Disorders of Lid
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OphthalmologyAnatomy
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1. The skin2. 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 ofeyelashes.
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 Zeisglands.
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 edemaRenal disease, Cardiac failure,
Cavernous sinus thrombosis
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INFLAMMATIONS OF THE EYELIDSBlepharitis
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 blepharitsSquamous
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 seborrhoeaMeibomianitis
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 MellitusTreatment
1. Hot fomentation
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2. Antibiotic eye ointment3. 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 complicationsComplete 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 themeibomian 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 THELASHES AND THE LIDS
Blepharospasm
Trichiasis
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EntropionEctropion
Symblepharon
Ankyloblepharon
Blepharophimosis
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LagophthalmosPtosis.
Blepharospasm
Involuntary, sustained and forcible closure of lids.
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Essential blepharospasmReflex 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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EntropionInward rolling of lid margin.
? Involutional
? Cicatricial
? Spastic
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? CongenitalENTROPION
Involutional Entropion (age related)
v Horizontal lid laxity
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v Vertical lid instabilityv Over-riding of pretarsal plate
v Orbital septum laxity
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Full thickness wedge excision/Bicks procedureTransverse 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 resectionTarsal Fracture
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Spastic entropionCongenital 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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? CongenitalECTROPION
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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TarsorrhaphyMedial 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. CongenitalSimple
Complicated
2. Acquired
Neurogenic
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MyogenicAponeurotic
Mechanical
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PTOSISMRD (margin reflex distance)
Normal 4mm ? 1mm
Mild ptosis- < 2mm
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Moderate - 3mmSevere ? 4mm
LPS Action
Good > 8mm
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Fair 5-7Poor 4mm
SURGICAL TREATMENT
Fasanella-Servat
LPS action good
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Mild ptosis < 2mmHorner's syndrome
SURGICAL TREATMENT
LPS Resection (Cunjunctival approach)
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LPS action fairAny 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 mmCongenital 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 CARCINOMASQUAMOUS CELL CARCINOMA
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SEBACEOUS CELL CARCINOMAMALIGNANT MELANOMA
Thank You
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