Lid diseases ii


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Lid diseases ii

  1. 1. Trichiasis
  2. 2. TrichiasisMisdirected eye lashes are called trichiasis.Eyelashes (cilia) emerging normally i.e. fromanterior border of lid margin are misdirectedbackward towards the ocular surface (cornea).Tarsal plate remains normal in position.Any condition causing entropion (involutional,cicatricial as in Trachoma or spastic entropion) willcause misdirected lashes (Trichiasis) to rubagainst cornea
  3. 3. Causes of Trichiasis1. Secondary to chronic inflammatory conditions like Trachoma, Stevens- Jhonson Syndrome, Pemphigus, Blepharitis, traumatic or operative scar, blepharitis (Ulcerative) and chemical burns2. It may be idiopathic
  4. 4. Traumatic Scar causing Trichiasis
  5. 5. Trichiasis in Trachoma Stage IV
  6. 6. Trichiasis with Corneal Opacity
  7. 7. Trichiasis associated with Ivolutional Entropion
  8. 8. Trichiasis associated with spastic entropion
  9. 9. Trichiasis associated with operative scar
  10. 10. Symptoms► Foreign body sensation► Irritation► Pain► Redness► Inability to open eyes► Watering
  11. 11. Signs► Misdirected eyelash(s)► Conjunctival congestion► Lacrimation/ blepharospasm► Recurrent corneal erosions / superficial corneal opacity(ies)► Corneal vascularization► Recurrent corneal ulcer/ Non-healing corneal ulcer
  12. 12. Trichiasis with corneal abrasion
  13. 13. Trichiasis
  14. 14. Trichiasis with Stevens Jhonson Syndrome
  15. 15. Treatment1. Epilation of affected eyelash, but they grow in 4- 6 weeks2. Diathermy: 30 mA current is passed in the root of affected eyelash for 10 seconds then epilated3. Electrolysis: done under local anaesthesia by injecting lignocaine along the lid margin to anaesthetize root of eyelashes. Positive pole is applied temple. Negative pole is introduced in hair follicle and current of 2 mA is used (bubble is seen at root of eyelash then) eyelash is then epilated
  16. 16. Epilation Forceps
  17. 17. Treatment4. Cryotherapy: used for treating portion of lid. This procedure is done under local anaesthesia. Temperature of -20 deg. C , two cycles then eyelashes are epilated
  18. 18. Distichiasis► In this condition there is an extra row of eyelashes emerging from the duct of the meibomian glands► It may be a congenital (autosomal dominant) condition or acquired following chronic inflammatory condition of the eyelids, conjunctiva or trauma► Treatment- epilation/ electrolysis/cryotherapy
  19. 19. Trichiasis
  20. 20. Symblepharon► Symblepharon is adhesion between the bulbar and palpabral conjunctiva due to raw opposing surfaces► Causes: opposing surfaces of palpabral and bulbar conjunctiva becomes raw and inflamed in cases of: a. Chemical burn (Alkali / Acid burn) b. Stevens- Johnson syndrome c. Pemphigus
  21. 21. SymblepharonTypes: - Anterior - Posterior - Total
  22. 22. Posterior symblepharon in Stevens Johnson Syndrome
  23. 23. Posterior and Anterior Symblepharon
  24. 24. Symptoms► Irritation, foreign body sensation► Restriction of ocular movements► Diplopia
  25. 25. Treatment► Prevention: Sweeping of glass rod and use of topical steroids► Treatment: surgical release + mucous membrane or amniotic membrane grafting
  26. 26. Lagophthalmos
  27. 27. LagophthalmosDefinition : Incomplete closure of the palpabral aperture when attempt is made to close the eyes.
  28. 28. Lagophthalmos in 7 nerve palsy th
  29. 29. Lagophthalmos with neuroparalytic keratitis
  30. 30. Causes of Lagophthalmos► Contraction of lids due to cicatrization or a congenital deformity► Ectropion► Paralysis of Orbicularis► Proptosis due to exophthalmic goitre, orbital tumour/ inflammmation etc.► Laxity of tissue and absence of reflex blinking in patients who are extremely ill.
