Aseg exam 1 Facts

vertical lid shortening (upper and lower)cause nocturnal lagophthalmus

• Fact: lid turns inward
• Location/cause: Upper - microphthalmos; Lower - malformed retractor muscle
• Management: Holtz

• Facts: narrowing of palpebral fissure vertically and horizontally
• Type 1: female only, ovarian failure
• Type 2: male and female

Junction of middle and Upper middle 1/3 of lidSuperior: nasal and unilateral (Goldenhar syndrome)Inferior: lateral and bilateral (system abnormality, Treacher Collins, Amniotic bands)

• Present at birth
• African Amercian
• Down Syndrome

• Complete: most common
• Incomplete: usually remains fused medially
• Symblepharon: usually remains used superiorly

• Involutional: Due to age (Most common cause in adults) (Laxity/sagging)(Usually lower lid)
• cicatricial: Due to burns, trauma, or chronic inflammation; Associated with rosacea, chronic blepharitis
• congenital: 2ndary to vertical shortening of skin
• inflammatory: Atopic dermatitis; Herpes Zoster; Rosacea
• mechanical: 2ndary to edema, lid tumors
• paralytic: CNVII; Bell’s Palsy

• congenital: Dysgenesis of the lower eyelid retractors orstructural defects in the tarsal plate; Tarsal Kink Syndrome; Upper lid
• Acute Spastic Entropion: Spastic closure of the eyelids allows the orbicularis oculi muscle to overcome the lower lid retractors
• Involutional: Involution of the posterior lid retractors; Similar to spastic; Digital eversion of the lid is easy; Involution of the soft tissues of the orbit may lead to involutional enophthalmos and the entropion
• Cicatrical: scar tissue of the conjunctiva; digital eversion of the lid is difficult; results from - trauma, chemical burns, Stevens-Johnson's sydrome, ocular cicatrical pemphigoid (OCP), infections, topical medication

• Simple: no other malformations
• Complex: associated coloboma
• With cyst: optical stalk closure failure leading to orbital cyst with associated cleft syndromes
• Posterior: decreased TAL, but normal corneal diameter (hyeropia)

• coronal and sagittal sutures fuse early
• brachycephaly and mandibular prognathism -> broad and concave appearance

• underdeveloped midface
• webbed fingers
• dental problems
• hearing loss (50%)

• oxycephaly
• midfacial hypoplasia
• Cleft palate
• syndactyly

• congenital
• from fetal vascularaccident with anomalous branchial arch dvlpment

• Mandibulofacial dystosis
• Zygomatic bone fails to fuse with maxilla, frontal and temporal bones
• small lower jaw

• megalocornea with enlarged lens
• CB band wider than TM and SS on gonio

• Iris stretching
• lens zonule stretchin
• gpigment dispersion
• lens subluxation
• ectopia lentis
• glaucoma
• excessive mesenchymal tissue in angle

lens vesicle separates, but doesn't form correctly

• nonprogressive
• sceralization of the cornea
• opaque collagen bundles
• no inflammatory vascularization

• Steeper post corneal curvature
• normal anterior corneal curvature
• generally good vision
• variation of Peter's anomaly
• nonprogressive
• no relation to keratoconus

• Generalized
• Circumscribed

• opaque cornea protroduces thru eyelids due to intrauterine keratitis
• poor vision

• anterior conical protrusion of the center of the lens surface up to 3-4 mm
• due to thin anterior capsule and fragile basement membrane
• spontaneous rupture can occur

• Lens is small and relatively spherical
• increased antero-posterior thickness

• not a true coloboma (no missing tissue)
• segmental agenesis
• lens shape chnges b.c of zonule attach
• mentinferior flattening b.c CB colobom
• acaused by cysts and/or tumors of CB

Thickened, anteriorly displaced SL

• Axenfeld's + pigmentary retinopathy
• has abnormal EOG and ERG

• Corectopia
• Esotropia
• Absent deep tendon reflexes
• Post embryotoxon

• Axenfeld's anomaly + iris atrophy + corectopia +ectropion uvea
• iris atrophy varies from mild to marked thinning

• Rieger's anomlay + dental, facial, cranial and skeletal abnormalities
• mental retardation

• development abnormalities of central anterior segment
• iris strands may extend from collarette to the corneal scar

• central corneal scar
• absent or defective posterior stroma, descemet's and endothlium
• corneal leukoma

• Type 1: no lens involvement (iris adhesion)
• Type 2: lens involvement (cataract, abnormal lens position, corneo-lenticular adhesion)

anterior remnant of the hyaloid artery as it joins the tunica vasculosa lentis

• Congenital absence of the iris (can be partial)
• total absence rare. stump often present

• sterile granulomatous lesions caused by retained sebaceous secretion from meibomian glands
• typically progression from hordeolum
• may casue WTR astigmatism
• may cause mechianical ptsosis

plug of keratin and sebum within dialted orifice of a hair follicle (black head and white heads)

• Proliferation of epidermal cells
• any age, but most common in 30s-40s
• discharge foul smelling

• firm, round, mobile, flesh-colored
• superficial or subcutaneous
• keratinized: most opaque of the cysts

• abnormal proliferation of apocrine secretory sweat gland
• mostly solitary
• no seasonal changes
• not more symptomatic in hot weather typically larger then eccrine

most translucent of the cysts

• cystic lesions with a lining resembling that of the eccrine sweat gland
• typically smaller than appocrine
• increased prevalence in female
• worsens in hot/humid weather

