Download MBBS Ophthalmology PPT 31 Disorders Of Lid Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 31 Disorders Of Lid Lecture Notes

Disorders of Lid

Department of Ophthalmology

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Learning Objectives

? At the end of this class the students shal be

able to :

? Understand the structure and function of the

eyelids

? Recognize common diseases of the eyelids
? Comprehend the principles of managing eyelid

diseases

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The eyelids

? Mobile structures

placed in front of

eyeballs.

? Protect eyes
? Spread tear film
? Help in tear drainage by

lacrimal pump system

3

Structure of eyelids

? The skin- elastic and

thin

? Subcutaneous areolar

tissue- very loose,

does not contain any

fat.

? Striated muscle layer-

orbicularis oculi

-- orbital, palpebral

and lacrimal portions.

? Sub muscular areolar

tissue- contains

nerves and vessels.

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Structure of eyelids

? Fibrous layer-

central tarsal

plate and

peripheral

orbital septum

? Layer of non-

striated muscle

fibres

? Conjunctiva ?

nonkeratinized

squamous

epithelium

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Glands of eyelids

? Meibomian

glands/Tarsal glands

Modified sebaceous

glands(30 in no.)

? Glands of Zeis -

sebaceous glands

open into follicles of

lashes

? Glands of Moll -

modified sweat glands-

open into

follicles/ducts of Zeiss

? Accessory Lacrimal

glands

? Krause

? Wolfring

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Edema of lids

? Inflammatory edema
Dermatitis, stye, insect bite
? Passive edema
Renal disease, Cardiac failure,
Cavernous sinus thrombosis

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INFLAMMATIONS OF THE EYELIDS

? Blepharitis
Subacute or chronic lid margin inflammation
1. Anterior blepharitis.
2. Posterior blepharitis.


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INFLAMMATIONS OF THE EYELIDS

? Blepharitis

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INFLAMMATIONS OF THE EYELIDS

1. Anterior blepharitis

? Squamous/Seborrhoeic

White dandruff like scales on the lid margin among

eyelashes

? Ulcerative

Chronic staphylococcal infection- hard crusts and ulcers

Treatment

Warm compresses

Lid hygiene, cleaning with diluted baby shampoo

Topical : antibiotic, steroids, tear substitutes

Oral : Azithromycin 500 mg OD for 3 days.



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INFLAMMATIONS OF THE EYELIDS

? Posterior blepharitis
Meibomian seborrhoea
Meibomianitis
Treatment:
Warm compress, lid hygiene & massage.
Oral doxycycline/erythromycin for 6 wks.

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INFLAMMATION OF GLANDS OF LIDS

? Hordeolum externum or

stye

Suppurative inflammation

of gland of Zeis.

? Hordeolum internum

Suppurative inflammation

of meibomian gland

? Chalazion/Tarsal or

Meibomian cyst

Chronic inflammatory

granuloma of meibomian

gland.

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Incision and curettage of chalazion

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ANOMALIES IN POSITION OF

LASHES AND LIDS

? Blepharospasm

? Trichiasis

? Entropion

? Ectropion

? Symblepharon

? Ankyloblepharon

? Blepharophimosis

? Lagophthalmos

? Blepharoptosis

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? Blepharospasm

Involuntary, sustained and forcible closure of

lids.

Essential blepharospasm-Rare, idiopathic.

Treatment: Botulinum toxin

Facial denervation

Reflex blepharospasm- Vth nerve reflex

Sensory stimulation

Treatment: of causative disease(Eg. corneal ulcer)

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? Trichiasis

Misdirection of cilia, directed backwards to rub

cornea.

Causes:

Trachoma, blepharitis, scars, chemical burns,

Steven-Johnson syndrome.

Treatment: Epilation

Electrolysis

Cryosurgery

Argon laser application

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ABNORMALITIES OF THE LASHES

? Trichiasis

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? Entropion

Inward

rolling/inturning of

lid margin.

?Involutional
?Cicatricial

(trachoma, burns,

SJ syndrome)
?Spastic(lower lid)
?Congenital

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? Involutional Entropion (age related)
v Horizontal lid laxity
v Vertical lid instability
v Over-riding of pretarsal plate
v Orbital septum laxity


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Surgical procedures for entropion

? Transverse everting sutures (Quickert)
? Transverse blepharotomy with everting

sutures- Weis procedure

? Jones procedure- tucking of inferior lid

retractors (recurrences)

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Transverse everting sutures

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Weis procedure

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Jones procedure

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? Cicatricial entropion
Due to conjunctival scarring
Causes:
Trachoma, chemical burns

Treatment : Tarsal fracture/ wedge resection

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Tarsal Fracture

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ECTROPION

? Eversion of lid margins and lashes away from

the globe.

