Oculoplasty Practice Questions

Q: Valve of Rosenmuller is present in which part of lacrimal system?

Lacrimal sac. ***Lacrimal sac*** - The **valve of Rosenmüller** is located at the junction of the **common canaliculus** and the **lacrimal sac**. - This valve prevents the reflux of tears from the lacrimal sac back into the canaliculi. - It acts as a functional sphincter at the opening of the lacrimal sac. *Canaliculi* - The **canaliculi** are small ducts that drain tears from the puncta to the lacrimal sac. - While they connect to the lacrimal sac, the valve of Rosenmüller is specifically at their junction with the sac, not within the canaliculi themselves. - The **valves of Krause** are found within the canaliculi. *Puncta* - The **puncta** are small openings on the eyelid margin that collect tears from the ocular surface. - They are the entry points into the lacrimal drainage system, upstream from the valve of Rosenmüller. *Nasolacrimal duct* - The **nasolacrimal duct** extends from the lacrimal sac down to the nasal cavity. - The **valve of Hasner** (plica lacrimalis) is located at the distal end of the nasolacrimal duct, not the valve of Rosenmüller.

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: These instruments are used for the surgery of

Chalazion. ***Chalazion*** - The image displays ophthalmic instruments, specifically a **chalazion clamp** which is used to evert the eyelid and apply pressure during the excision or drainage of a chalazion. - A **chalazion** is a chronic lipogranulomatous inflammation of the meibomian gland, presenting as a painless nodule on the eyelid. *Ptosis* - **Ptosis** surgery involves procedures to correct drooping of the upper eyelid, often requiring instruments for muscle reattachment or resection, different from those pictured. - Common instruments for ptosis repair include forceps, scissors, and needle holders, but not typically a chalazion clamp. *Entropion* - **Entropion** is the inward turning of the eyelid margin, causing eyelashes to rub against the cornea. Surgical correction typically involves sutures or lid repositioning procedures. - While ophthalmic instruments are used, the specific clamp visible in the image is not primarily for entropion repair. *Ectropion* - **Ectropion** is the outward turning of the eyelid margin, often leading to eye irritation and excessive tearing. Surgical repair focuses on tightening the eyelid or skin grafting. - Surgical instruments for ectropion aim to restore the eyelid's normal position and function, distinct from the clamp shown.

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.

Question 1

Valve of Rosenmuller is present in which part of lacrimal system?

Accepted Answer

Lacrimal sac

Answer

Canaliculi

Answer

Puncta

Answer

Nasolacrimal duct

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

These instruments are used for the surgery of

Accepted Answer

Chalazion

Answer

Ptosis

Answer

Entropion

Answer

Ectropion

Question 10

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

Oculoplasty — MCQs

Oculoplasty — MCQs

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