DISORDERS OF THE EYELIDS

Švehlíková G.Department of Ophthalmology LF UPJS v KošiciachPrednosta: prof. MUDr. Juhás T., DrSc.

EXAMINATION –INSPECTION OF TARSAL CONJ., FORNIX, THE BULBAR CONJ.

THE EYELID MALPOSITION

EctropionEntropionPtosis

ECTROPIONThe eyelid is everted

away from the globe

- Involutional – predisposing factors – laxity of the palpebral skin, laxity of eyelid, weaknes of the fascia and elongation of the medial and lateral cantal tendom

INVOLUTIONAL ECTROPION Medial portion of the

lower eyelid with lover punctum is everted

Epiphora

Dermatitis – iritation by frequent rubbing

PARALYTIC ECTROPION

Facial nerve palsy

Atony of the orbicularis muscle

Lagophthalmus

Complications . secondary conjunctivitis, exposure keratopathy

MECHANICAL ECTROPION

Fibroma in the lover eyelid

CICATRICAL ECTROPION

Scarring or contraction of the skin

SURGICAL TECHNIQUE

The eyelid is shortened by an excision of full-thickness wedge

ENTROPION

- inward turning of the eyelid and contact of eyelashes with cornea and conjunctiva

Surgical correction of involutional entropion

PTOSIS 1. neurogenic p. -

acquired or cong. innervation defect ( third n. palsy, Horner sy.)

2. myogenic p. ( myastenia gravis, myotonic dystrophy )

3. aponeurotic p. ( involutional )

4. mechanical p.

Aponeurotic ptosis - age – weakness of the aponeurosis of the levator muscle

Myogenic ptosis – myastenia gravis – pac. activates the frontalis m., and backward position of the head

EYELID ALLERGIC DISORDERS

CONTACT DERMATITIS Sensitivity to topical

medication Severe itching Erytema Edema of the eyelid

skin Changes are

restricted to the area of contact between skin and the noxious agent

Th- steroid

ACUTE ALLERGIC OEDEMA Insect bites,

angiooedema, urticaria

Bilateral, painless oedema

Th - systemic antihistamines

INFECTIONS

HS BLEPHARITIS

uncommon bilat. upper and

lower eyelids herpes simplex v. infection

small vesicles, rupture, crusts

occasionaly associated with conjunctivitis

th – acyclovir cream

HERPES ZOSTER Skin lesions follows

the first division of the trigeminal nerve

An involvement of the nasociliary nerve indicates ocular involvement

Th – systemic and topical

THE LID MARGIN GLANDS Meibomian glands –

modified sebaceous g., located in the tarsal plate – lipid layer

Glands of Zeis – modif. sebaceous g., associated with the lash follicles

Glands of Moll – modif. sweat g., ducts open either into lash follicle or onto the ant. Lid margin

HORDEOLUM

Acute inflamation of the gland of Zeis or Moll

swelling, erytema, pain

CHALASION

chronic granulomatous inflamation of Meibomian gland

painless, roundish lesion in the tarsal plate

treatment - incision

EYELID TUMORS

BINIGN TUMORSCyst of Zeis Xantelasmas

Papilloma Hemangioma

Nevus Surgical approach for resection

MALIGNANT TUMORSNodular basal cell carcinoma

Squamous cell carcinoma

Malignant melanoma

CONJUNCTIVA

ANATOMY layers - epitelium,

stroma the mucin secretors

( Goblet cells, crypts of Henle, glands of Manz)

accessory lacrimal gl. of Krause and Wolfring

INFLAMMATION

CONJUNCTIVITIS

Symptoms – lacrimation, irritation, burning, photophobia

Discharge- - watery- acute viral, acute

allergic inf.- mucoid – vernal conj.,

keratoconj. Sicca- purulent – acute bact. inf.- mucopurulent – mild

bact., chlamydial inf.

CONJUNCTIVAL APPEARANCE

Viral inf. Chlamydial inf. Hypersensitivity to

topical medication

Follicular reactionHyperplasia of lymphoid tissue within the stroma

Chronic blepharitis Allergic

conjunctivitis Bacterial inf. Contact lens-related

problems

Papillary reactionHyperplastic conj. epitelium

Oedema - chemosis

Membranes – beta-haemolytic str., diphtheria

Pseudomembranes – severe adenoviral inf., gonococcal inf.

