Download MBBS Ophthalmology PPT 19 Lid Disorder Lecture Notes

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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
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