The document provides information about anatomy and disorders of the eyelid: - The eyelids perform the important function of spreading tears over the cornea. The palpebral aperture is the space between the upper and lower lids. The lid margin helps in drainage of tears via the lacrimal pump system. - Disorders mentioned include blepharitis, styes, entropion, ectropion, and tumors. Bacterial blepharitis is caused by Staphylococci and can cause ulcers and redness of the lid margin. Tumors include benign papillomas and malignant carcinomas such as basal cell carcinoma and sebaceous gland carcinoma. - Embryology details

1. ‫بسم‬
‫هللا‬
‫الرحمن‬
‫الرحيم‬
1

2. Anatomy of the eyelid
1. Eye lids perform an important function of spreading the tear film
over the cornea and palpebral conjunctiva
A. True
B. False
2. ……………………… is the elliptical space between the upper and the
lower lid.
A. Palpebral aperture
B. Canthi
C. Punctum
D. grey line
3. ……………………….help in drainage of tears by lacrimal pump system
A. Cornea
B. Conjunctiva
C. Lid margin
D. Blepharon
2

3. 4. The medial canthus is about 2 mm higher than the lateral canthus.
A. True
B. False
5. Each eyelid is divided into an upper and lower part , upper portion is
A. orbital part
B. tarsal part
C. Ciliary part
D. Intermarginal grip
6. ………………………….. lacrimal portion of the lid margin is rounded and
devoid of lashes or glands.
A. Medial
B. Lateral
C. Ciliary part
D. None
3

4. 7. Lid margin is divided into medial and lateral portion
by
A. Punctum
B. Horizontal sulci
C. Intermarginal grip
D. None
8. The lateral, ciliary portion of the eyelid consists of
A. Anterior border
B. Posterior border
C. Grey line
D. None
E. A and B
F. A,B,C
4

5. 9. Connective tissue of the lower eyelid arises from
A. Neuro ectodermal cells
B. Surface Ectoderm
C. mesenchyme
D. mesoderm
10.…………………………………divides the intermarginal strip into
an anterior strip and posterior strip
A. Grey line
B. Punctum
C. Lacrimal portion
D. None
5

6. 11. …………………………………Is between anterior border and posterior
border of the lateral part of lid margin
A. Lid margin
B. Intermarginal strip
C. Grey line
D. None
12. Anterior strip of the intermarginal strip is bearing
A. Mebomian gland
B. Eye lashes
C. Zeis gland
D. Moll gland
13. junction of skin and conjunctiva is
A. limbus
B. punctum
C. grey line
D. intermarginal strip
6

7. 14. anatomical land mark on lid margin is
A. Lid margin
B. Intermarginal strip
C. Grey line
D. None
15. ALL of these are parts of orbicularis muscle which forms an oval
sheet across the eyelids
A. The orbital part
B. Pretarsal
C. Preseptal parts
D. lacrimal part
16. orbicularis muscle is supplied by
A. facial nerve.
B. Occulomotor
C. Sympathetic nervous system
D. Trigeminal nerve
7

8. 17.Orbicularis muscle raises the upper lid It is supplied by a
branch of oculomotor nerve
A. True
B. False
18. Levator palpebrae superioris muscle (LPS) closes the eyelids
and is supplied by zygomatic branch of the facial nerve.
A. True
B. False
19. The neurovascular layer of the eyelid where anesthetic drug
may applied is
A. Submuscular areolar tissue
B. muscularis layer
C. Fibrous layer
D. Layer of non-striated muscle fibres 8

9. 20. …………………..dense connective tissue, of each lid, which give
shape and firmness
A. Septum orbitale
B. Tarsal plate
C. Fibrous layer
D. None
21. The upper and lower tarsal plates join with each other at medial
and lateral canthi; and are attached to the lid margins through
medial and lateral palpebral ligaments
A. True
B. False
22. Muller muscle which lies deep to the septum orbitale in both the
lids is innervated by
A. facial nerve.
B. Occulomotor
C. Sympathetic nervous system
D. Trigeminal nerve
9

10. 25. Muller muscle In the upper lid it arises from the fibres of
………………...muscle and in the lower lid from prolongation of
the … …………………
A. Rectus muscle ,LPS
B. LPS, superior rectus muscle
C. Inferior rectus muscle ,LPS
D. LPS, inferior rectus muscle
26. Descemet’s membrane and endothelium of cornea
originated
A. Neuro ectodermal cells
B. Surface Ectoderm
C. mesenchyme
D. mesoderm
10

