1
Q
How is upper lid crease formed
A
Insertion of fibrous slips of tendon of LPS into the skin
2
Q
How is lower lid crease formed
A
Insertion of fibrous slips of fascia surrounding IR into the skin
3
Q
Function of eyelids
A
Protect from injuries and excessive light
Spreading tear film
Facial features
Convey State of wakefulness and attention
4
Q
Canthal tilt
A
Lateral Canthus is 2mm above MC
5
Q
LC more than 2mm above MC is called
A
Mongoloid slant
6
Q
LC more below MC is called
A
Anti mongoloid slant
7
Q
Horizontal palpebral fissure measures
A
30mm
8
Q
Vertical pallebral fissure measures
A
10mm
9
Q
Distance b/w Upper EL crease and U EL margin
A
4mm
10
Q
UL eyelid cover __mm of Cornea
A
2mm
Or 1/6th of cornea
11
Q
LL covers how much Cornea
A
It doesn’t
Just touches the limbus
12
Q
Tarsus is
A
Connective tissue that gives Framework to the eyelids
13
Q
Attachment on the upper border of the tarsus
A
Orbital septum
Mullers muscle
14
Q
Attachment to the anterior surface of the tarsus
A
LPS aponeurosis
15
Q
Attachment on lower border of the Inferior tarsus
A
Orbital septum
Capsulopalpebral fascia
Inferior Tarsal muscle
16
Q
Analogous of
1. LPS aponeurosis
2. Whitnals ligament
3. Mullers muscle
in the lower eyelid
A
Capsulopalpebral fascia
Lockwood’s ligament
Inferior tarsal muscle
17
Q
Length, thickness and height of tarsus
A
29 Mm long
1 Mm thick
Height: 10 Mm upper Tarsus; 5 Mm lower Tarsus
18
Q
Congenital malformations of Eyelid
A
Epicanthus
Epiblepharaon
BPES
Euryblepharon
Cryptophthalmos
Congenital Entropion/Ectropion
Coloboma
Congenital upper lid eversion
Ablepharon
Microblephron
Ankyloblephron
C
19
Q
Anterior to posterior anatomy of Eyelid margin
A
Skin
Cilia
Grey line
Meibomian gland orifice
Mucocutneous junction
Palpebral conjunctiva
20
Q
Pilosebaceous unit is
A
Cilia with sebaceous gland
Moll and Zeiss gland also present at the root
21
Q
Eye lid anatomy anterior to posterior
A
Skin
Subcutaneous areolar tissue
OO and LPS
Submuscular areolar tissue
Fibrous tissue (Tarsus & Orbital septum
Mullers
Conjunctiva
22
Q
Characteristic of Eyelid skin
A
Thinnest skin in body
Elastic, fine and folds easily
23
Q
Eyelid Epidermis layers
A
-Stratum Cornium
-Stratum Granulosum
-Stratum Spinosum
-Stratum Basale
24
Q
Dermis of Eyelid contains
A
Dense CT, Elastic fibers, BV, Lymphatics
-Papillae
-Glands: Sebaceous, Zeiss, Moll, Eccrine, Pilosebaceous unit
25
Grey line is made by
Riolan muscle
(Part of preseptal Orbicularis Oculi)
26
Grey line separates ____ &____
Anterior Lamellae
Posterior Lamellae
27
Why EL easily distended by edema or blood
Loose subcutaneous areolar tissue layer
28
Parts OO
Orbital
Prestarsal
Preseptal
29
Origin and insertion of ORBITAL parts of OO
1. MPL……LP Raphae
30
Origin of PRETARSAL, PRESEPTAL parts of OO
Deep head
-Lacrimal Fascia
-Post. Lacrimal Crest
Superficial head
-MPL
31
Insertion of PRETARSAL, PRESEPTAL parts of OO
LPL
32
Two muscles arising from Pretarsal OO
Horner/Pars lacrimalis
Riolan/Pars ciliaris
33
Function of Horner muscle
Drainage of tears by Lacrimal sac
34
Function of Riolan muscle
Keep lids in apposition to the globe
Forms grey line
35
Function of Orbital/Pretarsal/Preseptal
Close eyes forcefully
Winking
Blinking
36
Origin Of LPS
LWS
37
Insertion of LPS
Skin of UL
MPL
LPL
Upper Tarsal border
Superficial Tarsal border
Superior Conjunctival Fornix
38
Euryblepharon
Horizontal enlargement of PF
Lateral Canthal malposition
39
Ablepharon
No eyelids
Fish like mouth
40
Ankyloblepharon
A partial or complete adhesion of the upper and lower eyelid margins to each other.
