term
| How would you assess and diagnose your patient for ectropion? |
|
Definition
-take careful history
-perform slit-lamp exam- checking for PEE, exposure keratopathy
-treat based on cause and severity |
|
|
Term
| How would you assess and diagnose your patient for ectropion? |
|
Definition
-take careful history
-perform slit-lamp exam- checking for PEE, exposure keratopathy
-treat based on cause and severity |
|
|
Term
| Describe treatment for mild ectropion? |
|
Definition
-Lubrication and moisture shields for corneal exposure
-lubricating ointment for keratinized conj (used days or wks prior to ectropion repair)
-taping lids for temporary relief
-wiping lids up and in (towards nose) |
|
|
Term
| When should a patient suffering from corneal or conj drying be reevaluated? |
|
Definition
| 1-2 wks to evaluate efficacy of therapy |
|
|
Term
| What are the 2 temporary surgical treatments for ectropion? |
|
Definition
1) Tarsorrhaphy- lids partially sewn together
2)Electrocautery at junction of conj and lower margin of tarsus |
|
|
Term
| What are some permanent surgical treatment for involutional ectropion? |
|
Definition
-Tarsal Strip- shorten or tighten the lower lid; few stitches removed 7-14 days later; immediate resolution
-Blepharoplasty |
|
|
Term
| What are some treatments for cicatricial ectropion following trauma or lid surgery? |
|
Definition
-digital massage to stretch scar
-skin grafts (from upper lid if dermatochalasis or pre- or post-auricular skin) |
|
|
Term
Ectropion Summary:
1)Appearance?
2)Signs and symptoms?
3)Causes?
4)Treatment? |
|
Definition
1)outward turning of eyelid
2)Patient tearing, red eyes, or no problems at all
3)Differ: age, scarring, trauma
4)Range by cause and severity: Education, lubes, surgery |
|
|
Term
| Describe the word: entropion |
|
Definition
| Inward turning of the eyelid margin |
|
|
Term
| List the subjective symptoms that a patient suffering form entropion would express? |
|
Definition
-Ocular irritation
-Foreign-body sensation
-Pain or no pain
-Tearing
-Red-eye
-Light sensitivity (photphobia)
-Possible decreased vision |
|
|
Term
| List some objective signs that you may notice on a patient with entropic lid? |
|
Definition
-eyelid turned in
-PEE from lashes contacting globe
-Foreign body tracking
-Conj injection
-Corneal ulcer
-Decreased corneal sensation
-Corneal scarring (long-term) |
|
|
Term
| What are 4 potential causes for entropion? |
|
Definition
1)Involution- laxity
2)Acute spastic
3)Cicatricial- scarring
4)Congenital |
|
|
Term
| What could cause involutional entropion? |
|
Definition
-may be due to numerous problems
-patient may exhibit horizontal laxity or the medial and/or lateral canthal tendons |
|
|
Term
| What are some causes of acute spastic entropion? |
|
Definition
-Ocular irritation (due to infections, inflammation, trauma (surgery))
-Orbicularis oculi muscle overwhelms the oppositional action of the lower eyelid retractors
-involutional components |
|
|
Term
| What are causes for cicatricial entropion? |
|
Definition
| -Scarring of the palpebral conjunctiva (due to trauma, infection, chemical burns, Stevens-Johnson syndrome, ocular cicatricial pemphigoid (OCP)) |
|
|
Term
| A severe form of allergic reaction that most often results from a medication and can be sight threatening is known as. . . |
|
Definition
|
|
Term
| Describe what ocular cicatricial pemphigoid (OCP) is? |
|
Definition
-rare inflammation dyndrome primarily involving the oral and ocular mucous membranes
-process includes conjunctivitis, scarring, symblepharon
-can lead to entropion, keratinization, exposure keratopathy |
|
|
Term
| True/False The lower eyelid is usually involved in congenital entropion |
|
Definition
| True. However it is very rare |
|
|
Term
| List some underlying developmental abnormalities that cause congenital entropion? |
|
Definition
-Dysgenesis of the lower eyelid retractors
