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Download MBBS Ophthalmology PPT 19 Lid Disorder Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 19 Lid Disorder Lecture Notes

This post was last modified on 07 April 2022


Disorders of Lid



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Ophthalmology


Anatomy

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1. The skin
2. The subcutaneous areolar

tissue.

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3. The layer of striated muscle.
4. Submuscular areolar tissue.
5. Fibrous layer.
6. Layer of non-striated muscle

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fibres.

7. Conjunctiva.

The eyelid Margin

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GLANDS OF EYELIDS
1. Meibomian glands.
q In tarsal plate arranged vertically.

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qThese are modified sebaceous glands.
qTheir ducts open at the lid margin.
qTheir secretion constitutes the oily layer of tear film.

2. Glands of Zeis.

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qThese are also sebaceous glands which open into the follicles of

eyelashes.
3. Glands of Moll.
qThese are modified sweat glands situated near the hair follicle.

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qThey open into the hair follicles or into the ducts of Zeis

glands.

4. Accessory lacrimal glands of Wolfring.

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qThese are present near the upper border of the tarsal plate.

Edema of lids
Inflammatory edema
Dermatitis, stye, insect bite, blepharitis

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Passive edema
Renal disease, Cardiac failure,
Cavernous sinus thrombosis


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INFLAMMATIONS OF THE EYELIDS
Blepharitis
1. Anterior blepharits.
2. Posterior blepharitis.

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INFLAMMATIONS OF THE EYELIDS

Blepharitis
INFLAMMATIONS OF THE EYELIDS

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1. Anterior blepharits

Squamous

Ulcerative

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Treatment
Hot compress
Lid hygiene, cleaning with diluted baby shampoo
Topical : antibiotic, steroids, tear substitute

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Oral : Azithromycin 500 mg OD for 3 days.


INFLAMMATIONS OF THE EYELIDS
Posterior blepharitis

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Meibomian seborrhoea
Meibomianitis
Treatment:
Warm compress, lid hygiene & massage.
Oral doxycyclin or minocyclin for 6 wks.

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INFLAMMATION OF GLANDS OF LIDS

Hordeolum externum or stye

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Suppurative inflammation of gland of Zeis.
Hordeolum internum
Suppurative inflammation of meibomian gland
Chalazion
Chronic inflammatory granuloma of meibomian gland.

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STYE (EXTERNAL HORDEOLUM)
STYE (EXTERNAL HORDEOLUM)
It is an acute suppurative inflammation of gland of the Zeis.
Causative organism commonly involved is Staphylococcus aureus.

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Predisposing factors.
1. Refractive error
2. Blepharitis
3. Habitual rubbing of eyelids

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4. Diabetes Mellitus

Treatment

1. Hot fomentation

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2. Antibiotic eye ointment
3. Anagesics
4. Oral antibiotics
5. Treatment of underlying cause

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CHLAZION

CHLAZION
It is also called a tarsal or meibomian cyst.

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It is a chronic non-infective granulomatous inflammation of

the meibomian gland.

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Predisposing factors.
1. Refractive error
2. Blepharitis
3. Habitual rubbing of eyelids
4. Diabetes Mellitus

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Clinical course and complications
Complete spontaneous resolution may occur rarely.
Occasionally, it may burst on the conjunctival side, forming a

fungating mass of granulation tissue.

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Secondary infection leads to formation of hordeolum internum.
Calcification may occur, though very rarely.
Malignant change into meibomian gland carcinoma may be seen

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occasionally in elderly patients.

Treatment
1. Conservative treatment.
2. Intralesional injection of long-acting steroid.

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3. Incision and curettage.
4. Diathermy.


INTERNAL HORDEOLUM

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It is a suppurative inflammation of the meibomian gland

associated with blockage of the duct.

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It may occur as primary staphylococcal infection of the

meibomian gland or due to secondary infection in a chalazion

(infected chalazion).

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Treatment. It is similar to hordeolum externum, except
that, when the pus is formed, it should be drained by a

vertical incision from the tarsal conjunctiva.

