Quiz Challenge 2018 (i)
Quiz Challenge:
Try the following questions with your colleagues.
1. Chalazia or “tarsal cysts” are very common clinical findings. However, when non-resolving, do they represent something more serious?
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Although a BCC or SCC can masqerade as a chalazion, sebaceous carcinoma is the most well known for mimicking chalazia, or even blepharitis. Hence any non resolving chalazion or “blepharitis” which affects just one lid, warrants suspicion and a biopsy. Sebaceous carcinoma is also one of the more aggressive skin tumours, and can metastasise and be life threatening.
2. As we age, many of us begin to get skin hood (dermatochalasis) over our upper lids. What will be the criterion to determine whether it is functional rather than a purely cosmetic problem?
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It is deemed to be functionally significant if it impinges on the visual field. It is important that the patient reports this themselves. If, in addition, the skin hood rests on the lashes, it is considered sufficient supportive objective evidence.
3. Upper lid ptosis is also a common problem as we age. What other clinical features should also be checked for?
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One needs to look for an abnormally constricted pupil which does not dilate as well as the other side when the room lights are dimmed ( which would indicate a Horner’s syndrome), and also check for evidence of an oculomotor paresis, which would, by contrast, demonstrate a weaker direct constriction response to light shone into it, compared to the other side.