eyelid disorders - كلية الطب · 2019. 7. 5. · the eyelid is consist of four layers: 1- an...
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EYELID
DISORDERS
Instructor : Dr. Arkam
DONE BY :Sofian bni awwad
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ANATOMY :
The eyelid is consist of four layers:
1- An anterior layer of skin and subcutaneous tissue.
2- Muscular layer that comprises the orbicularis oculi muscle, which is responsible for the closing of the lids.
3- Tarsal plate which is a tough collagenous layer that houses meibomian gland.
4- Tarsal (palpebral )conjunctiva.
The orbital septum represents the anatomic boundary between the lid tissue and the orbital tissue.
Innervations: majorly by ophthalmic and maxillary branch of trigeminal nerve.
Blood supply: majorly by ophthalmic and lacrimal artery.
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FUNCTION
It offers mechanical protection to anterior globe
Spread the tear film over the conjunctiva and
cornea with each blink.
Contain the meibomian oil gland which provide
the lipid component of the tear film.
Prevent drying of the eyes.
Contain the puncta through which the tears
flow into the lacrimal drainage system.
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ABNORMALITIES OF LID POSITION
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PTOSIS
This is an abnormally low position of the upper
eyelid.
PATHOGENESIS
It may be caused by:
Mechanical factors:
(a) Large lid lesions pulling down the lid.
(b) Lid oedema.
(c) Tethering of the lid by conjunctival scarring.
(d) Structural abnormalities including a
disinsertion of the aponeurosis of the levator
muscle, usually in elderly patients.
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2.Neurological factors:
(a)Third nerve palsy
(b)Horner’s syndrome, due to a sympathetic
nerve lesion
(c)Marcus–Gunn jaw-winking syndrome.
3.Myogenic factors:
(a)Myasthenia gravis
(b)Some forms of muscular dystrophy.
(c)Chronic external ophthalmoplegia.
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SYMPTOMS
Patients present because:
they object to the cosmetic effect;
vision may be impaired;
there are symptoms and signs associated with
the underlying cause
(e.g. asymmetric pupils in Horner’s syndrome,
diplopia and reduced eye movements in a third
nerve palsy).
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Signs : There is a reduction in size of the interpalpebral
aperture.
The upper lid margin, which usually overlaps the upper limbus by 1–2imm, may be partially covering the pupil.
The function of the levator muscle can be tested by measuring the maximum travel of the upper lid from upgaze to downgaze (normally 15–18imm). Pressure on the brow (frontalis muscle) during this test will prevent its contribution to lid elevation.
If myasthenia is suspected the ptosis should be observed during repeated lid movement. Increasing ptosis after repeated elevation and depression of the lid is suggestive of myasthenia
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MANAGMENT
It is important to exclude an underlying cause
whose treatment could resolve the problem (e.g.
myasthenia gravis). Ptosis otherwise requires
surgical correction
In very young children this is usually deferred
but may be speed up if pupil cover threatens to
induce amblyopia.
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MARCUS GUNN JAW-
WINKING SYNDROME
- Also called Trigemino-oculomotor Synkineses
- Autosomal dominant
- In this congenital ptosis there is miswiring of the nerve supply to the pterygoid muscle of the jaw and the levator of the eye so that the eyelid moves in conjugation with movements of the jaw.
Treatment
Treatment is usually unnecessary but in severe cases, surgery with a bilateral levator excision and frontalis brow suspension may be used.
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DERMATOCHALASIS - excessive and lax eyelid skin and muscle is known as dermatochalasis.
Gravity, loss of elastic tissue in the skin, and weakening of the connective tissues of the eyelid frequently contribute to this lax and redundant eyelid tissue. These findings are more common in the upper eyelids but can be seen in the lower eyelids as well.