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ANOMALIES IN POSITION OF THE

LASHES AND THE LIDS
Blepharospasm
Trichiasis

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Entropion
Ectropion
Symblepharon
Ankyloblepharon
Blepharophimosis

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Lagophthalmos
Ptosis.

Blepharospasm
Involuntary, sustained and forcible closure of lids.

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Essential blepharospasm
Reflex blepharospasm
Treatment: Botulinum toxin
Facial denervation

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Trichiasis
Misdirection of cilia, directed backwards to rub cornea.
Trachoma, blepharitis, scars, chemical burns, Steven-

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Johnson synd,

Treatment: Epilation, Electrolysis, Cryosurgery, Argon laser

application.

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ABNORMALITIES OF THE LASHES
Trichiasis


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Entropion
Inward rolling of lid margin.
? Involutional
? Cicatricial
? Spastic

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? Congenital

ENTROPION
Involutional Entropion (age related)
v Horizontal lid laxity

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v Vertical lid instability
v Over-riding of pretarsal plate
v Orbital septum laxity


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Full thickness wedge excision/Bicks procedure
Transverse everting sutures (Over-riding)
Weis procedure (long standing correction)
Jones procedure (recurrences)

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Transverse everting sutures

Weis procedure

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Jones procedure

Cicatricial entropion
Due to cunjunctival scarring

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Treatment : Tarsal fracture/ wedge resection


Tarsal Fracture

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Spastic entropion
Congenital entropion


ECTROPION

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Eversion of lid margins and lashes away from the globe.
? Acquired ? Involutional
Cicatricial
Paralytic
Mechanical

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? Congenital

ECTROPION
Involutional Ectropion (Age Related)
? Horizontal lid laxity

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? Medial canthal tendon laxity
? Lateral canthal tendon laxity
? Disinsertion of lower lid retractors

Treatment

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? 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

Diamond excision for medial ectropion

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Kuhnt-Szymanowski Procedure

Cicatricial Ectropion
Due to burn, trauma, chronic inflammation of skin or

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surgical scarring.

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

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V-Y Plasty

Paralytic Ectropion
Facial nerve palsy or Bell's palsy.

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Tarsorrhaphy
Medial canthoplasty
Lateral canthal sling
Upper lid lowering
Mechanical ectropion (tumours)

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SYMBLEPHARON

ANKYLOBLEPHARON

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BLEPHAROPHIMOSIS

PTOSIS

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Drooping of the upper lid to a level that covers more than 2mm

of the superior cornea.

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1. Congenital
Simple
Complicated
2. Acquired
Neurogenic

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Myogenic
Aponeurotic
Mechanical


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PTOSIS

MRD (margin reflex distance)
Normal 4mm ? 1mm
Mild ptosis- < 2mm

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Moderate - 3mm
Severe ? 4mm

LPS Action
Good > 8mm

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Fair 5-7
Poor 4mm
SURGICAL TREATMENT
Fasanella-Servat
LPS action good

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Mild ptosis < 2mm
Horner's syndrome

SURGICAL TREATMENT
LPS Resection (Cunjunctival approach)

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LPS action fair
Any type of ptosis
Moderate congenital or acquired ptosis

SURGICAL TREATMENT

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LPS Resection (Anterior approach)
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

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Acquired ptosis.

SURGICAL TREATMENT
Frontalis suspension
LPS action poor

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Ptosis >2 mm
Congenital ptosis

TUMOURS OF LIDS
Benign growths

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? Xanthelasma
? Naevus or mole
? Haemangioma
? Neurofibromatosis

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XANTHELASMA

Malignant tumours
? Basal cell carcinoma

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? Squamous cell carcinoma
? Sebaceous cell carcinoma
? Malignant melanoma


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BASAL CELL CARCINOMA

SQUAMOUS CELL CARCINOMA


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SEBACEOUS CELL CARCINOMA

MALIGNANT MELANOMA
Thank You

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