DISORDERS OF THE EYELIDS
Švehlíková G.
Department of Ophthalmology LF UPJS v Košiciach
Prednosta: prof. MUDr. Juhás T., DrSc.
EXAMINATION –INSPECTION OF TARSAL CONJ., FORNIX, THE BULBAR CONJ.
THE EYELID MALPOSITION
Ectropion
Entropion
Ptosis
ECTROPION
The 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 TUMORS
Cyst of Zeis Xantelasmas
Papilloma Hemangioma
NevusSurgical approach for resection
MALIGNANT TUMORS
Nodular 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 reaction
Hyperplasia 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 TESTS
Break-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
THANK YOU FOR YOUR ATTENTION !
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