Lid 1 slideshare
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Lid 1 slideshare
- 1. Clinical Approach to Eyelid diseases Mohamed Abdelzaher MD, FRCS
- 2. 2 mm 7 -12 mm 25- 30 mm 🤔
- 3. The tissues of the lids from anterior to posterior :- 1- skin 2- subcutaneous areolar tissue 3- layer of striated muscle (orbicularis oculi) 4- sub muscular areolar tissue 5- the fibrous layer—tarsal plate, including Meibomian glands 6- conjunctiva
- 6. Orbicularis Oculi Origin Medial palpebral ligament & adjacent bone Insertion Lateral palpebral raphe Parts Palpebral part Orbital part Lacrimal part Nerve supply VII nerve
- 7. Orbital part
- 9. Lacrimal part (Horner muscle) • Origin: Posterior Lacrimal crest • Insertion: Lacrimal fascia
- 10. Levator Palpebrae Superioris Origin Course Orbital Apex (lesser wing of sphenoid) Nerve supply III nerve Action Lid elevation What about LL?? Between orbital roof & Superior rectus muscle
- 11. Insertion 1. Tarsus (upper border & lower 1/3 of anterior surface) 2. Upper conjuctival fornix 3. Skin of the upper lid (crease) 4. MPL & LPL
- 12. Dermal attachment of the levator
- 14. Smooth (non- striated) muscle Origin: under surface of levator Insertion: Upper border of tarsus Nerve supply: sympathetic Action: Elevate the lid
- 15. 😳LOWER LID RETRACTORS are smooth muscles that originates from the IR complex and receive sympathetic supply.
- 16. Main nerves & vessels (site of injection of LA) Orbital septum Tarsus
- 17. The Tarsus Fibrous skeleton of the lid Both upper & lower meet at medial & lateral palpebral ligaments contains miebomian glands 10 mm 4 mm
- 18. Firm adherent to the lid Contains sulcus subtarsalis FB
- 22. Lacrimal part: medial 6 mm Ciliary part: lateral 24 mm
- 23. Blood Supply of the Eyelid - UL: 2 arcades (Marginal & Peripheral) - LL: 1 arcade - Medial palpebral Artery (From ophthalmic A.) - Lateral Palpebral Artery (From lacrimal A.)
- 26. Nerve Supply of the Eyelid III ; Levator VII ; Orbicularis Muller UL; Ophthalmic division of V LL; Maxillary division of V
- 27. Functions of the Eyelid Blinking; Wipe out FB, spread tear film,visual rest Lashes; catch FB Share in secretion of tear film (Meibomian) Drainage of tears (Horner muscle)
- 29. Congenital Diseases of the eyelid Congenital adhesion between the lid margins Ptosis Epicanthus Telecanthus BPES
- 30. Full thickness lid defect Search for other colobomas Extra raw of lashes that arises from the white line
- 31. Skin fold covering the inner canthus
- 32. Inflammatory lid diseases Margin Glands Blepharitis Meibomian Zeis
- 33. Chronic inflammation of the lid margin Predisposing Factors Ocular; Uncorrected error of refraction, seborrhoea Environmental; dust, wind Poor hygiene, nutrition
- 34. Causes Seborrhoea Staphylococcus aureus Less commonly; streptococci & Propionibacterium acnes
- 37. Symptoms Non-specific Caused by tear film instability Burning Itching Grittiness Redness
- 38. Signs Hard crusts at lash bases Yellow crusts at lash bases Removal of which causes ulceration Lid margin hyperemia
- 39. Macerated canthus Lice anchored to the lashes by their claws Ova & empty shells adherent to base of lashes
- 40. Capping of Meibomian gland orifices with oil globules Pressure on Meibomian glands expresses toothpaste like material Hyperemia of posterior border go the lid margin
- 41. Complications Madarosis; loss of lashes Trichiasis; maldirection of lashes (3 L, 2 C) Lashes – Lid margin – Lacrimal – Conjunctiva - Cornea
- 42. Tylosis; thickening of lid margin Conjunctivitis
- 43. Epiphora Destruction of the sharp posterior border of the lid margin Occlusion of the puncti Marginal corneal ulcer
- 44. Treatment Warm compresses Lid wash with shampoo (Johnson) Mechanical removal of crusts, lice Lid Hygiene Correct the predisposing factors Correct refractive error Improve hygiene Improve nutrition (vit A)
- 45. Anti biotics & Anti inflammatory Topical: Antibiotics (Fusidic acid, Bacitracin, Chloramphenicol), Tear substitutes, Steroids. Oral: Azithromycin (Ulcerative blepharitis), Tetracyclines (anti lipase in seborrhea) Sodium bicarbonate; facilitates removal of crusts Zinc sulphate; destroys the proteolytic enzymes of Moraxella Yellow mercuric oxide; destroys the lice