-Paucity of tissue vertically in the posterior lamella of eyelid
-Tarsal kink syndrome (distortion) |
|
|
Term
| What are other conditions that we must rule out when diagnosing entropion? |
|
Definition
-Epiblepharon
-Eye retraction
-Trichiasis
-Distichiasis |
|
|
Term
| A condition where the pretarsal orbicularis muscle and the skin covering the lid push the eyelashes vertically or inwards. Lid margins in normal position and resolves spontaneously as face matures is known as. . . |
|
Definition
|
|
Term
| A condition where lashes are growing out of the meibomian glands is known as. . . |
|
Definition
|
|
Term
| The acquired misdirection of eyelashes toward the globe is known as what? |
|
Definition
|
|
Term
| What is your medical treatment plan for a patient suffering from an entropic lid? |
|
Definition
-Ocular lubrication & tears to protect ocular surface
-Lid hygiene, antibotics, and steroids for treating blepharitis
-Botulinum toxic weakens pretarsal orbicularis oculi muscle |
|
|
Term
| How could you treat a patient suffering from spastic entropion? |
|
Definition
-Ocular lubrication & tears
-Botulinum toxin
**treatments for blepharitis may cause this |
|
|
Term
| What is a surgical plan for patients suffering from involutional entropion? |
|
Definition
-Repair of the horizontal laxity
-Cautery (temperary) |
|
|
Term
| What is a surgical plan for patients suffering from cicatricial entropion? |
|
Definition
-Depending on the degree and etiology
Mild cases: removal of scar
Severe cases: grafts |
|
|
Term
Entropion Summary:
1)Appearance?
2)Signs and symptoms?
3)Causes?
4)Treatment? |
|
Definition
1)Inward turning of the lid
2)Painful, red, tearing, scarring
3)Age, spasm, scarring, etc
4)Based on cause (varies from lubrication (protection) to surgery) |
|
|
Term
| List the subjective symptoms for trichiasis? |
|
Definition
-FB sensation
-Red eyes
-Pain
-Photophobia
-Tearing |
|
|
Term
| List the objective signs that you would look for while examining a patient suffering from trichiasis? |
|
Definition
-Conj scarring
-FB tracking on cornea (linear defects)
-Entropion
-Distichiasis
-Symblepharon formation |
|
|
Term
| Why would a physical examination be important for trichiasis patient? |
|
Definition
-Exam helps elucidate the cause of lash misdirection
-treatment is based on cause of misdirection |
|
|
Term
| List 4 causes for trichiasis? |
|
Definition
1)Infections
2)Autoimmune
3)Inflammation
4)Trauma (postsurgical, chemical, thermal burns) |
|
|
Term
| What are 3 infections that could result in trichiasis? |
|
Definition
1)Blepharitis
2)Herpes zoster
3)Trachoma (chlamydia) |
|
|
Term
| What is an example of an autoimmune disease that can cause trichiasis? |
|
Definition
| Ocular cicatricial pemphigoid |
|
|
Term
| What are the 3 categories for trauma that can cause trichiasis? give examples |
|
Definition
1)Postsurgical: floor fracture repair or blepharoplasty, after enucleation, after ectropion repair
2)Chemical: alkali burns, medical drops (ex: for glaucoma)
3)Thermal burns to face/lids |
|
|
Term
| List some differentials for trichiasis? |
|
Definition
-Blepharitis
-Blepharospasm
-Chemical burns
-Cicatricial Pemphigoid (OCP)
-Corneal Abrasion
-Corneal Foreign Body
-Distichiasis
-Entropion
-Red eye
-Stevens-Johnson Syndrome (SJS)
-Trachoma |
|
|
Term
| What are 2 inflammatory conditions that could result in trichiasis? |
|
Definition
1)Stevens-Johnson syndrome
2)Vernal keratoconjunctivitis |
|
|
Term
| How would you treat a patient suffering from trichiasis? |
|
Definition
-Lubricants to decrease irritant effect
-Medical therapy geared toward cases were more serious disease is the cause
-Surgery |
|
|
Term
| What are the 2 categories of surgical care procedures for trichiasis? |
|
Definition
1)Lash/follicle destroying
2)Lash/follicle repositioning |
|
|
Term
| List the 5 Lash/follicle destruction surgery options preferred for segmental or follicle trichiasis? |
|
Definition