41
Cryptoophthalmos
Eyelids replaced by skin
Complete or incomplete
42
In utero eyelid formation
1 mo
3 mo
5 mo
EL folds
Join
Retract
43
Types of Epicanthus
Tarsalis
Inversus
Palpebralis
Superciliaris
44
Epicanthus is
Folds of skin from UL or LL towards Medial canthus
45
Epiblepharon
Extra fold of skin across the Ant. Lid margin
Lashes vertically up esp medially
46
Dematochalosis
Excess drooping loose skin
47
Bells phenomenon
Normal
Inverse
Reverse
Perverse
Up out
Up in
Down out
Any direction
48
What is the definition of congenital ptosis?
Drooping of the upper eyelid present since birth or within the first year of life; upper lid margin below superior limbus >2 mm.
49
Which muscle is the primary elevator of the upper eyelid?
Levator palpebrae superioris (LPS).
50
What are the main insertions of the levator palpebrae superioris?
Tarsal plate (anterior surface), skin of upper lid, superior conjunctival fornix; lateral horn → lateral orbital tubercle; medial horn → posterior lacrimal crest.
51
What is Whitnall's ligament and its function?
A condensation of tissue around levator muscle acting as a **superior suspensory ligament** for the **eyelid** and **lacrimal gland**;
serves as a **pulley** for levator direction.
52
What is Müller's (superior tarsal) muscle and its action?
Smooth muscle with sympathetic innervation;
contributes **2 mm elevation** of the upper lid
inserts at upper border of tarsus.
53
Name major syndromes/conditions associated with congenital ptosis.
Double elevator palsy,
Blepharophimosis syndrome (BPES),
Marcus Gunn jaw-winking,
congenital fibrosis of EOM,
congenital myasthenic syndromes,
chronic progressive external ophthalmoplegia
congenital 3rd nerve palsy
Horner syndrome.
54
What is 'simple congenital ptosis'?
Most common form (~81%); isolated ptosis not associated with other anomalies; developmental anomaly of the levator muscle.
55
Describe histopathologic features of congenital ptosis (levator muscle).
Defective **fibrosis**, reduced/disrupted myofibers, **fat** infiltration, internalized nuclei, **atrophic** striated muscle, inflammatory cells, abnormal mitochondria, amorphous extracellular material.
56
What are some genes associated with congenital ptosis?
ZFHX4, COL25A1, PTOS1, loci on Xq24–Xq27.1 and other reported balanced translocations; inheritance can be multifactorial or X-linked.
57
What elements should be covered in history when evaluating ptosis?
Onset/duration, variability, photos, associated symptoms (jaw-winking, diplopia), trauma/surgery, birth history (forceps), family history.
58
What external facial signs should be examined in ptosis?
Facial asymmetry, head posture (chin elevation), forehead wrinkling, periocular inflammation or masses, lid crease, tired appearance.
59
How is levator function measured and why is it important?
Berkes method
determines surgery choice
60
What is Bell's phenomenon and its grading relevance?
Upward/outward rotation of eye on forced eyelid closure; graded by visible cornea on lifting closed eyelid; important to predict postoperative corneal exposure risk.
61
What is Iliff's sign?
Spontaneous reversion of eyelid eversion indicating fair-to-good levator function.
62
What are the management determinants for congenital ptosis?
Etiology, age, amblyopia risk, functional and cosmetic defect magnitude, levator function; ideal timing often around 4 years unless amblyopia present.
63
When is early surgery indicated in congenital ptosis?
When ptosis threatens the visual axis / causes or risks amblyopia — treat earlier than elective timing.
64
What procedure is preferred for mild congenital ptosis with good levator function?
Fasanella-Servat procedure or mullerectomy (for specific indications); mild ptosis <3 mm with good levator function.
65
What procedure is preferred for moderate ptosis with reasonable levator function?
Levator resection and advancement.
66
What is the recommended surgery for severe ptosis with poor levator function?
Frontalis sling (brow suspension) to connect frontalis muscle to tarsus.
67
What are goals of ptosis surgery?