BACTERIAL CONJUNCTIVITIS

Staph. epidermidis, Staph. aureus, Strep. pneumoniae, H. influenzae, Moraxella

presentation – acute redness, burning, discharge – mucopurulent,

on waking – the eyelids are stuck together

hyperemia – max. in the fornices

Th- ATB drops and ointment

ADENOVIRAL KERATOCONJUNCTIVITIS

- Pharyngoconjunctival fever – children – respiratory tract inf.

- Epidemic keratoconj. – no system. sympt.

acute watering, redness,

photophobia follicular reaction,

hyperemia, oedema discharge – watery lymph node swelling risk of corneal involment Th- symptomatic, resolution

spontaneous within 2 weeks

TRACHOMA

population with poor conditions of hygiene

chronic conj. inflam., keratitis, progressive conj. scarring.

Chlamydia Trachomatis scarring of upper tarsal conj.

entropion, trichiasis, blindness

Th – azitromycin + hygiene end-stage trachoma

ALLERGIC CONJUNCTIVITIS

ALLERGIC RHINOCONJUNCTIVITIS

hypersensitivity reaction to specific airborne antigens

frequently associated nasal symptoms seasonal – allergens are pollens perennial – allergens – house-dust mites,

animal dander – symptoms throughout the year

presentation – acute itchy watery eyes, sneezing, watery nasal discharge

oedema of the eyelids milky appearance of

conj. Th – either a topical

mast cells stabilizer (nedocromil )

or a topical antihistamine ( azelastin )

VERNAL KERATOCONJUNCTIVITIS uncommon, recurent,

bilateral inflamation affecting children and young adults, more common in males, resolves around puberty, rarely persist beyond the age of 25y.

cell-mediated immune mechanisms play important role

¾ patients have associated atopy

VERNAL KERATOCONJUNCTIVITIS symptoms – ocular

itching, lacrimation, photophobia, foreign body sensation, burning, mucus discharge

clinical types:- palpebral - limbal- mixed

Palpebral VKCHyperemia, diffuse papillary hypertrophy

Limbal VKCMucoid nodules, composed predominantly of eosinophils

TH- MAST CELL STABILIZERS , TOPICAL STEROIDS.

Punctate epitelopathy Macroerosion

ATOPIC KERATOCONJUNCTIVITIS

rare typically affects

young patients with atopic dermatitis

characteristic skin changes + astma, urticaria, migraine, rhinitis

ocular symptoms similar to VKC

KERATOCONJUNCTIVITIS SICCA

tear film – layers : a.- lipid – to retard

evaporationb.- aqueous – to supply

atmospheric oxygen to the avascular corneal epith., antibacterila f., wash away debrits

c.- mucin – to convert the corneal epith. from a hydrophobic to a hydrophilic surface

atrophy and fibrosis of lacrimal tissue – Sjogren sy – prim. or sec. ( associated with rheumatoid arthritis, SLE, syst. sclerosis, psoriatic arthritis, juvenile chron. arthritis, polymyositis)

destruction of lacrimal tissue ( tumors, chron. inflamm.)

Meibomian gland dysfunction

blockage of the excretory ductules as a result of severe conj. scaring

Irritaion, a foreign body sensation, burning, transient blurring vision, tired or heavy feeling to the eyelids

Causes of a dry eye

Clinical features

SPECIAL TESTSBreak-up time test – assesse precorneal tear film stability

Schirmer test – mesuring the amount of secretion

PTERYGIUM

degenerative lesion conjunctiva grown

over the limbus unknown etiology Th- surgical

CONJUNCTIVAL NAEVUS

benign, usualy unilateral

signs of potential malignancy - -sudden increase in pigmentation or growth

CONJUNCTIVAL MELANOMA

rare solitary black or

grey nodule which is fixed to episclera

CONJUNCTIVAL PAPILOMA

Squamous cell carcinoma

Conjunctival Kaposi sarcoma

QUESTIONS AND DISCUSSION

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