11. 25. palpebral conjunctiva consists of three parts:
marginal, tarsal plate and orbital.
A. True
B. False
26. These figure shows
A. Cryptophthalmos.
B. Microblepharon.
C. Epiblepharon
D. Euryblepharon
E. None
11

12. 27. In the upper lid has another arterial supplied
A. superior arterial arcade
B. marginal arterial arcades
C. ophthalmic artery
D. none
28. ………………………………refers to unilateral or
bilateral horizontal widening of palpebral fissure
A. Cryptophthalmos.
B. Microblepharon.
C. Epiblepharon
D. Euryblepharon
12

13. 29. ………………………………….refers to a congenital anomaly
in which a horizontal fold of tissue rides above the
lower eyelid margin.
A. Cryptophthalmos.
B. Microblepharon.
C. Epiblepharon
D. Euryblepharon
30. Lymphatics draining the eyelids, conjunctiva and
orbital tissues are arranged in two groups Medial group
of lymphatics drain into:
A. Mandibular lymph nodes
B. subauricular lymph nodes
C. Periauricular lymph nodes
D. None
13

14. 31. facial nerve fibers to the sphenopalatine ganglion, then
Postganglionic secretomotor fibres finally reach the lacrimal
gland through the lacrimal nerve
A. True
B. False
32. The bones of orbit which one is delicate
A. Ethmoid
B. Sphenoid
C. Maxiliary
D. Zygometic
14

15. Embryology of eye
1. Development of eyeball can be considered to commence around
A. when the embryo has six pairs of somites
B. when the embryo has 16 pairs of somites
C. when the embryo has a pairs of somites
D. none
2. optic sulcus deepens, the walls of the prosencephalon overlying the
sulcus bulge out to form structure which later converted optic cup
A. optic stalk
B. lens placode
C. lens vesicle
D. surface ectoderm
3.The surface ectoderm overlying the optic vesicle form
A. lens placode
B. lens vesicle
C. surface ectoderm
D. None of the above 15

16. 4. part of the inner vascular layer of mesenchyme is
carried into the cup through the choroidal fissure
which locate :
A. optic stalk
B. lens placode
C. lens vesicle
D. surface ectoderm
5. The fibrous layer of mesenchyme surrounding the
anterior part of optic cup forms
A. optic stalk
B. iris
C. lens vesicle
D. cornea
E. sclera
16

17. 6. vascular layer of mesenchyme , which in the
peripheral region attaches to the anterior part of the
optic cup to form
A. iris
B. lens vesicle
C. cornea
D. sclera
E. None of the above
7. In the posterior part of optic cup the surrounding
fibrous mesenchyme forms
A. iris
B. lens vesicle
C. cornea
D. sclera
17

18. 8. Nervous retina arise from the
A. inner wall of the optic cup
B. Pigment epithelium
C. Outer wall of optic cup
D. Nueroectoderm
E. None of above
9. ……………………………… Cells of this layer form the
rods and cones.
A. Matrix cell layer.
B. Mantle layer.
C. Marginal layer
D. Surface Ectoderm
18

19. 10. Optic nerve fibres develop from the nerve
fibre layer of retina which grow into the optic
stalk by passing through the choroidal fissure
A. 7th week of gestation
B. 6th week of gestation
C. 33rd day of gestation
D. None of the above
11. Glial system of the nerve develops from
the
A. Neuro ectodermal cells
B. Surface Ectoderm
C. mesenchyme
D. mesoderm
19

20. 12. Sheaths of optic nerve arises from
A. Neuro ectodermal cells
B. Surface Ectoderm
C. mesenchyme
D. mesoderm
13. Lower and lateral walls of orbit
embryological y comes from Visceral
mesoderm of maxillary process respectively.
A. True
B. False
20

21. 14. All of these structure develop the end of 2nd month
of fetal life except
A. Lacrimal apparatus
B. The crystalline lens
C. Epithelium of the cornea
D. A and B
E. B and C
F. A only
G. None of the above
16. All of these part of Vitreous arises from
nueroecderm except
A. Primitive vitreous
B. Definitive vitreous
C. Tertiary vitreous
D. None of the above
21

