Board Certified Ophthalmologist Oculoplastics and Orbital Disease 2

Question 1

What is the most common cause of acquired ptosis in adults in the United States?

Accepted Answer

Aponeurotic ptosis

Answer

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)?

Accepted Answer

Frontalis suspension

Answer

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?

Accepted Answer

Sympathetic pathway to the eye

Answer

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?

Accepted Answer

MRI with fat suppression and gadolinium

Answer

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?

Accepted Answer

Mohs micrographic surgery or wide local excision with frozen section control

Answer

Sebaceous cell carcinoma requires complete excision with margin control (Mohs or frozen sections) due to its pagetoid spread and high recurrence risk.

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist Oculoplastics and Orbital Disease 2