THIS IS SLIDE SHARE FOR EYELID DISORDER

1. Disorder of Eyelids
By
P. Parameshwari
B. Optom

2. Anatomy of the eyelid
• The eyelids are mobile tissue curtains placed
in front of the eyeballs.
• These act as shutters protecting the eyes from
injuries and excessive light.
• These also perform an important function of
spreading the tear film over the cornea and
conjunctiva

3. Muscles
*Orbicularis occuli muscle ;
It helps to closure of plapebral aperture
*Levator palpebrae superioris;
it helps to elevates the upper eyelid
• Position of lids;
The upper lid covers about one-sixth of the
cornea and the lower lid just touches the
limbus.

4. ANATOMY OF EYELID
• The eyelids are mobile tissue curtains placed
in front of the eyeballs.
• These act as shutters protecting the eyes from
injuries and excessive light.
• These are preform an important function of
spreading the tear film over the cornea and
conjunctiva .

5. Parts of eyelid

6. Glands of eyelids
• It consists of 4 glands
1. Meibomian glands
2. Glands of zeis
3.Glands of moll
4.Glands of wolfring

7. 1. Meibomian glands
• These are also known as tarsal glands and are
present in the stroma of the tarsal plate
arrenged vertically.
• There are about 30-40 in the upper lid and 20-
30 in the lower lid.
• It modified sebaceous glands
• Their secretion constitutes the oil layer of tear
film.

8. 2. Glands of Zeis
• These are also sebaceous glands which open
into the follicles of eyelashes.
3.Glands wolfring
• These are present near the upper border of
the tarsal plate.

9. 4. Glands of moll
• These are modified sweat glands situated near
the hair follicles.
• They open into the hair follicles or into the
ducts of zeis glands.
• They do not open directly onto the skin
surface as elsewhere

10. Blood supply
• Superficial temporal artery

11. Never supply
• Motor nerves ;
are facial (which supplies orbicularis muscle),
oculomotor (which supplies LPS muscle) and
sympathetic fibres ( which supply the muller’s
muscle
• Sensory nerve;
Supply is derived from branches of the
trigeminal nerve.

12. Blepharitis
• It is the subacute or chronic inflammation of
the lid margins.
• It is divided into
Anterior blepharitis
Posterior blepharitis

13. 1. Bacterial blepharitis
2. Seborrhoeic blepharitis
3. Parasitic blepharitis
Anterior blepharitis

14. Bacterial blepharitis
• It is also called chronic anterior blepharitis.
• It is a common cause of ocular discomfort and
irritation
• The disorder usually starts in childhood and
may continue throughout life.

16. ETIOLOGY
Causative organisms are
*Coagulase positive staphylococci
*Streptococci
*Propionibacterium acne
*Moraxella

17. symptoms
• Chronic irritation
• Itching
• Mild lacrimation
• Gluing of cilia
• Mild photophobia

18. Sings
* yellow crusts,
*Small ulcers,
*Red thickened lid margins,
* Mild papillary conjunctivits

19. Treatment
1. Lid hygiene
* Crust removal and lid margin cleaning
*Avoid rubbing of the eyes
2. Antibiotic
3. Topical steroids
4. Ocular lubricants

20. Posterior blepharitis
• Inflammation of meibomian glands occurs in
chronic and acute forms.
• 1. chronic meibomitis
• 2. Acute meibomitis

22. • Chronic meibomitis is a commonly occuring
meibomian gland dysfunction
• More commonly in middle aged persons
Chronic meibomitis

23. Symptoms
• Chronic irritation
• Burning
• Itching
• Grittiness
• Mild lacrimation

24. Signs
• White frothy
• Opening of meibomian glands
• Vertical yellowish streaks shining
• Hyperemia
• Oily and foamy tear film
• Secondary changes;
papillary conjunctivitis,

25. Acute meibomitis
• Acute meibomitis occurs due to
staphylococcal infections.
• It is characterized by painful swelling around
the involved gland

26. Treatment
* Lid hygiene
*Topical antibiotics
*systemic tetracyclines
*Ocular lubericants
*Topical steroids

27. CHALAZION
• Chalazion, is also called a tarsal or meibomian
cyst is a chronic non- infective
lipogranulomatous inflammation of the
meibomian gland
• This is the commonest of all lid lumps.

29. Pathogenesis
• Chalazia are inflammatory lesions that from
when lipid breakdown products leak into
surrounding tissue and incite a granulomatous
inflammatory response on occasion , a
chalazion may enlarge and break through the
tarsal plate to the external portion of the lid.

30. Symptoms
• Painless swelling of the eyelid
• Blurred vision
• Watering (epiphora)

31. Signs
*Well defined subcutaneous nodule in the
eye lid
*Reddish purple area
*Marginal chalazion ,
may present as small reddish grey nodule on
the lid margin.

