Oculoplasty Practice Questions

Q: Surgery of choice in a patient with congenital ptosis with good levator action is:

LPS resection. ***LPS resection*** - **Levator palpebrae superioris (LPS) resection** is the surgery of choice for congenital ptosis with **good levator action** (typically defined as >8-10 mm of levator function). - This procedure directly shortens and strengthens the **levator muscle**, improving eyelid elevation. *Fascia lata sling surgery* - This procedure is indicated for patients with **poor or absent levator function** (typically 10 mm). - It involves resecting a small amount of **Müller's muscle**, **conjunctiva**, and occasionally the **tarsal plate**, but is less effective for moderate-to-severe ptosis. *Müller's resection* - **Müller's muscle resection** is generally reserved for **mild ptosis** (1-2 mm) that responds positively to the **phenylephrine test**. - It primarily addresses ptosis due to sympathetic denervation or mild aponeurotic disinsertion, not significant congenital ptosis with good levator function.

Q: MC site of basal cell carcinoma of eyelid:

Lower eyelid. ***Lower eyelid*** - The **lower eyelid** is the most common site for basal cell carcinoma (BCC) of the eyelid, accounting for approximately **50-60%** of all eyelid BCCs. - This high frequency is due to increased exposure to **UV radiation**, which is the primary risk factor for BCC development. - BCC often presents as a **pearly nodule** with telangiectasias and central ulceration, frequently found on the lower lid margin. *Medial canthus* - The medial canthus is the **second most common site**, accounting for approximately **25-30%** of eyelid BCCs. - Tumors in this area can be **more aggressive** and challenging to treat due to proximity to the lacrimal system and orbital structures. - Medial canthal BCCs may require more extensive surgical reconstruction. *Upper eyelid* - The upper eyelid accounts for only **10-15%** of eyelid BCCs, making it significantly **less common** than the lower eyelid. - This is due to **less direct sun exposure** compared to the lower lid, as the upper lid is often shaded by the brow. *Outer canthus* - The outer (lateral) canthus is the **least common site**, accounting for only about **5%** of eyelid BCCs. - Tumors here may present with similar features but are much less frequently encountered than those on the lower lid or medial canthus.

Q: The following is not a variety of entropion -

Pathological. ***Pathological*** - This term is not a specific variety used to classify entropion; rather, **entropion itself is a pathological condition**. - Entropion is categorized by its underlying cause or mechanism, such as involutional, spastic, or cicatricial, not by general pathological descriptor. *Involutional* - This is a common type of entropion, typically seen in older individuals due to **age-related laxity of the eyelid tissues**. - It results from horizontal eyelid laxity, disinsertion of the lower eyelid retractors, and overriding of the preseptal orbicularis muscle. *Spastic* - This type of entropion is caused by **spasm of the orbicularis oculi muscle**, often triggered by ocular irritation or inflammation. - It is frequently seen after eye surgery or in the presence of an ocular foreign body. *Cicatrix* - Also known as cicatricial entropion, this variety is caused by **scarring or fibrous contraction of the conjunctiva and tarsus**. - It can result from conditions like **trachoma**, chemical burns, or chronic blepharitis, pulling the eyelid margin inward.

Q: Most common cause of ptosis in adults

Aponeurotic. ***Aponeurotic*** - **Aponeurotic ptosis** is the most common cause of adult-onset ptosis, resulting from a dehiscence, disinsertion, or stretching of the **levator aponeurosis**. - It typically presents as a gradual onset of ptosis and often occurs bilaterally, though one eye may be more affected. *Idiopathic* - While many cases may initially be labeled idiopathic, a specific cause, such as **aponeurotic changes**, is often identified upon closer examination. - This term is a general descriptor and not a specific pathophysiological mechanism. *Myasthenia gravis* - **Myasthenia gravis** can cause fluctuating ptosis that worsens with fatigue, but it is not the most common cause overall. - It is an **autoimmune neuromuscular junction disorder** characterized by weakness in various skeletal muscles. *Paralysis of 3rd nerve* - **Third nerve palsy** causes ptosis along with other signs like an **out-and-down eye deviation** and a **dilated pupil** (if parasympathetic fibers are involved). - While it causes significant ptosis, it is less common than aponeurotic ptosis and presents with a distinct constellation of symptoms.

