Oculoplasty Practice Questions

Q: What does the following image show?

Entropion. ***Entropion*** - This image clearly depicts the **lower eyelid rolling inward towards the eye**, causing the eyelashes to rub against the cornea. - This inward turning is the defining characteristic of **entropion**, leading to irritation, pain, and potentially corneal damage. *Distichiasis* - **Distichiasis** is the presence of a double row of eyelashes, with the accessory row arising from the meibomian gland orifices. - The image shows a single, albeit inwardly directed, row of eyelashes, not an extra row. *Ectropion* - **Ectropion** is the opposite of entropion, where the eyelid turns **outward**, exposing the inner surface of the lid. - The image explicitly shows the eyelid turning *inward*, ruling out ectropion. *Normal eyelids* - **Normal eyelids** should properly cover and protect the eye, with the eyelashes directed outward, away from the corneal surface. - The depicted eyelid is clearly abnormal due to its inward rotation and irritation, indicating a pathological condition.

Q: What does the following image show?

Euryblepharon. ***Euryblepharon*** - The image shows an **enlarged palpebral fissure** and **vertical laxity of the eyelids**, consistent with euryblepharon. - This condition can lead to exposure keratopathy and tearing due to poor eyelid closure. *Coloboma* - A coloboma is a congenital defect where part of the eye structure (like the iris, retina, or eyelid) is **missing or malformed**. - It would typically appear as a **notch or gap** in the affected tissue, which is not depicted in this image. *Floppy eyelid syndrome* - Characterized by **loose, easily everted upper eyelids**, often occurring in obese males. - While there is eyelid laxity in the image, the primary feature here is the widened palpebral fissure and not easily everted eyelids. *Iridodialysis* - Iridodialysis is a **disinsertion of the iris root from the ciliary body**, often caused by trauma. - It would present as a **D-shaped pupil** with an area where the iris is detached, which is not seen here.

Q: What does the following image show?

Epicanthus. ***Epicanthus*** - The image shows an **epicanthal fold**, which is a fold of skin that covers the inner corner (medial canthus) of the eye, giving the appearance of a wider set of eyes. - This is a normal anatomical variation, especially common in individuals of East Asian descent and infants, but can also be a feature in certain genetic conditions like **Down syndrome**. *Telecanthus* - **Telecanthus** refers to an abnormally increased distance between the inner corners (medial canthi) of the eyes, while the interpupillary distance (distance between pupils) remains normal. - The image does not clearly depict an increased distance between the medial canthi that falls outside normal variation. *Ablepharon* - **Ablepharon** is an extremely rare congenital anomaly characterized by the partial or complete absence of eyelids. - The image clearly shows the presence of eyelids, ruling out ablepharon. *Epiblepharon* - **Epiblepharon** is a congenital condition where a fold of skin and muscle overrides the margin of the eyelid, causing the eyelashes to turn vertically or inward towards the globe, often leading to corneal irritation. - While it involves an extra fold of skin, it specifically affects the eyelid margin and eyelashes, which is distinct from the more generalized epicanthal fold seen in the image.

Q: What is the most common malignant tumour of eyelid?

Basal cell cancer. ***Basal cell cancer*** - **Basal cell carcinoma (BCC)** is by far the most common malignant tumor of the eyelid, accounting for approximately **90% of all eyelid malignancies**. - It typically appears as a **slow-growing nodule** with rolled borders, central ulceration, and telangiectasias, most commonly affecting the **lower eyelid and medial canthus**. - BCC is strongly associated with **chronic UV radiation exposure** and rarely metastasizes, but can cause significant local tissue destruction if untreated. *Sebaceous gland carcinoma* - **Sebaceous gland carcinoma** (also known as meibomian gland carcinoma) is a rare but aggressive malignant tumor arising from the sebaceous glands of the eyelid. - It accounts for approximately **1-5% of eyelid malignancies** and has a higher risk of metastasis compared to BCC. - More common in **Asian populations** and often masquerades as chronic blepharoconjunctivitis, leading to delayed diagnosis. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** is the **second most common** malignant eyelid tumor, accounting for approximately **5-10% of cases**. - It presents as a firm, erythematous nodule or plaque and has a higher metastatic potential than BCC. - Associated with **UV exposure, HPV infection**, and immunosuppression. *Melanoma* - **Melanoma** is a rare malignant tumor of the eyelid, accounting for less than **1% of eyelid malignancies**. - It arises from melanocytes and carries a significant risk of metastasis and mortality. - Presents as a pigmented lesion with irregular borders, but amelanotic variants can also occur.