32. Treatment
• Warm compresses
• Tropical antibiotic ointment
• Amoxicillin
• Doxycycline
• Erythromysin
• Surgery

33. TRICHIASIS
*It refers to inward misdirection of cilia with
normal position of the lid margin.
Etiology
*common causes of trichiasis are;
Ulcerative blepharitis
External hordeolum
Injuries , burns

35. Symptoms
• Foreign body sensation
• Photophobia
• Irritation
• Pain
• Lacrimation

36. • Misdirected eyelash
• Conjuctival congestion
• Lacrimation
• Reflex blephrospasm
• Sign of causative disease viz ; trachoma ,
blephritis, may be present
Signs

37. Complication
• Recurrent corneal abrasions
• Superficial corneal opacities
• Corneal vascularisation
• Non healing corneal ulcers

38. Treatment
• Epilation of affected eyelash
• Electrolysis
• cryoepilation

39. External hordeolum (syte)
• It is an acute suppurative inflammation of
lash follicle and its associated glands of zeis or
moll.

41. Etiology
• Usually caused by staphylococcus aureus.
• There is infection of hair follicle of eyelash
• It may complicate acne vulgeris in young
adults

42. Symptoms
• Acute pain associated with swelling of lid
• Mild watering
• Photophobia

43. Signs
• Stage of cellulitis ; is characterised by localised
firm, red, tender swelling at the lid margin
associated with marked oedema.
• Stage of abscess; is characterised by a visible
pus point on the lid margin in relation to
affected cilia.

44. Treatment
*Hot compresses
*Evacuation of the pus
*Surgical incision
*Antibiotic eye drops
*Systemic anti-inflammatory and analgesics

45. Internal hordeolum
• It is a suppurative inflammation of meibomian
gland associated with blockage of the duct.
• Causing organisam of staphylococcal

47. Symptoms
• Acute pain associated with swelling of the lid
• Mild watering
• Photophobia

48. Signs
• It localized, firm , red, tender, swelling of the
lid associated with marked oedema.
• Sometimes, pus point may be seen at the
opening of involved meibomian gland or
rarely on the skin.

49. Treatment
• It is similar to treatment of external
hordeolum i.e.
• Hot compresses
• Surgical incisions
• Antibiotic eye drops
• Systemic anti-inflammatory and analgesics

50. Symblepharon
*In this condition , lids become adherent with
the eyeball as a result of adhesions between the
palpebral and bulbar conjunctiva.

52. Etiology
• It results from healing of the kissing raw
surface upon the palpebral and bulbar
conjuctiva.
• Common causes ;
thermal or chemical burns
membranous conjuctivaitis
injuries
conjunctival ulcerations

53. Symptoms
• Ocular movement become restricted
• Diplopia
• Irritation
• Foreign body sensation

54. Types of symblepharon
• Anterior symblepharon
• Posterior symblepharon
• Total symblepharon

55. Complications
• Dryness
• Thickening and keratinisation of conjuctiva
due to prolonged exposure and corneal
ulceration

56. Treatment
• Sweeping a glass rod coated with loburicant
• Therapeutic soft contact lens of large size

57. LAGOPHTHALMOS
• Definition ;
In complete closure of the palpabral
aperture when attempt is made to close the
eyes.

59. Etiology
• It occurs in patient with Paralysis of orbicularis
oculi muscle ,Cicatricial contraction of lid ,
symblepharon, severe ectropion, proptosis,

60. Symptoms
• Inability to close eyes
• Dry eye
• Blurring of vision
• Foreign body sensation
• photophobia

61. Signs
• Incomplete closure of lid
• Exposure of conjunctiva and cornea
• Haziness of cornea , punctate infiltration
• Complication;
corneal ulcer

62. Treatment
• Medical treatment;
1.lubricating eye drops
2.procetion of ocular surface
3.close affected eye and tape upper lid or
application of suture
*surgical treatment;
Tarsorrhaphy

63. ENTROPION
• Entropion refers to inward rolling and rotation
of the lid margin toward glope.
• Types entropion
1.congenital entropion
2.Cicatricial entropion
3.Senile (involutional) entropion
4.Mechanical entropion

65. 1. Congenital entropion
• It is a rare condition seen since birth.
• Seen more commonly in lower than upper
eyelid
• There are two types of congenital entropion
*Lower eyelid congenital entropion
*upper eyelid congenital entropion

67. 2. Cicatricial entropion
• It is a common variety usually involving the
upper lid.
• Distortion of the tarsal plate
Common causes;
Trachoma , chemical burns , stevens-
johnson syndrome.

69. 3. Senile entropion
• It is common occurrence and affects only the lower lid
in elder people
• Etiological factors;
Horizontal laxity (weakening of orbicularis muscle)
Vertical lid instability
Over- riding of pretarsal orbicularis
Laxity of orbital septum

71. 4. Mechanical entropion
• It occurs due to lack of support provided by
the glope to the lids.
• It may be occur in patients with phthisis bulbi,
enophthalmos and after enucleation or
evisceration operation.

72. Symptoms
• Foreign body sensation
• Irritation
• Lacrimation and photophobia

73. Signs
1. Inturning of lid margin;
*Grade 1 entropion ; only the posterior lid border
is inrolled
* Grade 2 entropion ; inturing up to the inter-
marginal strip
*Grade 3 entropion; in which the whole lid
margin including the anterior border is inturned.