22. Disorders of the eyelid
1. nflammations of the lacrimal sac is called
A. dacryocystitis
B. lacrimal abscess.
C. acute dacryoadenitis
D. None pf the above
2. Local causes of oedema are:
A. cavernous sinus thrombosis,
B. Loosening of lid connective tissue
C. Angioedema
D. None
E. All
22

23. 3. ulcerative blepharitis is caused by
A. Staphylococci infection
B. Streptococci
C. Propionibacterium acnes,
D. Moraxella
E. None
F. All
4. Aisha Hussein ,16 years old complaining about
chronic irritation, itching, mild photophobia.
She doesn’t have pain , diplopia but mild lacrimation on
watching TV .The symptoms are characteristically
worse in the morning. on examination she has small
ulcers and redness of lid margin . what disease you
may suspect ?
23

24. A. Bacterial blepharitis,
B. seborrhoeic or squamous blepharitis,
C. seborrhoeic blepharitis,
D. Posterior blepharitis
E. Meibomitis
5. Recurrent styes are associated with
A. Chalazion
B. Bacterial blepharitis,
C. Meibomitis
D. All
6. Predisposing factors of stye is except
A. Age.
B. Habitual rubbing of the eyes or fingering of the lids and
nose
C. chronic blepharitis
D. diabetes mellitus
E. acute dycryocystitis 24

25. 7. The inward turning of lashes along with the lid
margin is
A. Trichiasis
B. Pseudotrichiasis.
C. Ectropion
D. Madarosis
8. causes of trichiasis are except
A. cicatrising trachoma,
B. ulcerative blepharitis
C. Acute membranous conjunctivitis,
D. hordeolum externum
E. C and D
F. None
25

26. 1o. All eyelash disorders may complicate of these
recurrent corneal abrasions, superficial corneal
opacities, corneal vascularisation and non-
healing corneal ulcer.
A. True
B. False
11. Madarosis systemically causes include
A. chronic blepheriris,
B. radiotherapy or surgery done for any eyelid
lesion.
C. psoriasis,
D. leprosy.
E. C and D
F. D and A
G. All 26

27. 12. congenital entropion mostly seen
………………caused by improper development of lid
retractor
A. Upper lid
B. Lower lid
C. Both lids
D. All
13. This picture shows us
A. Viral blepharitis
B. Bacterial blepharitis
C. Tumor
D. None 27

28. 14. Blurred vision is symptoms of
A. Chalazion
B. Meibomitis
C. hordoelum externa
D. Anteroir blepharitis
E. None
15. chalazion usually leads
A. sebaceous cell carcinoma
B. hordoelum internum
C. A and B
D. None of the above
28

29. 16. Corynebacterium acne is associated
A. Bacterial blepharitis,
B. squamous blepharitis
C. seborrhoeic blepharitis,
D. Posterior blepharitis
E. None
17. Staphylococci eye infections include
A. Acute bacterial blepharitis
B. Chronic meiboimitis
C. Stye
D. All of the above
E. None
29

30. 18. Involutional entropion. It is common
occurrence due to
A. weakening of orbicularis muscle.
B. weakening or dehiscence of capsulopalpebral
fascia (uper lid retractor).
C. Over-riding of preorbital orbicularis.
D. Degeneration of palpebral conjunctiva tissue
E. All of the above
19. Involutional ectropion, It occurs due to
following changes
A. Horizontal laxity of lid margin
B. Normal canthals
C. Disinsertion of lower lid retractors.
D. A and C
E. None 30

31. 20. The most commonly observed malignant
tumours of the eyelid include
A. squamous cell carcinoma
B. basal cell carcinoma
C. sebaceous gland adenocarcinoma.
D. xeroderma pigmentosa
21. All of these are Pre-cancerous tumours except
A. squamous cell carcinoma
B. basal cell carcinoma
C. sebaceous gland adenocarcinoma.
D. xeroderma pigmentosa
E. A,B C
F. D only
31