Q: Internal hordeolum is due to inflammation of-

Meibomian glands. ***Meibomian glands (Correct)*** - An **internal hordeolum** results from acute **bacterial infection** (usually *Staphylococcus aureus*) and inflammation of a **Meibomian gland**, which are modified sebaceous glands located within the tarsal plate of the eyelid. - These glands produce the **lipid layer** of the tear film, and their blockage and infection lead to a painful, red lump on the **inner surface of the eyelid**. *Moll's gland (Incorrect)* - **Moll's glands** are modified apocrine sweat glands located near the base of the eyelashes. - Inflammation or infection of a Moll's gland would more commonly contribute to an **external hordeolum (stye)**, not an internal one. *Lacrimal gland (Incorrect)* - The **lacrimal gland** produces the watery component of tears and is located in the superotemporal orbit. - Inflammation of the lacrimal gland is called **dacryoadenitis**, which presents with swelling in the outer part of the upper eyelid and is distinct from a hordeolum. *Zeis gland (Incorrect)* - **Zeis glands** are sebaceous glands associated with the hair follicles of the eyelashes. - Similar to Moll's glands, infection of a Zeis gland is a common cause of an **external hordeolum (stye)**, which appears on the eyelid margin.

Q: Appropriate treatment for mild congenital ptosis?

LPS Resection. ***LPS Resection*** - **LPS (levator palpebrae superioris) resection/advancement** is the most common surgical treatment for congenital ptosis, especially in mild to moderate cases. - This procedure strengthens the levator muscle, improving eyelid position and is appropriate when the **levator function is good** (typically greater than 4mm). *Frontalis sling procedure* - The **frontalis sling procedure** is generally reserved for severe congenital ptosis with poor levator function (<4mm) or in cases where the levator muscle is absent or highly dysfunctional. - It uses the frontalis muscle to lift the eyelid indirectly, which is less ideal for mild ptosis. *Antibiotics and hot compression* - **Antibiotics and hot compression** are treatments for infectious or inflammatory conditions of the eyelid, such as a **hordeolum** (stye) or **chalazion**. - They are not effective treatments for anatomical defects like congenital ptosis, which requires surgical intervention. *Wedge resection of conjunctiva* - **Wedge resection of the conjunctiva** might be used in some cases of conjunctival prolapse or for correction of specific conjunctival lesions or abnormalities. - It is not a standard or appropriate treatment for congenital ptosis.

Q: In dacryocystorhinostomy (DCR), Lacrimal sac opens into:

Middle meatus. ***Middle meatus*** - In **dacryocystorhinostomy (DCR)**, a new connection is created between the lacrimal sac and the **nasal cavity**, specifically directing tears into the middle meatus. - This surgical procedure aims to bypass an obstruction in the **nasolacrimal duct**, allowing tears to drain directly into the nasal passage through this newly formed opening. *Supreme meatus* - The supreme meatus is a **rare anatomical variation**, located superior to the superior meatus, and is not the standard site for lacrimal drainage. - Surgical intervention in DCR does not target this region for tear evacuation. *Inferior meatus* - The **nasolacrimal duct** normally drains into the inferior meatus, but DCR is performed when this duct is **obstructed**. - Connecting the lacrimal sac directly to the inferior meatus is not the typical surgical approach for DCR. *Superior meatus* - The superior meatus receives drainage from the **posterior ethmoid cells** and the **sphenoid sinus**. - It is not the anatomical location for the lacrimal drainage system, nor is it the target for DCR.

Q: Chronic granulomatous inflammation in upper lid (painless swelling) is characteristic of:

Chalazion. ***Chalazion*** - A chalazion is a **chronic**, sterile, **lipogranulomatous** inflammation of the **meibomian glands**. - It presents as a **painless**, firm, round swelling in the eyelid, often in the upper lid due to the larger meibomian glands. *Trachoma* - Trachoma is a **chronic keratoconjunctivitis** caused by *Chlamydia trachomatis*. - It primarily affects the conjunctiva and cornea, leading to scarring, entropion, and eventual blindness, not a painless eyelid swelling. *Internal Hordeolum* - An internal hordeolum is an **acute** bacterial infection of a **meibomian gland**, forming an abscess. - It is typically **painful**, red, and tender, contrasting with the painless nature of the given presentation. *External hordeolum* - An external hordeolum (stye) is an **acute** bacterial infection of the **glands of Zeis or Moll** at the lid margin. - It is usually **painful**, red, and tender, presenting as a small pustule or nodule on the eyelid margin, not a deep-seated painless swelling.