  31. 31. Clinical PictureSymptoms:1. Inability to close eye(s)2. Symptoms of dry eye3. Blurring of vision4. Foreign body sensation5. Photophobia
  32. 32. Clinical PictureSigns1. Incomplete closure of lid2. Exposure of conjunctiva and cornea3. Dryness, congestion4. Haziness of cornea, punctate infiltrationComplications1. Corneal ulcer (Non-healing)
  33. 33. TreatmentMedical Treatment1. Lubricating Eye drops2. Control of infection3. Protection of ocular surface4. Close affected eye and tape upper lid or application of sutureSurgical Treatment:Tarsorrhaphy (Lateral or paramedian)
  34. 34. PTOSIS
  35. 35. Ptosis► Definition: Drooping of upper lid usually due to paralysis or defective development of the levator palpebrae superioris (LPS)
  36. 36. Types► Congenital 1. Simple 2. Complicated► Acquired 1. Neurogenic 2. Myogenic 3. Aponeurotic 4 Mechanical
  37. 37. Types► Pseudoptosis – in Phthisis bulbi and anophthalmos► Condition may be Unilateral or Bilateral► Partial or complete
  38. 38. Measurement► Normal position of lids► Abnormal – Margin Reflex Distance (MRD)- Normal MRD is 4 mm +/- 1 mm► Ptosis of less than 2 mm – Mild► Ptosis of 3 mm – moderate► Ptosis of 4 mm or more – severe
  39. 39. Compensatory Mechanism► Overaction of frontalis► Throwing back the head► Assessment of LPS function – Excursion of 8 mm or more – good action Excursion of 5-7 mm – Fair action Excursion of 4 mm or less – poor► Look for Bell phenomenon
  40. 40. Congenital Ptosis► Commonest form of ptosis► Usually bilateral / Heriditary► Due to defective development of LPS► Simple congenital ptosis is an isolated abnormality
  41. 41. Ptosis of left eye
  42. 42. Marcus Gunn Phenomenon
  43. 43. Blepharophimosis syndrome
  44. 44. Congenital Ptosis► Complicated – when associated with developmental abnormality of surrounding structures Associated Sup rectus palsy Abnormal synkineses – Marcus Gunn ptosis Dystrophy of the LPS Blepharophimosis syndrome (Ptosis, horizontal shortening of palp aperture, epicanthus inversus, telecanthus lat ectropion of the lower lids)
  45. 45. Treatment of Congenital Ptosis► Age (3-5 years), early surgery when pupil is covered► Fasanella –servat operation (indicated when ptosis is 1.5 – 2 mm – excision of 4-5 mm upper tarsus)► LPS resection – 10 mm resection is minimum (resection ranges from 12 – 24 mm)► Conjunctival (Blaskovics operation) or skin (Everbusch operation) route for surgery
  46. 46. Treatment of Congenital Ptosis► Frontalis suspension- intact LPS with poor function (3 mm or less) 4-0 Supramid suture or fascia lata is used Complications associated with this operation
  47. 47. Acquired Ptosis► Usually unilateralTypes1. Neurogenic – Third nerve paralysis or due to reduced sympathetic innervation (Horner syndrome – ptosis, anhydrosis and miosis) Treatment – of cause, crutch spectacle, surgery – LPS resection/ Frontalis suspension
  48. 48. Left Eye 3 nerve Palsy rd
  49. 49. Left Eye 3 nerve Palsy rd
  50. 50. Acquired Ptosis2. Myogenic – gradual onset, bilateral condition, symmetrical Myotonic dystrophy Chronic progressive exophthalmoplegia Mysthenia gravis ( damage to acetyl-cholin receptor at postsynaptic membrane with presence of antiacetylcholine receptor antibodies)
  51. 51. Acquired PtosisMysthenia Gravis-Symptoms – variableSigns – bilateral ptosis, increases byprolonged fixation or attempt to look up ,external ophthalmoplegia – partial orcompleteConformation by prostigmin or edrophoniuminjection test
  52. 52. Acquired PtosisAponeurotic PtosisIs involutional is due to weakness ordisinsertion of LPS aponeurosis from antsurface of tarsal plateHigh lid fold with good LPS functionTreatment – reinsertion of LPS andresection of LPSMechanical Ptosis - Tumour orinflammation weigh down the lid
  53. 53. Contusions► Black Eye – swelling and ecchymosis of lids and conjunctiva► Cryptophthalmos – rare condition characterized by presence of skin passing continuously from brow over the eye to the cheek.
  54. 54. Cryptophthalmos