32. 22. Papillomas are the most common benign tumours arising
from the surface epithelium. The following statement are
true about papillomas
A. Squamous papillomas derived from squamous cells
occur in adults, specific or related to human papilloma
virus (viral wart or verruca vulgaris). Its treatment
consists of simple excision.
B. basal cell papilloma), derived from basal cells occurs in
middle-aged the most common pattern is solid basal cell
carcinoma in which the dermis is regular appearance
C. A and B
D. None
23. Oral tetracycline should be given as prophylaxis in
recurrent acute meibomitis , especially if associated with
acne rosacea or seborrhoeic dermatitis.
A. True
B. False
32

33. 24. Sebaceous gland carcinoma is a rare tumour arising
from the sebaceous gland (western literature).
However, presents initially as a nodule (which may
be mistaken for a chalazion), more frequently on the
upper eyelid. Which locally spread as well as to
distant sites by lymphatics and bloodstream then
grows to form a big growth and diffuse tumour along
the lid margin.
A. True
B. False
25. Melanocarcinoma is malignant tumour and It is
metastasized in
A. preauricular lymph nodes
B. submandibular lymph nodes.
C. Postauricular lymph nodes
D. None of the above
33

34. 27. The plexiform type tumour is
A. Haemangioma
B. neurofibroma
C. sebaceous adenoma
D. none of the above
28. ………………………………… are developmental venous
anomaly ,It consists of large endothelium-lined
vascular channels and usually does not show any
regression.
A. Cavernous haemangiomas
B. capillary haemangiomas
C. cavernous sinus thrombosis
D. A,B and C
E. none of above
34

35. 29. Uraemia often seen chronic renal failure may
lead several consequence ,on eye most
commonly features include
A. Oedema
B. Lid retraction
C. Ptosis
D. Proptosis
E. A and B
F. A and C
30. Horner’s syndrome, occurring due to paralysis
of Muller’s muscles
A. True
B. False
35

36. 31. Grade III entropion, is
A. When the whole lid margin including the
anterior border is inturne
B. When posterior lid border is enrolled
C. When the inter-marginal strip enrolled
32. All of these which are corrections of Cicatricial
entropion: except
A. Altering the direction of lid margin
B. Transplanting the Palpebral conjunctiva
C. Incision of the distorted tarsus
D. All of the above
E. None of the above
36

37. 33. congenital ptosis, blepharophimosis, telecanthus
and epicanthus inversus may leads
A. Blepharophimosis syndrome
B. Horner’s syndrome
C. Ophthalmoplegic migraine,
D. Multiple sclerosis.
E. None of the above
34. After failure of Botulinum toxin, injected
subcutaneously over the orbicularis muscle,Facial
denervation is required
A. Neurogenic ptosis
B. Blepharophimosis
C. Reflex blepharospasm
D. None of the above
37

38. 35. Phenylephrine test is carried out in patients
suspected of
A. Horner’s syndrome
B. Myasthenia gravis
C. Effect of sympathomimetic eyedrops
D. Nystigmus
36. use this information in questions
36,37,38,39,40,41,42,43
patient has acute pain associated with swelling of lid,
mild watering and photophobia,after examination
and history doctor evacuated of the pus ,epilated
the involved cilia to avoid trichiasis ,Antibiotic eye
drops and eye ointment (at bed time) to control the
infection. Systemic anti-inflammatory and analgesics
relieve pain and reduce oedema.
38

39. 37. What was the possible diagnose of this patien
A. Meibomitis
B. hordoelum externa
C. hordoelum interna
D. All except A
E. None
38. Does the management of the was right
A. Yes? Justify
B. No? justify
39. To avoid early infection what may add to treatment of
this patient
A. Systemic antibiotics
B. Local antibiotics ( ointment)
C. Steroids
D. NSAIDS
39

40. 40. To relieve pain and reduce oedema we can
give
A. Systemic anti-inflammatory and analgesics
B. Diuretics
C. NSAID
D. None
41. The doctor needed further information to
specify the disease so how could he obtain
A. To make another history
B. Conduct physical examination again
C. Draw blood sample
40

41. 42. On signs , the point of maximum tenderness
and swelling is away from the lid margin and
that pus usually points on the tarsal conjunctiva
, there is no abscess. After you saw these what is
your exact diagnose
A. Meibomitis
B. hordoelum externa
C. hordoelum interna
D. Anteroir blepharitis
43. After confirming the diagnose ,would you
continuo your treatment strategy or use other
way
A. Yep? Why
B. No ? why
41

42. 42