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
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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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This post was last modified on 07 April 2022