- 46. Acute suppurative inflammation of Zeis gland Hordeolum Externum Predisposing Factors Ocular; Uncorrected error of refraction, seborrhoea Environmental; dust, wind Poor hygiene, nutrition Causative organism Staph aureus
- 47. Symptoms Lid swelling Redness Throbbing pain Signs Localized, tender lid swelling pointing at lash root Complications 1. Cavernous sinus thrombosis ☠️ 2. Trichiasis 3. Recurrence 4. Orbital cellulitis
- 48. Treatment Warm compresses Lid wash with shampoo (Johnson) Lid Hygiene Correct the predisposing factors Correct refractive error Improve hygiene Improve nutrition (vit A)
- 49. Anti biotics & Anti inflammatory Epilation of the lash to facilitate pus drainage Horizontal skin incision to drain the pus
- 50. Acute suppurative inflammation of Meibomian gland Predisposing Factors Ocular; Uncorrected error of refraction, seborrhoea Environmental; dust, wind Poor hygiene, nutrition Causative organism Staph aureus
- 51. Symptoms Lid swelling Redness Throbbing pain Signs Localized, painful lid swelling pointing at white line or palpebral conjunctiva
- 52. Treatment Warm compresses Lid wash with shampoo (Johnson) Lid Hygiene Correct the predisposing factors Correct refractive error Improve hygiene Improve nutrition (vit A)
- 53. Anti biotics & Anti inflammatory Vertical Conjunctival incision to drain the pus
- 54. Hordeolum Externum Hordeolum Internum Infected gland Zeis Meibomian Lid closure (Orbicularis contraction) Not affected Decreases in size Pointing at lid margin (lash line) at white line or conjunctiva Incision Horizontally (Skin side) Vertically (Conjunctival side)
- 55. Chronic Granulomatous inflammation of Meibomian gland Pathogenesis Obstruction of Meibomian gland ducts by dried secretion or epithelial debris Retaining of Meibomian secretion inside the gland Foreign body granuloma Predisposing Factors Ocular; Uncorrected error of refraction, seborrhoea Environmental; dust, wind Poor hygiene, nutrition
- 56. Symptoms Lid swelling PAINLESS Signs Firm swelling non tender not attached to skin Fixed to the tarsus
- 57. Fate Resolution with or without medical treatment Infection; Hordeolum internum Pointing Skin sideConjunctival side Complications UL; Mechanical ptosis LL; Mechanical ectropion Cornea; Astigmatism
- 58. Treatment Surgical excision Local anaesthesia Chalazion forceps Vertical incision Conjunctival side
- 59. Intra- or peri-lesional triamcinolone injection Small chalazion Recurrent chalazion Recurrent chalazion in old age biopsy to exclude malignancy Small chalazion might be treated with topical antibiotic/steroid along with warm compresses. 🤔
- 61. DDx Other lid swellings Cyst of Zeis Cyst of Moll Sebaceous cyst
- 62. Lashes malposition Abnormally directed lashes that arise from its normal origin Causes Entropion Blepharitis Blepharitis Cicatricial diseases Entropion أسبابهم 🤔
- 63. Symptoms FB sensation Lacrimation, phtophobia (Corneal affection) Signs Abnormally directed lashes that arise from normal position (DDx Distichiasis) The cause e.g. entropion
- 64. Extra raw of lashes that arises from the white line Abnormally directed lashes that arise from its normal origin
- 65. Complications Conjunctivitis Corneal abrasions Conjunctival epithelial hyperplasia & keratinisation
- 66. Treatment Of the cause Temporary Epilation Electrolysis Chemical denaturation of hair follicle protein Permanent (30 mA for 3 sec) Rubbing lashes (Less than 4 lashes) + ve - ve Na + عددهمقليل كهربهم جمدهم ليزرهم 😎 😈 😱 ☠️
- 67. Cryo-application freezing to -60 C for 30 seconds under local anesthesia
- 69. Surgery Anterior lamella Posterior lamella van Mellingin operation Mal- directed lash Mucus Membrane Graft
- 70. Principle Buccal mucus membrane graft is inserted in an incision in the grey line to displace the map-directed lashes away from the globe Indications Trichiasis of the UL Contra-indications Trichiasis of the LL (poor cosmosis) Combined trichiasis & entropion of the UL
- 72. Principle Buccal mucus membrane graft is inserted in an incision in the Sulcus subtarsalis to displace the map-directed lashes away from the globe Indications Trichiasis of the LL Cicatricial entropion of the LL