1)Epilation (temporary, grows back short and irritating)
2)Electrolysis (painful)
3)Radiofrequency ablation (effective)
4)Cryosurgery (effective, complaints)
5)Wedge resection of lid |
|
|
Term
| What is a Lash/follicle repositioning surgery option directed towards an anatomical cause of trichiasis? |
|
Definition
|
|
Term
Trichiasis summary:
1)Describe
2)Common sign or symptom
3)Cause
4)Common treatment |
|
Definition
1)misdirection of lashes towards globe
2)Irritation
3)Infection, autoimmune, inflammation, trauma
4)Epilation |
|
|
Term
| What is an eyelid coloboma? |
|
Definition
-full-thickness defect of the eyelid (looks like notch missing)
-triangle defect- base of notch is primarily at the margin |
|
|
Term
| Which lid is primarily affected by a coloboma? |
|
Definition
upper lid
-usually between inner and middle 3rd of lid |
|
|
Term
| In cases were the lower lid has a coloboma, which section is involved? |
|
Definition
| Between the middle and outer 3rd of the lid |
|
|
Term
| What is the most common cause of a coloboma? |
|
Definition
-Though they are rare, it is primarily congenital, but may be do to trauma
-Upper lid colobomas often associated w/ cryptophthalmos (failure of lid to form) |
|
|
Term
|
Definition
-failure of eyelid formation
-lid skin grows continuously from forehead to the cheek, covering underlying globe |
|
|
Term
| What things should be included in history taken for a coloboma patient? |
|
Definition
-Perinatal and pregnancy history
-Family Hx of congential eyelid colobomas or other anomalies
-Hx of other current birth defects
-Pediatric review of systems
-Hx of progressive corneal problems |
|
|
Term
| What are 2 other things that you may see with an iris coloboma, associated to the eyelids? |
|
Definition
1)Trichiasis
2)Dermoid tumors |
|
|
Term
| What are 3 other things that you may see with an iris coloboma, associated to the conj? |
|
Definition
1)Injection (redness)
2)Symblepharon
3)Malformation of the caruncle |
|
|
Term
| What are 2 other things that you may see with an iris coloboma, associated to the cornea? |
|
Definition
1)Exposure keratopathy
2)Corneal scarring |
|
|
Term
| What are 2 other things that you may see with an iris coloboma, associated to the lens? |
|
Definition
|
|
Term
| What other ocular condition may you see with an iris coloboma, associated to the sclera? |
|
Definition
|
|
Term
| What are some causes for a coloboma? |
|
Definition
-congenital
-trauma
-defective fusion of temporal and nasal waves of mesodermal tissue
-ischemia- lid farthest from blood supply |
|
|
Term
| How would you treat a small defect or large defect awaiting surgery in a coloboma patient? |
|
Definition
-Artificial tears and ointment
-Moist chamber optical bandages
-Bedtime patching |
|
|
Term
| When would you suggest surgery for a coloboma patient? |
|
Definition
-When cornea is at risk due to size and location of coloboma
-Cosmesis |
|
|
Term
| In general, what does surgery entail for a large lid coloboma? |
|
Definition
| -2-stage reconstruction: tarsal reconstruction w/ skin graft |
|
|
Term
| Coloboma consultations would be scheduled w/ whom? |
|
Definition
-Pediatrician and/or neonatologist
-Genetic counselor |
|
|
Term
Coloboma summary:
1)Describe
2)Plan
3)Common treatment |
|
Definition
1)Rare, primarily congenital, full-thickness eyelid defect
2)Our goal is to protect the cornea and assist aesthetially
3)Surgery |
|
|
Term
|
Definition
| A crescent fold of skin that extends from the side of the nose to the lower lid and partially covers the inner canthus |
|
|
Term
| True/False Epicanthus is often described as asymmetrical. |
|
Definition
| False. Although it may be asymmetrical it invariably bilateral |
|
|
Term
| What would patient with epicanthus decribe as symptoms? |
|
Definition
-None in most cases
-Could limit field of view |
|
|
Term
| What is pseudo-esotropia? |
|
Definition
