The Eyelids Husam Salhab

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  • This was a nice little presentation. I am currently preparing to do a presentation on common eye conditions requiring surgery for a group of operating department assistants, which led me to your site. It's great to see that you are sharing your work.

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The Eyelids Husam Salhab

  1. 1. THE EYELIDS Husam Salhab
  2. 2. Objectives <ul><li>Anatomy of the eyelids </li></ul><ul><li>Function of the eyelids </li></ul><ul><li>Diseases of the eyelids </li></ul>بسم الله الرحمن الرحيم
  3. 3. Modified sebaceous gland, oily secretions Ciliary glands (glands of moll) Modified sweat glands open b/n adjacent lashes
  4. 4. Function of the eyelids: <ul><li>The eyelids provide physical protection to the eye . </li></ul><ul><li>Prevent drying of the eyes. </li></ul><ul><li>Ensuring normal tear film and drainage. </li></ul><ul><li>Secrete the oily part of the tear film. </li></ul>
  5. 5. Diseases of the eyelid Abnormal position Inflammation Lumps (masses) Abnormalities of the lashes
  6. 6. ABNORMAL LID POSITION Ptosis Entropion Ectropion
  7. 7. Ptosis: Abnormal low position of the upper eyelid
  8. 8. <ul><li>Causes: </li></ul><ul><li>1-Mechanical factors </li></ul><ul><li>(a) large lid lesions. </li></ul><ul><li>(b) lid edema. </li></ul><ul><li>(c) tethering of the lid by conjunctival scaring. </li></ul><ul><li>(d) structural abnormalities. </li></ul><ul><li>(disinsertion of aponeurosis of the lavator muscle) </li></ul>Ptosis
  9. 9. <ul><li>2-neurological factors </li></ul><ul><li>(a) 3 rd nerve palsy (oculomotor) </li></ul><ul><li>(b) horner’s syndrome </li></ul><ul><li>(c) marcus-gunn jaw-winking syndrome </li></ul><ul><li>3-myogenic factors </li></ul><ul><li>(a) myasthenia gravis </li></ul><ul><li>(b) some forms of muscular dystrophy </li></ul><ul><li>(c) chronic external opthalmoplegia </li></ul><ul><li>(ocular myopathy). </li></ul>
  10. 10. <ul><li>Symptoms: </li></ul><ul><li>-cosmotic effect. </li></ul><ul><li>- vision impairment. </li></ul><ul><li>-symptoms associated with the </li></ul><ul><li>underlying cause (diplopia, reduced </li></ul><ul><li>eye movment). </li></ul><ul><li>signs : </li></ul><ul><li>-Reduction in size of interpalpebral opening. </li></ul><ul><li>-Abnormal function of the levator muscle. </li></ul><ul><li>-Increasing ptosis after repeated elevation and </li></ul><ul><li>depression of the lid . </li></ul><ul><li>-others(miosis, lack of sweating..). </li></ul>
  11. 11. <ul><li>Treatment : </li></ul><ul><li>-Treat the underlying cause </li></ul><ul><li>-surgical correction. </li></ul>
  12. 12. <ul><li>Entropion: It is an inturning of the lid. </li></ul><ul><li>(usually the lower lid). </li></ul>
  13. 13. <ul><li>Causes: </li></ul><ul><li>-Weakness of the orbicularis muscle </li></ul><ul><li>-Conjuctival scarring </li></ul><ul><li>Symptoms and signs : </li></ul><ul><li>-Irritation of the eye </li></ul><ul><li>-Redness </li></ul><ul><li>Treatment : </li></ul><ul><li>-Lubricants or taping of the eyelid for </li></ul><ul><li>short term treatment. </li></ul><ul><li>-Surgery for permanent treatment </li></ul>
  14. 14. <ul><li>Ectropion: an outwards turning of the lid from globe. </li></ul>
  15. 15. <ul><li>-Frequently associated with epiphora and </li></ul><ul><li>chronic conjunctivitis. </li></ul><ul><li>Causes: </li></ul><ul><li>-Orbicularis muscle laxity </li></ul><ul><li>-Scarring of the periorbital skin </li></ul><ul><li>-7 th nerve palsy (facial) </li></ul><ul><li>Treatment: surgical. </li></ul>
  16. 16. INFLAMMATION OF THE EYELIDS <ul><li>Blepharitis </li></ul><ul><li>-Chronic eyelid inflammation. </li></ul><ul><li>-sometimes associated with staphylococcal infection. </li></ul><ul><li>-It causes squamos debris, inflammation </li></ul><ul><li>of the lid margin, skin and eyelash follicles. </li></ul><ul><li>- the meibomian gland may be affected. </li></ul>
  17. 17. Blepharitis squamos debris, inflammation of the lid margin, skin and eyelash follicles
  18. 18. <ul><li>Signs and symptoms : </li></ul><ul><li>-Tired eyes (worse in the morning) </li></ul><ul><li>-Crusting </li></ul><ul><li>-Scaling </li></ul><ul><li>-debris around the eyelash </li></ul><ul><li>-Reduction in number of eyelash </li></ul><ul><li>-Obstructon,plugging and cloudy secretions of meibomian ducts. </li></ul>
  19. 19. <ul><li>Treatment : </li></ul><ul><li>-Lid toileting or diluted baby shampoo. </li></ul><ul><li>(anterior blepharitis) </li></ul><ul><li>-lid massage after a hot bath to remove </li></ul><ul><li>the abnormal meibomian gland </li></ul><ul><li>secretions </li></ul><ul><li>-topical or systemic antibiotic for staph. </li></ul><ul><li>Infection. </li></ul><ul><li>-topical steroids. </li></ul><ul><li>-artificial tears. </li></ul>
  20. 20. DISORDERS OF THE EYELID GLANDS <ul><li>Chalazion : </li></ul><ul><li>Common painless condition </li></ul><ul><li>Meibomian gland obstruction cause chronic granulomatous inflammation within the tarsal plate. </li></ul><ul><li>Symptoms: lid swelling,usually resolves within 6 months. </li></ul><ul><li>If not resolved :surgical incision </li></ul><ul><li>Complications: - painful abscess within the </li></ul><ul><li>meibomian gland </li></ul><ul><li>-stye.(abscess in the eyelash </li></ul><ul><li>follicle) </li></ul>
  21. 21. Chalazion
  22. 22. BENIGN LUMPS <ul><li>Ductal Cysts : </li></ul><ul><li>Cyst of Moll: </li></ul><ul><li>translucent cyst on the lid margin </li></ul><ul><li>caused by sweat gland obstruction </li></ul><ul><li>Cyst of Zeis: </li></ul><ul><li>opaque cyst on the eyelid margin </li></ul><ul><li>caused by accessory sebacous gland blockage </li></ul><ul><li>Rx: excision for cosmetic reasons </li></ul>
  23. 23. <ul><li>Squamous cell papilloma: </li></ul><ul><li>frond-like lid lesion ( ورق الشجر ) with fibrovascular core and thickened squamous epithelium. </li></ul><ul><li>Usually asymptomatic but can be excised for cosmotic reasons with cautery to the base. </li></ul><ul><li>Naevus : </li></ul><ul><li>Lesions derived from naevus cells(altered melanocytes) </li></ul><ul><li>Can be pigmented or non pigmented. </li></ul><ul><li>No treatment is necessary. </li></ul>
  24. 25. <ul><li>Xanthelasma : Bilateral soft yellow lipid containing plaques </li></ul><ul><li>Associated with hypercholesterolaemia </li></ul>
  25. 26. MALIGNANT TUMORS <ul><li>Basal cell carcinoma : </li></ul><ul><li>90% of eyelid malignancies </li></ul><ul><li>Nodular ,sclerosing or ulcerative(rodent ulcer) lesions </li></ul><ul><li>Pale pearly margins </li></ul><ul><li>Painless </li></ul><ul><li>Slow growing </li></ul><ul><li>Non metastatising </li></ul><ul><li>Locally invasive </li></ul><ul><li>Rx : the earlier it is detected the easier to be removed </li></ul><ul><li>excision biopsy with a margin of healthy tissue. </li></ul><ul><li>cryotherapy </li></ul><ul><li>radiotherapy </li></ul>
  26. 27. Pale, Ulcerated, Nodule
  27. 28. <ul><li>Squamous cell carcinoma: </li></ul><ul><li>2 nd most common </li></ul><ul><li>More malignant </li></ul><ul><li>Metastatize to regional LNs </li></ul><ul><li>Rapidly growing </li></ul><ul><li>Hard nodules or scaly patches </li></ul><ul><li>Rx: complete surgical removal. </li></ul>
  28. 29. Hard nodules or scaly patches
  29. 30. ABNORMALITIES OF THE LASHES <ul><li>Trichiasis : </li></ul><ul><li>Condition in which eyelashes turn inward toward the globe. </li></ul><ul><li>Corneal irritation and abrasion . </li></ul><ul><li>Presentation : irritation and tearing. </li></ul><ul><li>Rx : pluck( قص ) eyelash ; recurrence can be treated with electrolysis . </li></ul>
  30. 31. THANK YOU تمّت بحمد الله

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