Q: Tylosis refers to:

Hypertrophy and drooping of eyelid. ***Hypertrophy and drooping of eyelid*** - **Tylosis** specifically refers to the **thickening and hypertrophy** of the eyelid margins, often accompanied by **ptosis** or drooping. - This condition can lead to cosmetic concerns and, in severe cases, obstruct vision. *Distortion of cilia* - **Distortion of cilia** (trichiasis) involves misdirected eyelashes that rub against the cornea, causing irritation. - While cilia are part of the eyelid, their distortion alone is not what tylosis signifies; tylosis involves the eyelid margin itself. *Senile eversion of eyelid* - **Senile eversion of the eyelid** is known as **ectropion**, where the eyelid turns outwards, commonly due to age-related tissue laxity. - This is distinct from tylosis, which is about thickening and drooping, not the eversion of the lid margin. *Inversion of eyelid* - **Inversion of the eyelid** is called **entropion**, where the eyelid turns inwards, causing eyelashes to rub against the globe. - Like ectropion, entropion is a positional abnormality of the eyelid, functionally different from the hypertrophy and drooping characteristic of tylosis.

Q: Incomplete closure of palpebral aperture is called:

Lagophthalmos. ***Lagophthalmos*** - This condition refers to the **inability to close the eyelids completely**, leading to exposure of the ocular surface. - It can result from **facial nerve palsy**, trauma, or an abnormally prominent globe, increasing the risk of dry eyes and corneal damage. *Entropion* - This is a condition where the **eyelid margin turns inward**, causing the eyelashes to rub against the cornea. - It typically causes irritation, foreign body sensation, and tearing, but not incomplete closure of the palpebral aperture itself. *Chalazion* - A chalazion is a **painless, firm nodule** in the eyelid caused by the obstruction and inflammation of a Meibomian gland. - It does not primarily affect the ability to close the eyelid, although a very large chalazion might mechanically interfere with full closure. *Ectropion* - This condition involves the **everting or turning outward of the eyelid margin**, leading to exposure of the conjunctiva. - While it primarily affects tear drainage and causes conjunctival irritation, it is a distinct entity from lagophthalmos, though the two conditions may occasionally coexist.

Q: Which of the following is not a type of surgery done for entropion?

Kuhnt surgery. ***Kuhnt surgery*** - **Kuhnt surgery** refers to procedures for **ectropion**, which is the outward turning of the eyelid margin, not entropion. - This procedure typically involves **resection of the tarsus and conjunctiva** to tighten the lower lid and correct its eversion. *Wheeler Procedure* - The **Wheeler procedure** is a surgical technique used to correct **entropion**, particularly to address chronic or spastic forms. - It involves a skin and muscle flap to evert the eyelid margin. *Lateral tarsal split procedure* - The **lateral tarsal split procedure** is a common surgical method for **entropion** repair. - It involves a horizontal incision through the eyelid, often combined with placement of sutures, to evert the eyelid margin. *Quicke Procedure* - The **Quickert procedure** (often spelled "Quickert") is a surgical technique for **entropion** that involves everting sutures and sometimes a horizontal shortening of the eyelid. - It aims to reposition the eyelid margin to prevent the inward turning of the lashes.

Q: All of the following are methods to treat spastic entropion except:

Wies marginal rotation. ***Wies marginal rotation*** - The Wies marginal rotation procedure is a surgical technique primarily used for the permanent correction of **involutional entropion**, involving horizontal eyelid shortening and rotation of the eyelid margin. - While it can address severe entropion, it is generally considered a definitive surgical correction rather than a temporary or non-surgical method for spastic entropion, which might resolve spontaneously or with less invasive interventions. *Quickert suture* - The Quickert suture technique is a minimally invasive surgical procedure that uses sutures to evert the eyelid, providing a temporary or semi-permanent solution for entropion, including **spastic entropion**. - It is commonly employed to stabilize the eyelid in cases of spastic entropion by tightening the lower eyelid retractors and reducing inward rotation. *Eyelid taping* - **Eyelid taping** is a non-invasive, temporary method used to manage spastic entropion by mechanically everting and holding the eyelid in the correct position. - This technique is often used as a first-line treatment, especially for new-onset cases or in situations where definitive surgical treatment is delayed, to protect the cornea from irritation. *Botox injection* - **Botox (botulinum toxin type A) injections** are used to treat spastic entropion by temporarily paralyzing the preseptal orbicularis oculi muscle, which is responsible for the spasm and inward turning of the eyelid. - This leads to relaxation of the muscle and eversion of the eyelid, effectively relieving the symptoms of spastic entropion for a limited period.