74. 2. Signs of causative disease
• Scarring of palpebral conjunctiva in cicatricial
entropion,
• Horizontal lid laxity
3. Signs of complications
*corneal abrasions , superficial corneal
opacities , corneal vascularization , corneal
ulceration.

75. Treatment
1. Congenital entropion;
Hotz procedure
2.Cicatricial entropion;
Altering the direction of lashes
Transplanting the lashes
Straightenting the distroted tarsus

76. Surgical techniques
• Anterior lamellar resection
• Tarsal wedge resection
• Transposition of tarsoconjunctival wedge
• Posterior lamellar graft

77. 3. Senile entropion
• Transverse everting suture
• Wies operation
• Plication of lower lid retractors
• Quickert procedure

78. ECTROPION
• Out rolling or outward turning of the lid
Margin is called ectropion.
• types of ectropion;
1.congenital ectropion
2.involutional ectropion
3.cicatricial ectropion
4.paralytic ectropion
5.mechanical ectropion

80. symptoms
*Chronic conjuctivitis
*Irritation
*Discomfort and mild photophobia.

81. Signs
• 1. lid margin is outrolled ;
*Grade 1; only punctum is everted
*Grade 2; lid margin is everted and palpebral
conjuctiva is visible
*Grade 3; the fornix is also visible

82. 2. In involutional ectropion
• Horizontal lid laxity
• Medial canthal tendon laxity
• Lateral canthal tendon laxity

83. Treatment
1.congential ectropion
No treatment
2.Involutional ectropion
*Mild conjunctivoplasty
*Horizontal lid shortening
*Lateral tarsal strip technique

84. 3. Cicarticial ectropion
*V-Y operation
*Z- plasty (Elschnig’s operation)
*Excision of scar tissue and full thickness skin
grafting.

85. TUMOURS OF EYELIDS
• Almost all types of tumours arising from the
skin, connective tissue, glandular tissue, blood
vessels, nerves & muscles can involve the lid.

86. CLASSIFICATION
• BENIGN TUMOURS
1. Papillomas
2.Xanthelasma
3.Haemangioma
4.Neurofibroma

87. • MALIGNANT TUMOURS
1. Basal cell carcinoma
2.Squamous cell carcinoma
3.Sebaceous gland carcinoma
4. Malignant melanoma

88. 1.PAPILLOMAS
• These are the most common benign tumours
arising from the surface epithelium.
• These occur in two forms ;
squamous papillomas
seborrhoeic keratosis

89. • Squamous papillomoas;
• Derived from squamous cells occur in
adults, as very growing or stationary,
raspberry – like

91. • Seborrhoeic keratosis;
Derived from basal cells occurs in middle-
aged and older person
Their surface is friable, verrucous and slightly
pigmented.
TREATMENT
Simple excision

93. XANTHELASMA
• These are creamy- yellow plaque- like lesions
which frequently involve the skin of upper and
lower lids near the inner canthus.
• Xanthelasma occurs more commonly in
middle-aged women.
• Xanthelasma represents lipid deposits in
histiocytes in the dermis of the lid.
• These may be associated with diabetes
mellitus or high cholesterol levels.

95. Treatment
• Excision may be advised for cosmetic reasons;
but recurrences are common

96. Basal cell carcinoma
• As per western literature it is the commonest
malignant tumors of the lids usually seen in
elderly people
• It is locally malingnant and involves most
commonly lower lid (50%)followed by medial
canthus (25%) upper lid (10-15%) and outer
canthus (5-10%)

98. Clinical features
• It may be present in four forms;
*non- ulcerated nodular form
* Sclerosing or morphea type
* Pigment basal cell carcinoma
* Noduloulcerative basal cell carcinoma

99. Treatment
• Surgery ( Moh’s microsurgival technique)
• Radiotherapy
• Cryotheraphy

100. SQUAMOUS CELL CARCINOMA
• It forms the second commonest malignant
tumour of the lid.
• It incidence (5%) is much less than the basal
cell carcinoma.
• It commonly arises from the lid margin in
elderly patient.
• Affects upper & lower lids equally.

102. Clinical features
• Ulcerated , scaly, erythematous plaque
• Fungating or polypoid
• Treatment
Is on the lines of basal cell carcinoma

103. SEBACEOUS GLAND CARCINOMA
• It is rare tumour arising from the meibomian
glands(western literature)
• Indian literature reports ; the sebaceous
gland carcinoma being the commonest
malignancy of eyelid followed by basal cell
and squamous cell carcinoma

105. Clinical features
• It uaually presents initially as a nodule, more
frequently on the upper eyelid.
• Rarely , a diffuse tumour along the lid margin
may be mistaken as chronic blepharitis.
Treatment
surgical excision with reconstruction of lids;
recurrences are common.

106. MALINGNANT MELANOMA
• It is a rare tumour of the lid
• It may arise from a pre-existing naevus, but
usually arises from the beginning from the
melanocytes present in the skin.

108. Clinical features
• It may be present in three forms;
*Lentigo maligna type
* Superficial spreading type
*Nodular type
Treatment
* It is a radio- resistant tumour
*Surgical excision with reconstruction of lid.