Correct lid position, achieve symmetry, minimize lagophthalmos and corneal exposure, preserve ocular surface health.
68
What is the aim of a frontalis sling?
To bypass a dysfunctional LPS by using frontalis contraction to elevate the upper lid via a sling connecting frontalis to tarsus.
69
What materials are used for frontalis slings?
Autogenous fascia lata (from thigh), preserved fascia lata, silicone bands/rods, Silastic, ePTFE (Gore-Tex), nonabsorbable sutures.
70
List common complications of frontalis sling surgery.
Thigh wound hematoma/muscle herniation (if autogenous), foreign body reaction/granuloma, infection, extrusion, lagophthalmos, recurrence, need for repeat procedures.
71
What are indications for levator resection?
Good levator function (>5 mm) and moderate ptosis; amount of resection tailored to levator function and severity.
72
What are advantages and disadvantages of levator resection?
Advantages: customizable elevation, preservation of anatomy, small incision, quick recovery. Disadvantages: limited view, undercorrection ~19%, overcorrection ~7%.
73
What is a Whitnall's sling and when is it used?
Sling where levator aponeurosis is resected up to Whitnall's ligament and sutured to superior tarsal plate; used for moderate-severe ptosis with levator function 3–5 mm.
74
What are disadvantages of Whitnall's sling?
Eyelid eversion, undercorrection, high recurrence (~31% reported).
75
What is Fasanella-Servat procedure and its indication?
Posterior approach removing up to 3 mm of superior tarsus, conjunctiva, and Müller's muscle; indicated for mild ptosis (<3 mm) with good levator function.
76
What is mullerectomy (Müller's muscle-conjunctival resection) and when is it used?
Posterior resection of Müller's muscle and conjunctiva for mild ptosis when phenylephrine test is positive; removes 6.5–9.5 mm of tissue.
77
Compare frontalis sling vs levator resection—when to choose which?
Use levator resection when levator function is good; use frontalis sling for severe ptosis with poor levator function or bilateral severe cases.
78
What is Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome (BPES)?
A congenital syndrome with blepharophimosis, telecanthus, epicanthus inversus, and ptosis; may be AD with FOXL2 mutation; Type I includes ovarian insufficiency.
79
What is the two-stage surgical approach for BPES?
Stage 1 (age 3–5 yrs): medial canthoplasty for telecanthus/epicanthus; ~1 year later: ptosis correction (frontalis sling etc.).
80
What is Monocular Elevation Deficit / Double Elevator Palsy and its relation to ptosis?
Weakness of elevation in all superior gaze positions often with ptosis; may have inferior rectus restriction in 70% of cases and often associated strabismus.
81
What is Marcus Gunn jaw-winking syndrome?
A synkinesis where eyelid elevates with jaw movement due to aberrant connections between CN V motor branches and CN III superior division; graded mild/moderate/severe.
82
How is Marcus Gunn jaw-winking managed surgically?
Occlusion therapy for amblyopia; surgery often requires levator excision with frontalis sling to eliminate synkinetic movement.
83
What are main causes of Horner syndrome-related ptosis in children?
**Birth trauma** causing interruption of sympathetic pathway
presents with mild ptosis, miosis, iris heterochromia
phenylephrine test may be positive.
84
What are the key 'take home' points for congenital ptosis management?
Differentiate congenital vs acquired; detect sensory deprivation/amblyopia; identify cause; check for aberrant regeneration/EOM involvement; plan surgery mindful of complications.
85
What are the main classifications of ptosis?
Neurogenic (innervational defect),
Myogenic (muscle or neuromuscular junction disease)
Aponeurotic/involutional (levator aponeurosis defect)
Mechanical (mass effect or scarring).
86
What conditions can cause pseudoptosis due to lack of globe support?
Artificial eye, microphthalmos, phthisis bulbi, enophthalmos.
87
How can contralateral lid retraction mimic ptosis?
It makes the opposite normal lid appear ptotic since the upper lid normally covers the superior 2 mm of cornea.
88
How does ipsilateral hypotropia cause pseudoptosis?
The upper lid follows the hypotropic eye down; disappears when the hypotropic eye is used for fixation.
89
What are two causes of pseudoptosis from brow or skin changes?
Brow ptosis (skin excess or CN VII palsy) and dermatochalasis (overhanging upper lid skin).
