Lids and Adnexa Class1: The eyelid margin

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www.ophthalclass.blogspot.com has the complete class and MCQs on lids and adnexa for undergraduate medical students. Class 1 in the series deals with the basic anatomy of the eyelid and the eyelid margin. A few of the congenital eyelid disorders are mentioned. Special emphasis is given to blepharitis – inflammation of the eyelid margin, its types, clinical features and management. Next, common causes of eyelid swellings including hordeolum or stye and chalazion are discussed. Finally a brief mention is made about disorders of the eyelashes – trichiasis, poliosis, madarosis and distichiasis.

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Lids and Adnexa Class1: The eyelid margin

  1. 1. THE EYELIDS and the eyelid margin<br />Dr. Anupama Karanth<br />www.ophthalclass.blogspot.com<br />
  2. 2. Anatomy<br />What does it have?<br />
  3. 3. Anatomy<br />In simpler terms<br />Anterior lamella<br />skin and orbicularis<br />Posterior lamella<br />tarsus and conjunctiva<br />
  4. 4. Development<br />The story begins very early…<br />Two folds of ectoderm and mesoderm appear at 8 weeks<br />
  5. 5. Development<br />…and fuse by the tenth week<br />
  6. 6. Development<br />They separate again in the <br />seventh month<br />
  7. 7. Congenital anomalies<br />
  8. 8. Congenital anomalies<br />Blepharophimosis syndrome<br />Ptosis<br />Epicanthusinversus<br />Horizontally shortened palpebral aperture<br />
  9. 9. Congenital anomalies<br />
  10. 10. The eyelid margin<br />Posterior edge<br /> sharp<br />mucocutaneous junction<br />Meibomian orifices<br />Gray line ( muscle of Riolan)<br />Lash line <br />Anterior edge<br />
  11. 11. Eyelid inflammation<br />
  12. 12. Eyelid inflammation<br />
  13. 13. Anterior blepharitis<br />
  14. 14. Clinical features of anterior blepharitis<br />
  15. 15. Ulcerative blepharitis<br />
  16. 16. Squamousblepharitis<br />
  17. 17. Management of anterior blepharitis<br />Lid hygiene<br />Warm compresses<br />Mechanical removal of crusts and scales by scrubbing<br />Baby shampoo as scrubbing solution<br />Application of antibiotic eye ointment (Staphylococcal)<br />Anti-dandruff shampoo for scalp (Squamous)<br />
  18. 18. Posterior blepharitisMeibomian gland disease/meibomianitis<br />Symptoms<br />Nonspecific, burning, itching, redness<br />Associated condition<br />Acne rosacea<br />Complications<br />Secondary dry eyes<br />Epithelial keratitis<br />Recurrent styes / chalazia<br />Papillary conjunctivitis<br />
  19. 19. Clinical features of posterior blepharitis<br />Meibomian orifices<br />Pouting, obstructed, oily globules<br />Telangiectasia around orifices<br />Digital pressure on lid margin<br />Hyposecretion <br />Hypersecretion – foamy, turbid or tooth paste like secretion<br />
  20. 20. Meibomian gland disease<br />Foamy secretion<br />Blocked meibomian orifices<br />
  21. 21. Management of posterior blepharitis<br />Warm compresses<br />Lid massage to express oily secretion<br />Short term antibiotic – steroid eye ointment, ocular lubricants<br />In severe cases and in acne rosacea – oral tetracycline / doxycycline for at least 6-8 weeks<br />
  22. 22. Eyelid gland inflammations<br />Acute inflammation (stye)<br />Staphylococcal infection<br />Glands of Zeiss / Moll (associated with hair follicles) – Hordeolumexternum<br />Meibomian glands – Hordeoluminternum<br />Acute, painful and tender nodular swellings of the lid<br />
  23. 23. Hordeolum<br />Hordeoluminternum<br />Hordeolumexternum<br />
  24. 24. Acute infection (Staphylococcal abscess)<br />Internal hordeolumExternal hordeolum<br />Meibomian gland<br />Tarsal plate<br />Zeis or Moll glands<br />Lid margin<br />
  25. 25. Multiple styes<br />
  26. 26. Hordeolum<br />Management of hordeolum<br />Mainstay of therapy – hot compreses<br />If pus pointing present at eyelash base – remove eyelash<br />If pus pointing at the skin or conjunctiva – drain pus<br />If associated with blepharitis – treat blepharitis<br />
  27. 27. Hordeoluminternum<br />Pointing on the skin<br />
  28. 28. Internal hordeolum<br />Pointing on the conjunctival side<br />
  29. 29. Eyelid gland inflammations<br />Chronic inflammation of meibomian gland – Chalazion<br />Meibomian cyst<br />Chronic<br />Sterile<br />Granulomatous inflammation<br />Blocked meibomian gland orifice<br />Painless, non-tender nodular swelling of the eyelid<br />
  30. 30. Chalazion<br />Chalazion breaking through the conjunctiva<br />1A<br />1B<br />
  31. 31. Recurrent chalazia<br />
  32. 32. Management of chalazion<br />
  33. 33. Incision and curettage<br />
  34. 34. Local anesthesia<br />
  35. 35. Chalazion clamp<br />
  36. 36. Incision<br />
  37. 37. Curettage<br />
  38. 38. Clamp removed<br />
  39. 39. The eyelid infections<br />Molluscumcontagiosum<br />
  40. 40. The eyelid infections<br />Herpes zoster ophthalmicus<br />
  41. 41. Eyelash disorders<br />Trichiasis<br />Inturned eyelash<br />Poliosis<br />White colored lashes<br />Madarosis<br />Loss of lashes<br />Distichiasis<br />Lashes from meibomian orifices<br />
  42. 42. Trichiasis<br />
  43. 43. Poliosis<br />
  44. 44. Distichiasis<br />

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