Small Ani. Sx- Optho- Eyelids 1

wilsbach's version from 2015-11-29 00:30

anatomy + basic wedge resection

Question Answer
Components of the eyelidSkin, Subcutaneous CT, Orbicularis oculi, Tarsal glands/plate, Conjunctiva, cilia
functions of the eyelid?Corneal protection, FB removal, Production, distribution, and drainage of tear film, Oxygen exchange (conjunctiva)
If there is an eyelid laceration, how do you go about prepping to fix it? (dos and donts?)Clean the wound margins and conjunctival sac with saline and/or dilute betadine solution (no chlorhex!!). YOU MUST Minimize debridement! Just Freshen edges with scalpel blade (dont cut off to make a clean edge tho), don't need to worry too much bc Excellent vascular supply usually ensures healing of even contaminated wounds
what are some of the tools you would need to fix an eyelid?Need CRAZY tiny suture (as small as 10-0) and many tools
how once you have cleaned and freshened up and have all your tools you will need, how do you go about closing the eyelid laceration? (how many layers? what suture pattern?)Close in 2 layers, with 5-0 Vicryl for deep layer and 4-0 Vicryl for skin. Ensure accurate apposition of eyelid margin with figure-of-eight suture pattern.
aftercare of fixing an eyelid laceration?TAB ointment TID x 7-10 days, Systemic antibiotics x 7-10 days, Systemic NSAIDs x 3-5 days, Ecollar!!!
you cant do wedge resection repair of eyelid if you have lost more than how much of it?1/3 rule- can't 1* repair if lost more than 1/3
what is critical in simple eyelid laceration repairs?Margin apposition critical
Wedge Resection eyelid laceration repair... for closure must have less than _________ amount of eyelid gone. close in _________ layers.Must have lost less than 1/2 eyelid. And it is a 2 layer closure with a figure 8 suture pattern

Primary repairs / congenital eyelid conditions

Question Answer
3 reasons youd have to do Primary Repair of eyelid?(1) Greater than 1/3 margin affected (2) Large eyelid lacerations (3) Eyelid tumor resection
what are 2 primary repair procedures for eyelid repair?(1) H-plasty (2) Pedicle grafts
when performing primary repair of the eyelid (H-plasty or pedicle grafts) what is a big concern you will have?Concern for post-surgical trichiasis
what are 3 Congenital Eyelid Lesions?(1) Ankyloblepharon (2) Eyelid Agenesis (3) Dermoid
what is Ankyloblepharon? Since it is congenital, how old are they when you can dx this? What is the etiology of this?This is Delayed/Incomplete eyelid opening. Normally seen at 10-15 days old. Etiological agent is usually Staph/FHV-1
how should you go about treating ankyloblepharon?(fusion of eyelids, usually staph of FHV1 to blame) “All puss must drain”! Blunt NOT sharp dissection. Can try some warm moist compresses too. Eyelid closes temporal to nasal, so you should try to open nasal to temporal direction
which direction do eyelids close in?temporal to nasal (makes sense, pushing tears towards puncta and such)
what is coloboma?Partial palpebral fissure absence (like a subset of eyelid agenesis)
what is Eyelid Agenesis? WHO gets this most often? what are the consequences of this?Eyelids never developed. CATS get it more often than dogs. Consequences: Inability to blink normally--> Exposure keratitis + Conjunctivitis. Might also have Other congenital ocular diseases
what technique can you use to try to tx eyelid agenesis?pedicle graft
explain Pedicle Graft for Eyelid Agenesis procedurebasically graft part of skin around lid to make an eyelid
what is a Choristoma?Normal tissue in an abnormal location
what is a dermoid?basically a Choristoma (Normal tissue in an abnormal location) where the abnormal tissue is on the eye.
common dog and cow breeds to get dermoids?DOGS: St. Bernard, G.S., Dalmatian. COWS: Hereford
How do you treat a dermoid? (What does tx depend on?)Depends on size, location, visual impairment. Resection (may be indicated), +/- skin or conjunctival grafts