- The patients who complain of dermatochalasis frequently complain of visual difficulties
- Causes: - The most common cause of dermatochalasis is the normal aging phenomenon
- Patients with severe periorbital edema may develop dermatochalasis
- Trauma can be associated with dermatochalasis
- Chronic dermatitis
- Thyroid eye disease
- Chronic renal insufficiency
- Amyloidosis
- Genetics may play a role in some patients who develop dermatochalasis
- Treatment: - Blepharoplasty is the procedure of choice for upper and/or lower eyelid
dermatochalasis
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ENTROPION
- It is an inturning, usually of the lower lid towards the globe.
- Patients present with irritation caused by eyelashes rubbing on the cornea.
- more common in elderly, because orbcularis muscle become spasm.
- it may also caused by Conjuctival scarring distorting the lid (cicatrical entropion)
Treatment:
Short term :include the application of lubricants
to the eye or taping of the eyelid.
Permenant :surgery
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ECTROPION
- Eversion of the lid away from the globe. - Causes:- -age related orbicularis muscle laxity. -facial nerve palsy. -scarring of periorbital skin. - initial complaint of watery eye, because
the mal position of the lids everts the puncta and prevents drainge of the tears leading to epiphora(overflow of the tears over the cheeks )
-it also exposes the conjuctiva leading to irratable eye.
- treatment: surgical
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LID INFLAMMATION
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BLEPHARITIS
Inflammation of the eyelid margins.
It is a chronic disease.
Symptoms:
- tired, itchy, sore eye, worse in the morning.
- Crusting of the lid margin.
Classified into: anterior and posterior .
Both forms are strongly associated with
seborrhoeic dermatitis, atopic eczema and acne
rosacea.
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ANTERIOR BLEPHARITIS
Is when the inflammation is located in the outside surface the lid margin, specifically in lash line.
Signs are:
-Redness and scaling of the lid margin.
-Debris in the form of a collarette around the eyelashes.
-Reduction in the number of eyelashes.
-Some lash bases may ulcerated- sign of staphylococcal infection.
In severe diseases the cornea is affected (blepharokeratitis)
Small infiltrate ulcers may form in the peripheral cornea (marginal keratitis)due to immune complex response to staphlococcal exotoxins .
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POSTERIOR BLEPHARITIS
Have another name which is meibomian gland
dysfunction.
Signs are:
- Obstruction and plugging of the meibomian
orifices.
- Thickened , cloudy, expressed meibomian
secretion.
- Injection of the lid margin and conjuctiva.
- Tear film abnormalities and punctuate keratitis.
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TREATMENT
Anterior blepharitis:
Cleaning with a cotton bud wetted with bicarbonate
or diluted baby shampoo to remove squamous debris
from lash line .
Topical steroid: used infrequently.
Topical (fusidic acid) +- systemic antibiotic in
staphylococcal lid disease .
Posterior blepharitis:
Hot compressors and lid massage.
Oral tetracycline.
Artificial tears to prevent dryness
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LID LUMPS
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CHALAZION
, -It is a granuloma
within the tarsal
plate caused by
obstructed
meibomian gland.
-Painless.
-Symptoms are
unsightly lid
swelling which
resolve within six months if the lesion
persist we remove
it surgically
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INTERNAL HORDEOLUM
, an abscess in
meibomian
gland.
-Painful.
-May respond
to topical
antibiotics but
incision maybe
necessary.
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,
. - It is an abscess
in eyelash follicle.
painful
-Most cases are
self limiting .
-Treatment
requires the
removal of the
associated
eyelash and
application of
hot compresses.
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,
, -Is a viral infection of
the skin or the mucous
membranes, caused by
pox virus.
-Can be presented with
umbilicated lesion
found on the lid margin.
-Cause irritation,
redness, follicular
conjuctivitis(small
elevation of lymphoid
tissue found on tarsal
conjunctiva)
-Treatment requires
excision of the lid lesion.
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- Lipid
containing
bilateral lesions.
- Usually
associated with
hyperlipidemia .
- Removed for
cosmetic
reasons.
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THANX FOR
LISTENING
DONE BY: Sofian bni awwad
:”)