?Acquired ? Involutional/senile-lower lid
Cicatricial- burns and injuries
Paralytic- 7th nerve paralysis
Mechanical-tumors/proptosis
?Congenital

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ECTROPION

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? Involutional Ectropion (Age Related)
? Horizontal lid laxity
? Medial canthal tendon laxity
? Lateral canthal tendon laxity
? Disinsertion of lower lid retractors

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? Treatment
? Wedge resection for horizontal lid laxity
? Diamond excision for medial ectropion
? Kuhnt-Szymanowski Procedure modified
by Byron Smith for lateral ectropion

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Wedge resection for horizontal lid

laxity

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Diamond excision for medial ectropion

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Modified Kuhnt-Szymanowski Procedure

for lateral ectropion

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? Cicatricial Ectropion
Due to burn, trauma, chronic inflammation of

skin or surgical scarring.

Treated with Z/ V-Y Plasty or skin grafts.

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V-Y Plasty

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? Paralytic Ectropion

Due to Facial nerve palsy

Treated by:

Tarsorrhaphy

Medial canthoplasty

Lateral canthal sling

Upper lid lowering

? Mechanical ectropion (tumours)- corrected by

treating the underlying cause.

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SYMBLEPHARON

? Adhesion of palpebral

and bulbar conjunctiva

? Causes:
Chemical injuries
Burns
Trauma

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ANKYLOBLEPHARON

? Partial or complete

fusion of margins of

upper and lower lids.

? Congenital or acquired

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BLEPHAROPHIMOSIS SYNDROME

? Autosomal dominant
? Blepharophimosis
? Ptosis
? Epicanthus inversus
? Telecanthus

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BLEPHAROPTOSIS

? Abnormal drooping of the upper lid to a level that

covers more than 2mm of the superior cornea.

1. Congenital
Simple
Complicated
2. Acquired
Neurogenic- 3rd Nerve palsy, Horner's syndrome
Myogenic ? Myasthenia , Myotonic dystrophy
Aponeurotic- Involutional, postoperative
Mechanical- lid tumors

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BLEPHAROPTOSIS

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? MRD (margin reflex distance)
Normal 4mm ? 1mm

Severity
? Mild ptosis- < 2mm
? Moderate - 3mm
? Severe ? 4mm

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? Levator Palpebrae Superioris (LPS) Action
Good > 8mm
Fair 5-7
Poor 4mm

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SURGICAL TREATMENT

? Fasanella-Servat operation
LPS action good
Mild ptosis < 2mm
Horner's syndrome

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SURGICAL TREATMENT

? LPS Resection (Conjunctival approach)
LPS action fair
Any type of ptosis
Moderate congenital or acquired ptosis


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SURGICAL TREATMENT

? LPS Resection (Skin approach)
? Most preferred surgery for ptosis correction
LPS action fair
Any type of ptosis
For larger resection in congenital or acquired

ptosis.



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SURGICAL TREATMENT

? LPS Resection with aponeurotic reinsertion
LPS action fair
Any type of ptosis
Acquired ptosis.


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SURGICAL TREATMENT

? Frontalis Sling surgery (Brow suspension)
LPS action poor
Ptosis >2 mm
Congenital ptosis

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NEOPLASMS OF LIDS

? Benign lesions
? Xanthelasma
? Naevus or mole
? Haemangioma
? Neurofibromatosis

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XANTHELASMA

? Yellow plaques on eyelids
? Lipid laden macrophages

in superficial dermis and

subdermal tissue

? May be associated with

diabetes mellitus and

hypercholesterolemia

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? Malignant tumours
?Basal cell carcinoma
?Squamous cell carcinoma
?Sebaceous gland carcinoma
?Malignant melanoma

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BASAL CELL CARCINOMA

? Commonest malignant

lid tumour/Rodent ulcer

? Noduloulcerative
? Sclerosing
? Pigmented
? Treated by surgery
At least 3mm clear
margins with lid
reconstruction

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SQUAMOUS CELL CARCINOMA

? More aggressive tumour
? Ulcerative or fungating
? Treated by surgery
Surgical excision with
wide margins with lid
reconstruction

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SEBACEOUS GLAND CARCINOMA

? Occurs more commonly

on the upper lid

? Masquerades as benign

lesions like chalazia

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MALIGNANT MELANOMA

? Rare tumour
? Lentigo maligna

melanoma

? Nodular melanoma

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Thank You

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