Q: Hordeolum internum is -

Chronic granulomatous inflammation of Meibomian gland. ***Chronic granulomatous inflammation of Meibomian gland*** - A **hordeolum internum**, also known as an **internal chalazion** or simply **chalazion**, is a sterile, chronic **granulomatous inflammation** resulting from the obstruction and subsequent leakage of lipid secretions from a **Meibomian gland**. - It presents as a **painless, firm nodule** located deeper within the eyelid tissue (tarsal plate), differentiating it from an acute infection. - **Note:** While the acute phase may be called an "internal hordeolum," the chronic granulomatous stage is more commonly referred to as a **chalazion**. *Chronic infection of Zeis gland* - A chronic infection of the **gland of Zeis** would typically manifest as a persistent **external hordeolum (stye)** with chronic inflammation. - The **glands of Zeis** are sebaceous glands associated with eyelash follicles, located at the eyelid margin (more superficial than Meibomian glands). - This would present more superficially and is less common than Meibomian gland pathology. *Acute infection of Zeis gland* - An **acute infection** of the **gland of Zeis** is an **external hordeolum (stye)**, which is an acute, painful, localized infection at the eyelash follicle. - This typically presents as a **tender, red, swollen lump** at the eyelid margin, distinct from the painless, deeper lesion of hordeolum internum. *Acute infection of Moll gland* - An **acute infection** of the **gland of Moll** would also be a form of **external hordeolum (stye)**, as these are modified apocrine sweat glands located near the eyelash follicles. - Like Zeis gland infections, it would be characterized by **acute pain, redness, and swelling** at the eyelid margin, rather than the chronic granulomatous inflammation of a Meibomian gland.

Q: Which surgery is indicated for ptosis in Horner's syndrome?

Fasanella-Servat. ***Fasanella - servat*** - This procedure involves resecting the **tarsus**, **Müller's muscle**, and conjunctiva, effectively shortening the posterior lamella of the eyelid. - It is particularly useful for **mild ptosis** with good levator function, often seen in cases secondary to sympathetic denervation like **Horner's syndrome**. *Blaskovics operation* - This is a more complex external approach that involves the resection of the **levator aponeurosis** and Müller's muscle, which is generally reserved for more severe ptosis. - It is typically indicated for patients with **poor levator function** or significant ptosis that cannot be corrected by less invasive methods. *Frontalis sling* - This procedure is used for severe ptosis with **very poor or absent levator function**, often seen in congenital ptosis or oculomotor nerve palsy. - It involves using a sling material to connect the eyelid to the **frontalis muscle**, allowing the eyebrow to lift the eyelid. *Levator resection* - This operation is performed when there is moderate to severe ptosis with **some levator function** present. - It involves shortening the **levator palpebrae superioris muscle** to elevate the eyelid margin.

Question 1

What does the following image show?

Accepted Answer

Entropion

Answer

Distichiasis

Answer

Ectropion

Answer

Normal eyelids

Question 2

What does the following image show?

Accepted Answer

Euryblepharon

Answer

Coloboma

Answer

Floppy eyelid syndrome

Answer

Iridodialysis

Question 3

What does the following image show?

Accepted Answer

Epicanthus

Answer

Telecanthus

Answer

Ablepharon

Answer

Epiblepharon

Question 4

What is the most common malignant tumour of eyelid?

Accepted Answer

Basal cell cancer

Answer

Sebaceous gland carcinoma

Answer

Squamous cell carcinoma

Answer

Melanoma

Question 5

Internal hordeolum is due to inflammation of-

Accepted Answer

Meibomian glands

Answer

Moll's gland

Answer

Lacrimal gland

Answer

Zeis gland

Question 6

Appropriate treatment for mild congenital ptosis?

Accepted Answer

LPS Resection

Answer

Frontalis sling procedure

Answer

Antibiotics and hot compression

Answer

Wedge resection of conjunctiva

Question 7

In dacryocystorhinostomy (DCR), Lacrimal sac opens into:

Accepted Answer

Middle meatus

Answer

Supreme meatus

Answer

Inferior meatus

Answer

Superior meatus

Question 8

Chronic granulomatous inflammation in upper lid (painless swelling) is characteristic of:

Accepted Answer

Chalazion

Answer

Trachoma

Answer

Internal Hordeolum

Answer

External Hordeolum

Question 9

Hordeolum internum is -

Accepted Answer

Chronic granulomatous inflammation of Meibomian gland

Answer

Chronic infection of Zeis gland

Answer

Acute infection of Zeis gland

Answer

Acute infection of Moll gland

Question 10

Which surgery is indicated for ptosis in Horner's syndrome?

Accepted Answer

Fasanella-Servat

Answer

Blaskovics operation

Answer

Frontalis sling

Answer

Levator resection

Oculoplasty — MCQs

Oculoplasty — MCQs

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