90
What is the normal margin–reflex distance (MRD1)?
4–5 mm (distance between upper lid margin and corneal reflex).
91
What is the normal palpebral fissure height in males and females?
Males: 7–10 mm; Females: 8–12 mm.
92
How is ptosis severity graded by palpebral fissure difference?
Mild: up to 2 mm; Moderate: 3 mm; Severe: 4 mm or more.
93
How is levator function graded?
Normal ≥15 mm, Good 12–14 mm, Fair 5–11 mm, Poor ≤4 mm.
94
What upper lid crease findings suggest congenital vs aponeurotic ptosis?
Absent crease = poor levator (congenital); high crease = aponeurotic defect.
95
What is pretarsal show?
Distance between lid margin and skin fold in primary gaze.
96
What bedside sign may reveal contralateral lid droop in unilateral ptosis?
Manually elevating the ptotic lid → drooping of the opposite lid due to Hering’s law of equal innervation.
97
How is fatigability of ptosis tested?
Ask patient to maintain upgaze for 30–60 seconds; progressive drooping suggests myasthenia gravis.
98
What is Cogan’s twitch sign?
Overshoot of upper lid on saccade from downgaze to primary position, typical of myasthenia.
99
What extraocular muscle association may occur with congenital ptosis?
Superior rectus weakness (due to embryological association with levator).
100
What are common associations with simple congenital ptosis?
Unilateral/bilateral ptosis, absent lid crease, poor levator function, higher lid in downgaze, superior rectus weakness, refractive errors, chin elevation.
101
What proportion of congenital ptosis cases have Marcus Gunn jaw-winking?
About 5%.
102
What movements can trigger jaw-winking?
Chewing, sucking, opening mouth, contralateral jaw movement; less often jaw protrusion, smiling, swallowing, clenching teeth.
103
What is the treatment for moderate Marcus Gunn jaw-winking with significant synkinesis?
Unilateral levator disinsertion + ipsilateral brow suspension.
104
What is the treatment for severe/bilateral Marcus Gunn jaw-winking?
Bilateral levator disinsertion + bilateral brow suspension for symmetry.
105
What are third nerve misdirection syndromes?
Ptosis with bizarre lid movements accompanying eye movements, often post-acquired CN III palsy or facial nerve regeneration.
106
What are the features of involutional (aponeurotic) ptosis?
Age-related; variable usually bilateral ptosis, high/absent lid crease, good levator function, worsens at end of day, deep upper sulcus.
107
What condition can involutional ptosis mimic?
Ocular myasthenia gravis (due to diurnal worsening).
108
What are causes of mechanical ptosis?
Dermatochalasis, eyelid/ orbital tumors (e.g., neurofibroma), scarring, edema, anterior orbital lesions.
109
What anatomical differences predispose Asians to lash ptosis and absent lid crease?
Low insertion of levator aponeurosis near lashes, low septum insertion, presence of medial canthal fold.
110
What is conjunctiva–Müller resection and its indication?
Excision of Müller muscle + conjunctiva with reattachment; elevates lid 2–3 mm; used in mild ptosis with good levator function (≥10 mm), e.g., Horner syndrome.
111
When is levator advancement/resection indicated?
Ptosis of any cause with levator function ≥5 mm; amount of resection tailored to severity.
112
What are advantages of posterior levator advancement approach?
Predictable lid contour compared to anterior approach.
113
When is brow (frontalis) suspension indicated?
Severe ptosis (>4 mm) with very poor levator function (<4 mm); common in CN III palsy, BPES, failed levator surgery.
114
What sling materials are used for brow suspension?
Non-absorbable materials (silicone most common) or less commonly autologous fascia lata.
Eye
flashcards
Decks in class (23)
# Cards
-
Glaucoma46
-
Proptosis3
-
Lasers In Glaucoma9
-
Cataract102
-
Glaucoma 25
-
Trials In Glaucoma19
-
TRON3
-
Orbit21
-
Uveitis21
-
Squint80
-
Eyelids114
-
Glaucoma Surgery87
-
Corneal Ulcer35
-
Primary Congenital Glaucoma7
-
Miscellaneous37
-
Cornea95
-
Neuro-ophthalmology129
-
Optics132
-
Injury34
-
Retina144
-
Retina Anatomy24
-
Lens Anatomy7
-
Dry Eye32