| A condition in which the alignment of the eyes is straight; however, they appear to be crossed |
|
|
Term
| Describe the patients that you would likely see in your office with epicanthus? |
|
Definition
-Infants and toddlers, esp of Asian descent (normal for 3-6ths old)
-Pts w/ autosomal dominant inheritance patterns (ex: trisomy 21)
-Pts w/ nonchromosomal systemic disorders |
|
|
Term
| List some systemic disorders associated w/ epicanthus? |
|
Definition
-Chromosomal Disorders
-Turner's syndrome
-Klinefelter's syndrome
-Deletion of short term arm of chromosome 5 or 18
-Deletion of long arm of chromosome 13
-Trisomy 10q+, 14q+, 18, 21, 22 |
|
|
Term
| List some nonchromosomal systemic disorders? |
|
Definition
-Ehlers-Danlos syndrome
-Smith-Lemli-Opitz syndrome
-Cerebrohepatorenal (Zellweger) syndrome |
|
|
Term
| What is the treatment plan for epicanthus? |
|
Definition
-Nothing
-Reassure parents that child will most likey outgrow the condition
-Reevaluate infants every 6 months for esotropia
-If it limits visual field, then surgery can be done |
|
|
Term
|
Definition
| Redundant and lax eyelid skin overhanging the margin |
|
|
Term
| Is dermatochalasis rare or common? |
|
Definition
|
|
Term
| What is age of onset for dermatochalasis? |
|
Definition
-Most frequently noted in the 40s and progresses with age
-Pts w/ familial tendency develop condition in their 20s |
|
|
Term
| What are the some causes for dermatochalasis? |
|
Definition
-Gravity
-Loss of elastic tissue in the skin
-Weakening of connective tissue |
|
|
Term
| Which lid is most commonly affected by dermatochalasis? |
|
Definition
| upper lid, but can be seen in the lower lid |
|
|
Term
| List some of the symptoms that a dermatochalasis patient may notice? |
|
Definition
-functional
-cosmetic (full or heavy upper lid, bags in lower lid, wrinkles in lower lid and lateral canthus)
-ocular irritation
-entropion of upper eyelid
-ectropion of lower eyelid
-Blepharitis
-Dermatitis (local inflammation) |
|
|
Term
| What signs would you observe/evaluate on a patient with dermatochalasis? |
|
Definition
-Amount of lid skin, thickness of skin, skin inflammation, skin lesions
-Note presence & measure upper lid creases(norm: 8-12 mm above lid)
-Levator muscle function (usually intact)
-Note abnormal lid margin position(norm: ~1mm below superior limbus) |
|
|
Term
| List some causes of dermatochalasis? |
|
Definition
-Aging
-Trauma
-Pts w/ severe periorbital edema may develop redundancy of the eyelid skin
-Chronic dermatitis
-Thyroid eye disease
-Floppy eyelid syndrome |
|
|
Term
| Thyroid eye disease frequently can be associated w/ dermatochalasis via? |
|
Definition
| Associated w/ infiltration of the orbital fat and extraocular muscles w/ immunoglobin complexes |
|
|
Term
| What is floppy eyelid syndrome? |
|
Definition
Disorder of the eyelids associated w/ severly redundant and lax lids
-affects skin and muscles
-tarsal plate develops rubbery consistency
-Chronic form leads to lax lid skin and orbicularis muscle |
|
|
Term
| List 5 differential diagnoses for dermatochalasis? |
|
Definition
1)Entropion
2)Floppy Eyelid Syndrome
3)Blepharochalasis
4)Steatoblepharon
5)Ptosis |
|
|
Term
What is blepharochalasis?
How is it distinct from dermatochalasis? |
|
Definition
-Rare disorder, typically affects upper lids
-Characterized by intermittent eyelid edema
-Results in relaxation of lid tissue & resultant atrophy
-Unilateral in ~50% |
|
|
Term
| A herniation of the orbital fat in the upper or lower eyelids is know as. . . |
|
Definition
|
|
Term
| How would you treat a dermatochalasis patient with blepharitis? |
|
Definition
| May benefit from lid hygiene and topical antibiotics |
|
|
Term
| How would you treat a patient w/ dermatochalasis and dermatitis? |
|
Definition
| May benefit from topical steroid ointment |
|
|
Term
| What is the general treatment for a patient suffering from dermatochalasis? |
|
Definition
Surgery
-upper eyelid blepharoplasty |
|
|