Q: Fasanella Servat operation is specifically indicated in -

Horner's syndrome. **Horner's syndrome** * The **Fasanella-Servat procedure** is a useful surgical technique for correcting mild to moderate ptosis, particularly in cases where the **Müller's muscle** function is impaired, as seen in **Horner's syndrome**. * This operation involves resecting a small portion of the conjunctiva and **Müller's muscle**, effectively tightening the eyelid and elevating it. *Congenital ptosis* * Cases of **congenital ptosis** often involve poor function of the **levator palpebrae superioris muscle**, making procedures that rely on Müller's muscle such as Fasanella-Servat less effective. * More extensive surgical interventions, such as **levator resection** or **frontalis sling surgery**, are typically indicated for congenital ptosis depending on the degree of levator function. *Steroid induced ptosis* * **Steroid-induced ptosis** is generally reversible upon discontinuation or reduction of steroid use. * Surgical intervention is rarely the primary treatment for steroid-induced ptosis, as the underlying cause is often transient. *Myasthenia gravis* * **Myasthenia gravis** causes fluctuating ptosis due to an autoimmune attack on **acetylcholine receptors** at the neuromuscular junction. * Treatment primarily involves medical management with **cholinesterase inhibitors** or immunosuppressants; surgery is generally considered only in stable, well-controlled cases with significant residual ptosis, and often involves less invasive **Müllerectomy** procedures.

Q: Ankyloblepheron is defined as

Adhesion of the eyelid margins to each other. ***Adhesion of the eyelid margins to each other*** - **Ankyloblepharon** specifically refers to the condition where the **eyelid margins fuse together**, either partially or completely. - This can be congenital or acquired due to inflammation, trauma, or burns. *Adhesion of the lid to the eyeballs* - This condition is known as **symblepharon**, where the conjunctiva of the lid adheres to the bulbar conjunctiva or cornea. - It often results from severe conjunctival inflammation or injury, such as chemical burns. *Inturned eyelash* - An inturned eyelash is called **trichiasis**, where eyelashes grow inwards and rub against the cornea or conjunctiva. - This can cause irritation, corneal abrasions, and ultimately vision impairment. *Inflammation of the lid margin* - Inflammation of the lid margin is known as **blepharitis**, a common condition characterized by redness, swelling, and crusting along the eyelid edges. - It is typically caused by bacterial infection, meibomian gland dysfunction, or allergic reactions.

Question 1

Surgery of choice in a patient with congenital ptosis with good levator action is:

Accepted Answer

LPS resection

Answer

Fascia lata sling surgery

Answer

Fasanella-Servat operation

Answer

Müller's resection

Question 2

MC site of basal cell carcinoma of eyelid:

Accepted Answer

Lower eyelid

Answer

Medial canthus

Answer

Upper eyelid

Answer

Outer canthus

Question 3

The following is not a variety of entropion -

Accepted Answer

Pathological

Answer

Involutional

Answer

Spastic

Answer

Cicatrix

Question 4

Most common cause of ptosis in adults

Accepted Answer

Aponeurotic

Answer

Idiopathic

Answer

Myasthenia gravis

Answer

Paralysis of 3rd nerve

Question 5

Tylosis refers to:

Accepted Answer

Hypertrophy and drooping of eyelid

Answer

Distortion of cilia

Answer

Senile eversion of eyelid

Answer

Inversion of eyelid

Question 6

Incomplete closure of palpebral aperture is called:

Accepted Answer

Lagophthalmos

Answer

Entropion

Answer

Chalazion

Answer

Ectropion

Question 7

Which of the following is not a type of surgery done for entropion?

Accepted Answer

Kuhnt surgery

Answer

Wheeler Procedure

Answer

Lateral tarsal split procedure

Answer

Quickert Procedure

Question 8

All of the following are methods to treat spastic entropion except:

Accepted Answer

Wies marginal rotation

Answer

Quickert suture

Answer

Eyelid taping

Answer

Botox injection

Question 9

Fasanella Servat operation is specifically indicated in -

Accepted Answer

Horner's syndrome

Answer

Congenital ptosis

Answer

Steroid induced ptosis

Answer

Myasthenia gravis

Question 10

Ankyloblepheron is defined as

Accepted Answer

Adhesion of the eyelid margins to each other

Answer

Adhesion of the lid to the eyeballs

Answer

Inturned eyelash

Answer

Inflammation of the lid margin

Oculoplasty — MCQs

Oculoplasty — MCQs

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