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Pigmentations
Ephelis (Common freckle)
- Small, tan to brown macules
Lentigo simplex
- Small, brown to black macules
Solar lentigo
- Large, evenly pigmented macules on sun exposed skin
- Associated with Xerderma pigmentosum
Nevi
- Not all pigmented
- May change due to hormones (Pregnancy, puberty)
- Dermal
- Junctional
- Transitional
Nevus of Ito and Ota
- Large flat irregular regions of blue/gray pigmentation
- Ito: Deltoid, scapular region
- Ota: Periocular and face skin. Also episcleral, uveal hyperpigmentation
Mongolian spot
Blue nevus
Non-serious tumors
Benign sweat gland tumors
- Small yellow-white tumors in young women
Chloasma
- Large brown hyperpigmented areas
- Rule out melanoma
- Common with birth control pills
Dermoid
- Congenital, solid, slightly movable mass with overlying skin easily
movable
Granuloma
- Follow trauma or inflammation (Chalazion)
Keratoacanthoma
- Smooth domed papule from a hair follicle
- Rapidly grows to its max. size (to 2.6 cm) in 6 weeks
- Develops a central crater
- Eventually (1 yr.) central keratin plug discharged leaving a small
saucer shaped scar
- Always scars
- Not malignant
Milia
Sebaceous cyst
- Smooth, round, non-inflammed nodule
- Caseous (Cheesy) yellow in cyst if less than 3 mo. old
- Older cysts become fibrotic with paler white - yellow color
- Superficial are creamy white
- Deep have normal color skin above
- Central pore
- Puncture and express superficial cysts. Surgery for deep
Seborrhic keratosis
- Extremely common
- Tan, brown or black plaques
- Crumbling granular surface
- Grainy not keratinized
Senile sebaceous hyperplasia
- Enlarged glands
- Pale yellow, domed papules, with central umbilication
- Geriatrics
Skin tag
- Multilobular
- Non infectious
- No black dots like verrucae
Sudoriferous cyst
- Retention cyst (plugged) of sweat (Moll) gland
- May have fluid (clear) or sebum (cloudy) interior
- Non-inflammed, fluid filled cyst on anterior lid margin
- Puncture and wipe away contents
Serious tumors
Basal cell carcinoma
- 90% on head and neck (Sun)
- More common in fair complexion
- Pre 1950 acne treatments cause
- Waxy, smooth, shiny, with telangiectasia and pearly
- Rolled border
- Lower eyelid common
- Sunlight is factor
- No mestasization
- 30x more common than squamous
Nodular
- Raised noduleFirm
- Pearly smooth surface
- Surface telangiectasis
- Most common type
- Begins as translucent waxy gray or white papule
- Eventually ulcerate
Ulcerative
- Raised nodule
- Pearly rolled border
- Central ulcer crater
- Possibly bloody crust
Sclerosing
- Plaque
- Indistinct borders
- Pale, waxy, yellow
- Indurated
Multicentric
Capillary hemangiomas
- Can present in any orbital or periorbital location
- Proptosis, strabismus, amblyopia, astigmatism
Metastatic carcinoma
Sebaceous gland carcinoma
- Resemble benign inflammatory conditions (Chalazion)
- Yellowish gray nodule
Squamous cell carcinoma
- Start as actinic keratosis from sun damage
- Gray - brown scale floating above skin
- Sandpaper feel
- 25% keratosis become squamous
- May ulcerate and bleed
- Especially on lower lip, or from thermal damage
- May metastasize to lymph glands
- Firm scaly nodule with ulceration and bleeding
Malignant melanoma
- Bluish with red border
- Often grow, bleed, change color
Sarcomas
- Rhabdomyosarcoma
- Most common lid or conj. tumor
- Malignant
Disorders of the adnexa
Blepharochalasis
- Redundancy of skin due to lymphedema
Blepharoptosis
- Upper lid droop
- Congenital
- Acquired (Multiple sclerosis, myasthenia gravis, Graves disease)
Blepharospasm
- Does not occur during sleep
- Spastic forced closure of obicularis muscle
- "Tic"
- RX = Botulin A toxin injection or surgery
Coloboma
- Medial superior lid most often
Contusions
- Check for crepitation (Air in tissue)
- Sinus fracture
- Possible blowout fracture in floor
Dermatochalisis
- Lid skin overhanging lid margin due to aging
Ectropian
- Punctum hanging away from the tear contact
- Tearing eye
- Lubricants
Entropian
- Congenital defect
- Cicatricial
- Spastic
- Involutional (Senile)
- Trichiasis
- RX = Epilate, prophylactic antibiotic ung, lubricants, surgery
Epicanthal folds
Essential blepharospasm
Lagophthalmos
- Exposure keratitis
- AM syndrome
- Types
- Paralytic (VII palsy)
- Proptosis due to mass or fat
- Exophthalmos (Thyroid)
- Shallow orbit / Long eye
- Lid retraction (Hyperthyroid)
- Scarring
- Inferior cornea SPK
- RX = Lubricants, goggles, surgical tarsorrhapy
Lithiasis
- Calcium deposits in palpebral conjunctiva
Lymphangiectasis
- Dilated lymphatic vessels in conjunctiva
Myokemia
- Twitch
- Rule out foreign body, multiple sclerosis, myasthenia gravis,
high IOP
Poliosis
Ptosis
- Mechanical (Weight)
- Myogenic (Muscular dystrophy or Myasthenia gravis)
- Neurologic (III nerve damage)
Trichiasis
- Due to entropian, blepharitis, trauma
- RX = Epilate
- Lashes grow back in 2-4 weeks in children, 4-6 weeks
- Lubricants
- Broad spectrum antibiotics
Trichotillomania
- Neurotic twisting of hair
Vitiligo
- 50% Family history
- Autosomal dominate
- Rule out Vogt-Kayanagi-Harada and albinism
- Alopecia, poliosis, vitteligo, uveitis, hearing defect
- Check for thyroid disease, anemia's, pituitary disorder
Tear problems
Canaliculitis
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