Board Certified Ophthalmologist Oculoplastics and Orbital Disease 2 — Questions and Answers
Question 1: What is the most common cause of acquired ptosis in adults in the United States?
- Aponeurotic ptosis (Correct answer)
- Myogenic ptosis
- Neurogenic ptosis (Horner syndrome)
- Mechanical ptosis
Correct answer: Aponeurotic ptosis
Aponeurotic (involutional) ptosis from dehiscence or disinsertion of the levator aponeurosis is the most common cause of acquired ptosis in adults.
Question 2: Which surgical procedure is preferred for correction of ptosis with poor levator function (less than 4 mm)?
- Frontalis suspension (Correct answer)
- Levator aponeurosis advancement
- Müller muscle-conjunctival resection
- Fasanella-Servat procedure
Correct answer: Frontalis suspension
Frontalis suspension is used for severe ptosis with poor levator function (<4 mm) because it harnesses the frontalis muscle to elevate the lid.
Question 3: A patient develops ipsilateral ptosis, miosis, and anhidrosis following carotid artery dissection. Which pathway is disrupted?
- Sympathetic pathway to the eye (Correct answer)
- Oculomotor nerve (CN III)
- Trochlear nerve (CN IV)
- Abducens nerve (CN VI)
Correct answer: Sympathetic pathway to the eye
Horner syndrome results from disruption of the sympathetic pathway; carotid artery dissection affects the postganglionic fibers that travel with the internal carotid artery.
Question 4: Which imaging modality is preferred for evaluating suspected optic nerve sheath meningioma?
- MRI with fat suppression and gadolinium (Correct answer)
- CT with contrast
- Ultrasound B-scan
- Plain X-ray of the orbits
Correct answer: MRI with fat suppression and gadolinium
MRI with fat suppression and gadolinium contrast best demonstrates the tram-track sign and soft tissue extent of optic nerve sheath meningioma.
Question 5: What is the first-line treatment for a small, localized sebaceous cell carcinoma of the eyelid with clear margins?
- Mohs micrographic surgery or wide local excision with frozen section control (Correct answer)
- Radiation alone
- Topical chemotherapy
- Observation with serial photography
Correct answer: Mohs micrographic surgery or wide local excision with frozen section control
Sebaceous cell carcinoma requires complete excision with margin control (Mohs or frozen sections) due to its pagetoid spread and high recurrence risk.
Question 6: Which of the following findings is most consistent with a diagnosis of basal cell carcinoma of the eyelid?
- Pearly nodule with rolled edges and loss of eyelashes (madarosis) (Correct answer)
- Painless yellow nodule with umbilicated center
- Rapidly growing lesion with central ulceration and bleeding
- Pigmented lesion with irregular borders
Correct answer: Pearly nodule with rolled edges and loss of eyelashes (madarosis)
Basal cell carcinoma typically appears as a pearly, indurated nodule with rolled edges; loss of eyelashes (madarosis) is an important clinical sign.
Board Certified Ophthalmologist Oculoplastics and Orbital Disease 2
What is the most common cause of acquired ptosis in adults in the United States?