Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 19 Lid Disorder Lecture Notes
Disorders of Lid
Ophthalmology
Anatomy
1. The skin
2. The subcutaneous areolar
tissue.
3. The layer of striated muscle.
4. Submuscular areolar tissue.
5. Fibrous layer.
6. Layer of non-striated muscle
fibres.
7. Conjunctiva.
The eyelid Margin
GLANDS OF EYELIDS
1. Meibomian glands.
q In tarsal plate arranged vertically.
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.
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.
qThey open into the hair follicles or into the ducts of Zeis
glands.
4. Accessory lacrimal glands of Wolfring.
qThese are present near the upper border of the tarsal plate.
Edema of lids
Inflammatory edema
Dermatitis, stye, insect bite, blepharitis
Passive edema
Renal disease, Cardiac failure,
Cavernous sinus thrombosis
INFLAMMATIONS OF THE EYELIDS
Blepharitis
1. Anterior blepharits.
2. Posterior blepharitis.
INFLAMMATIONS OF THE EYELIDS
Blepharitis
INFLAMMATIONS OF THE EYELIDS
1. Anterior blepharits
Squamous
Ulcerative
Treatment
Hot compress
Lid hygiene, cleaning with diluted baby shampoo
Topical : antibiotic, steroids, tear substitute
Oral : Azithromycin 500 mg OD for 3 days.
INFLAMMATIONS OF THE EYELIDS
Posterior blepharitis
Meibomian seborrhoea
Meibomianitis
Treatment:
Warm compress, lid hygiene & massage.
Oral doxycyclin or minocyclin for 6 wks.
INFLAMMATION OF GLANDS OF LIDS
Hordeolum externum or stye
Suppurative inflammation of gland of Zeis.
Hordeolum internum
Suppurative inflammation of meibomian gland
Chalazion
Chronic inflammatory granuloma of meibomian gland.
STYE (EXTERNAL HORDEOLUM)
STYE (EXTERNAL HORDEOLUM)
It is an acute suppurative inflammation of gland of the Zeis.
Causative organism commonly involved is Staphylococcus aureus.
Predisposing factors.
1. Refractive error
2. Blepharitis
3. Habitual rubbing of eyelids
4. Diabetes Mellitus
Treatment
1. Hot fomentation
2. Antibiotic eye ointment
3. Anagesics
4. Oral antibiotics
5. Treatment of underlying cause
CHLAZION
CHLAZION
It is also called a tarsal or meibomian cyst.
It is a chronic non-infective granulomatous inflammation of
the meibomian gland.
Predisposing factors.
1. Refractive error
2. Blepharitis
3. Habitual rubbing of eyelids
4. Diabetes Mellitus
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.
Secondary infection leads to formation of hordeolum internum.
Calcification may occur, though very rarely.
Malignant change into meibomian gland carcinoma may be seen
occasionally in elderly patients.
Treatment
1. Conservative treatment.
2. Intralesional injection of long-acting steroid.
3. Incision and curettage.
4. Diathermy.
INTERNAL HORDEOLUM
It is a suppurative inflammation of the meibomian gland
associated with blockage of the duct.
It may occur as primary staphylococcal infection of the
meibomian gland or due to secondary infection in a chalazion
(infected chalazion).
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.
ANOMALIES IN POSITION OF THE
LASHES AND THE LIDS
Blepharospasm
Trichiasis
Entropion
Ectropion
Symblepharon
Ankyloblepharon
Blepharophimosis
Lagophthalmos
Ptosis.
Blepharospasm
Involuntary, sustained and forcible closure of lids.
Essential blepharospasm
Reflex blepharospasm
Treatment: Botulinum toxin
Facial denervation
Trichiasis
Misdirection of cilia, directed backwards to rub cornea.
Trachoma, blepharitis, scars, chemical burns, Steven-
Johnson synd,
Treatment: Epilation, Electrolysis, Cryosurgery, Argon laser
application.
ABNORMALITIES OF THE LASHES
Trichiasis
Entropion
Inward rolling of lid margin.
? Involutional
? Cicatricial
? Spastic
? Congenital
ENTROPION
Involutional Entropion (age related)
v Horizontal lid laxity
v Vertical lid instability
v Over-riding of pretarsal plate
v Orbital septum laxity
Full thickness wedge excision/Bicks procedure
Transverse everting sutures (Over-riding)
Weis procedure (long standing correction)
Jones procedure (recurrences)
Transverse everting sutures
Weis procedure
Jones procedure
Cicatricial entropion
Due to cunjunctival scarring
Treatment : Tarsal fracture/ wedge resection
Tarsal Fracture
Spastic entropion
Congenital entropion
ECTROPION
Eversion of lid margins and lashes away from the globe.
? Acquired ? Involutional
Cicatricial
Paralytic
Mechanical
? Congenital
ECTROPION
Involutional Ectropion (Age Related)
? Horizontal lid laxity
? Medial canthal tendon laxity
? Lateral canthal tendon laxity
? Disinsertion of lower lid retractors
Treatment
? Wedge resection for horizontal lid laxity
? Diamond excision for medial ectropion
? Kuhnt-Szymanowski Procedure modified
by Byron Smith for lateral ectropion
Wedge resection for horizontal lid laxity
Diamond excision for medial ectropion
Kuhnt-Szymanowski Procedure
Cicatricial Ectropion
Due to burn, trauma, chronic inflammation of skin or
surgical scarring.
Treated with Z/ V-Y Plasty or skin grafts.
V-Y Plasty
Paralytic Ectropion
Facial nerve palsy or Bell's palsy.
Tarsorrhaphy
Medial canthoplasty
Lateral canthal sling
Upper lid lowering
Mechanical ectropion (tumours)
SYMBLEPHARON
ANKYLOBLEPHARON
BLEPHAROPHIMOSIS
PTOSIS
Drooping of the upper lid to a level that covers more than 2mm
of the superior cornea.
1. Congenital
Simple
Complicated
2. Acquired
Neurogenic
Myogenic
Aponeurotic
Mechanical
PTOSIS
MRD (margin reflex distance)
Normal 4mm ? 1mm
Mild ptosis- < 2mm
Moderate - 3mm
Severe ? 4mm
LPS Action
Good > 8mm
Fair 5-7
Poor 4mm
SURGICAL TREATMENT
Fasanella-Servat
LPS action good
Mild ptosis < 2mm
Horner's syndrome
SURGICAL TREATMENT
LPS Resection (Cunjunctival approach)
LPS action fair
Any type of ptosis
Moderate congenital or acquired ptosis
SURGICAL TREATMENT
LPS Resection (Anterior approach)
LPS action fair
Any type of ptosis
For larger resection in congenital or acquired ptosis.
SURGICAL TREATMENT
LPS Resection with aponeurotic reinsertion
LPS action fair
Any type of ptosis
Acquired ptosis.
SURGICAL TREATMENT
Frontalis suspension
LPS action poor
Ptosis >2 mm
Congenital ptosis
TUMOURS OF LIDS
Benign growths
? Xanthelasma
? Naevus or mole
? Haemangioma
? Neurofibromatosis
XANTHELASMA
Malignant tumours
? Basal cell carcinoma
? Squamous cell carcinoma
? Sebaceous cell carcinoma
? Malignant melanoma
BASAL CELL CARCINOMA
SQUAMOUS CELL CARCINOMA
SEBACEOUS CELL CARCINOMA
MALIGNANT MELANOMA
Thank You
This post was last modified on 07 April 2022