• Smith: single
• Robinson: multiple

• proliferation of intra-epidermal duct eccrine sweat gland epithelium
• usually appears at puberty

blocked zeiss lash follicle gland

• non-translucent (may be sebaceous)
• Keratin, degenerated epithelial cells, granulates of fat and cholesterin in CT sac

• caused by occlusion of polosebaceous units
• results in retention of keratin
• tiny epidermoid cysts

• Most common benign eyelid growth
• benign hyerplasia of the squamous epi
• if cancerous it will change color, size, or show irregular margins
• generic germ for any papilloma of non-viral origin
• "papilloma" means benign epi lesion of skin or mucosa
• usually in older patients (30-40)
• de novo
• also called Acrochordan (skin tag)

• keratotic growth surrounds errythema
• scaly appearance, red underneath
• most common precancerous skin lesion
• 25% develop squamous cell carcinoma
• due to chronic sun exposure

• composed of basal intraepithelial cells
• found in old pple
• can be found all over body

• fibrovascular tissue
• risk of malignancy
• may resolve spontaneously
• can be spread by contact or with excision
• usually young pple, and pedunculated

• non-pigmented papillomatous lesion
• zones of squamous cells arranged in whrols
• may grow rapidly
• inflammatory variant of seborrheic keratosis
• may be viral. not certain
• mostly in males and old pple

• form of pseudoepitheliumatous hyperplasia
• some classify as squamous carcinoma
• appear in sun exposed areas
• may resolve spontaneously

• Blue Nevi: derived from dermal melanocytes, nevus cells located deep in dermis. uncommon
• Compound: derived from epidermal melanocytes. nevus cells from epidermis into dermis. middle aged pts
• Junctional Nevi: derived from epidermal melanocytes, cells at epidermal/dermal junction. younger ppl
• Intradermal: dervied from epidermal malanocytes; cells confined to dermis only. older pple. MOST COMMON NEVI. papillomatous with little/no pigment. no malignant potential

• "kissing" or "split" nevus
• very rare

• ispilateral melanocytosis of sclera and uveal tract
• can also be conjunctiva
• usually CNV (V1 or V2)
• low risk of malignancy

• Plexiform: kids wtih Neurofibromatosis 1
• Solitary: adults, 25% with NF1

• freckles
• focal areas of cutaneous melanocytic over activity
• no malignant potential
• common with light complexions in sun-exposed areas

• flat or slightly elevated, creamy yellow plaques composed of lipid histocytes and inflammation
• most pple have normal lipid levels
• if age 30 wth arcus and xanthelesma suspect Hyperlipidemia

• congenital, subcutaneous venular formation (dilated, blood filled space)
• follows dermatomes
• always present at birth
• does not blanch
• risk of glaucoma

• hamartomatous growth of capillary blood vessels
• proliferation of vascular channels in dermis and subcutaneous tissue
• most common pediatric eyelid/orbital tumor (but still rare)
• appears witin 1mo of age
• rapid growth in 2 phases (peak 3-8mo)
• may spontaneously involute after 1yr
• "strawberry nevus"
• females 3x more likely
• blanches with pressure
• may swell with crying
• can have extraconal elements (muscle)
• involvement of conj common

• Red mass at site of chronic inflammation
• collection capillaries
• Bleeds readily
• Hemorrhagic pyogenic granuloma (very red)
• not pyogenic or granulomatous

• central ulceration
• firm, pearly in color
• nodular or flatter presentation
• most common malignant eye tumor (90%)
• locally invasive, rarely metastatic
• typicall in males, older pple

LL>UL>M canthus> L canthus

• Nodular: "rodent ulcer" (most common)
• Morpheaform: sclerosing (most invasive)

• scaly, ulcerated
• more of an erythematous plaque
• often arise from actinic keratosis
• less common than basal cell carcinoma
• more aggressive than basal cell carcinoma
• less than %5 of malignant eyelid tumors
• 2nd most common tumor
• low risk of metastasis
• spreads through lymph noes (20%)

• Hutchinson Freckle
• uncommon (10% of cases)
• old ppl, sun damaged skin infiltrates dermis and becomes malignant

• very rare
• highly malignant
• most common age 50-70, mostly in females
• pagetoid spread (uneven)

• MOST LETHAL PRIMARY SKIN TUMOR
• very rare (<1%)
• rapid growth with color change

• soft tissue sarcoma
• vascular tumor
• biolaceous nodule
• nontender
• very malignant if immunocompromised

• entropion (pseudo-trichaisis)
• cicatrical eye disease: Steven-Johnson and ocular cicatrical pemphigoid where lid is scarred
• Chronic blepharitis
• inflammation
• idiopathic

Upper lid lashes sag downward

• double row of lashes
• ectopic lashes that grow posterior to or out of meibomian glands
• normally softer, shorter and finer

• rare
• primary epithelial germ cell destined to differentiate into a specialized sebaceous gland of the tarsus develops into a complete pilosebaceous unit
• distichiasis lymphadenopathy syndrome

• Metaplasia and dedifferentiation of the meibomian glands to become hair follicles
• most important cause = late stage cicatrizing conunctivitis associated with chemical injury, Steven-Johnson, and ocular cicatrical pemphigoid

Excessive lash growth

• AIDS
• hypothyroidism
• Latisse (Allergan)
• Cyclosporin (restasis)
• Prostaglandin Analog (glaucoma med)
• Oculocutaneous albinism type 1

loss of lashes, brow, or both

• chronic blepharitis
• sebaceous cell carcinoma
• burn
• trauma
• trichotillomania
• hypothyroidism
• psoriasis
• seborrheic dermatitis (assoc dry skin)
• chemo
• CT disease
• malnutrition
• Alopecia (hair loss)

total absent of melanin in hair follicle of lash or brow