Oculoplasty Practice Questions

Q: Best method of treatment for segmental trichiasis

Cryoepilation. ***Cryoepilation*** - Cryoepilation is effective for **segmental trichiasis** because it destroys the **hair follicle** and the associated melanocytes, preventing regrowth. - It utilizes **freezing temperatures** to create a zone of necrosis, leading to permanent destruction of misdirected eyelashes. *Argon laser destruction* - Argon laser destruction is generally **less effective** for trichiasis because it primarily targets pigmented structures and may not reliably destroy the entire **hair follicle**. - It has a higher risk of **collateral damage** to surrounding tissues compared to cryotherapy, especially in non-pigmented lashes. *Electrolysis* - Electrolysis is useful for **solitary** or a few misplaced lashes but is **time-consuming** and less practical for segmental involvement. - The procedure involves inserting a **fine needle** into each follicle to deliver an electric current, which can be tedious and prone to recurrence if the follicle isn't fully destroyed. *Epilation* - Epilation, or **plucking**, offers only **temporary relief** as the lash will regrow in 3-6 weeks. - Repeated epilation can lead to **follicular distortion** and ultimately worsen trichiasis or cause secondary complications like infection.

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.

Question 1

Best method of treatment for segmental trichiasis

Accepted Answer

Cryoepilation

Answer

Argon laser destruction

Answer

Electrolysis

Answer

Epilation

Question 2

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 3

MC site of basal cell carcinoma of eyelid:

Accepted Answer

Lower eyelid

Answer

Medial canthus

Answer

Upper eyelid

Answer

Outer canthus

Question 4

The following is not a variety of entropion -

Accepted Answer

Pathological

Answer

Involutional

Answer

Spastic

Answer

Cicatrix

Question 5

Most common cause of ptosis in adults

Accepted Answer

Aponeurotic

Answer

Idiopathic

Answer

Myasthenia gravis

Answer

Paralysis of 3rd nerve

Question 6

Tylosis refers to:

Accepted Answer

Hypertrophy and drooping of eyelid

Answer

Distortion of cilia

Answer

Senile eversion of eyelid

Answer

Inversion of eyelid

Question 7

Incomplete closure of palpebral aperture is called:

Accepted Answer

Lagophthalmos

Answer

Entropion

Answer

Chalazion

Answer

Ectropion

Question 8

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 9

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 10

Fasanella Servat operation is specifically indicated in -

Accepted Answer

Horner's syndrome

Answer

Congenital ptosis

Answer

Steroid induced ptosis

Answer

Myasthenia gravis

Oculoplasty — MCQs

Oculoplasty — MCQs

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