EYELASH DISORDERS + treatments + brachycephalic ocular syndrome

Question Answer
***WHAT IS TRICHIASIS?eyelids curl in and irritate cornea
***WHAT IS Distichiasis??When the eyelashes grow out of the MEIBOMIAN GLAND ORIFICES
***what is ECTOPIC CILIA?This is when the eyelash grows OUt OF THE CONJUNCTIVAL SURFACE (underside of eyelid)--- worst one, lots of ulcers
which is the worst- trichiasis, distichiasis, or ectopic cilia?ectopic cilia (most prone to causing ulcers)
**trichiasis vs distichiasis vs ectopic cilia (pic)
what 4 things compose Brachycephalic Ocular Syndrome?Macropalpebral fissures + medial trichiasis + medial lower lid entropion + pigmentary keratitis
what procedure can you do to tx brachycepahlic ocular syndrome? how is it done? (pic)(Macropalpebral fissures + medial trichiasis + medial lower lid entropion + pigmentary keratitis) Do a Medial Canthoplasty.
brachycephalics often get nasal fold do you tx this, what should you warn owners about?Need to do a Skin Fold Excision....but need to warn owners that you are removing those wrinkles they paid so much to get.
2 tx options for distichica? (when would you pick one over the other maybe?)(1) Electroepilation (if one or a few hairs- she doesnt really like bc can scar the area you are working with easily) (2) Cryoepilation (if many distichia) [she said never use CO2 laser to repair distichia]
distichia is when the eyelashes come out of the meibomian gland orifice-- where is this, why do we care about it?the openings of these glands is a surgical landmark called "the grey line". It is a landmark for eyelid repair- you don't want to go past the grey line
Ectopic Cilia- who tends to get these, and where?Think: young dogs, upper eyelids
what are the main clinical signs (basically sequelae) to ectopic cilia?Pain & blepharospasm & epiphora, Corneal ulceration!!!
gee you sure are having problems finding that ectopic cilia... what are some things that can tell you where it might be?(1) ULCER TELLS YOU WHERE THE PROBLEM IS (2) sometimes will see little pigment spot where problematic hair is coming out
how do you tx ectopic cilia?Excision +/- cryoepilation

Conformational (positional) Eyelid Abnormalities

Question Answer
what is Entropion?Eyelid inversion
what is Ectropion?Eyelid eversion
what is Lagophthalmos? who tends to get this?Inability to completely blink, usually brachycephalics
Combined Entropion-Ectropion is usually secondary to what? who tends to get this? what is it aka?Secondary to excessive eyelid length (euryblepharon). common in Bloodhounds, St. Bernards, Clumber Spaniel. sometimes called "diamond eye".
*what are the three etiological reasons for entropion?(1) Congenital/Genetic (2) Spastic (3) Cicatricial (Cats esp)
who tends to get congenital/genetic entropion?shar pei, chow chow, lab, many others...
*what is happening in Spastic entropion?Eyelids touch cornea--> there is pain, retrobulbar muscle pulls eye in to avoid pain--> eyelids roll in more bc eyeball isnt there to push them out more--> vicious cycle
what is Cicatricial entropion? who tends to get this?cats esp get this. caused by Fibrosis secondary to... Chronic spastic entropion, trauma, and irritation
Feline Entropion--> why do YOUNG cats tend to get entropion? (2)(1) 2° to conjunctivitis (more common...leads to the cicatricial entropion) (2) 2° corneal ulceration (from spastic type)
2 reasons OLD cats tend to get entropion?Lid laxity, Globe enophthalmos
why do persian cats tend to get entropion?Brachycephalic anatomy
why do maine coon cats tend to get entropion?Large jowls
*******When you are considering Entropion repair, in which you will need to "take out" the eyelid, what MUST YOU DO BEFORE YOU START TO FIX IT???MUST get rid of spastic component or you will over-correct!--> ectropion. USE proparacaine drops/ some LA to reduce spastic component before assessing for sx. (can always take more out, cant put it back in)
what is a way to TEMPORARILY fix entropion (say, it is a puppy too young to take to sx yet but you don't want the cornea ulcerating in the meantime)Eyelid Tacking-- helps treat spastic component.
what is the Hotz-Celsus Procedure? how do you do it?most common sx tx of entropion. You: (1) Do away with spastic component (2) Measure amount of skin to take out (w/ calipers) (3) Close using “law of bisection”
basically, know that there are TONS of sx ways to treat entropion, choice often depends on...area and degree of lid affected
*what happens if you forget to neutralize the spastic component of the entropion before you sx correct it?Over-correction --> Ectropion
what is a procedure you can do to help correct ectropion caused by overcorrection of entropion (or i guess just ectropion in general?)V to Y plasty.
Ectropion/Entropion (Euryblepharon) Combination do you do this?Hotz-Celsus & Wedge Resection PLUS Arrowhead with Eyelid Fissure Reduction: