eyelid diseases

1. PRESENTATION BY NAZNEEN NASIR
MBBS FORTHYEAR

2. 1. ENTROPION
2. ECTROPION
3. EYELID SWELLINGS

3.  Entropion is abnormal inversion of the eyelid (usually the lower) toward the globe.
 Causes corneal abrasions or Infections.
 usually acquired as a result of involutional or cicatricial processes but may occasionally be
congenital.
TYPES
 SPASTIC
 CICATRICIAL
 INVOLUTIONAL

4.  Due to spasm of ORBICULARIS OCULI
 CAUSES
 Tight bandage post surgery
 Chronic irritative corneal condition
 Common in old people
 Mostly lower lid is involved

5.  mostly due to inward direction of lashes
 Symptoms : foreign body sensation
,photophobia,irritation ,pain.
 Signs: reflex blepherospasm if cornea is
involved
 Corneal abrasion ,ulceration ,superficial
opacities
 Conjunctival congestion

6.  If due to bandage ;simply discontinue the
application of bandage
 If senile patient ,the lower lid is pulled
downwards by strip of adhesive plaster

7.  Cicatricial means new tissue that forms over a
wound and later contracts into a scar.
 results due to contraction of palpebral
conjunctiva in;
 Trachoma stage IV
 Ulcerative blepharitis
 Burns
 Surgeries
 Diphtheric membranous conjunctivitis
 Radiotherapy
 Ocular cicatricial pemphigoid
 trauma

8. • Chronic: loss of plica semilunaris, loss of
forniceal depth, formation of
symblepharon/ankyloblepharon, dry eye
signs( redness ,lacrimation).
In trachoma, subtarsal fibrosis is likely to be
evident.
• Acute: papillary conjunctivitis,
subconjunctival vesicles.

9.  Medical: the cicatrizing process should be optimally
controlled, especially before surgical intervention .
 Principles of treatment through surgery are
 Altering lash direction
 Transplantation of lashes
 Straightening the distorted tarsus
Treated by operative procedures
1. Resection of skin and muscle
2. Resection of tarsus, skin and muscle
3. Burow`s operation.

10.  Congenital entropion
 very rare
 often resolves with time, without the need
for intervention.
 Pretarsal orbicularis is hypertrophied,
forming a marked ridge.
 the lashes do not usually damage the cornea
 recurrent infections are common.

11.  CONDITION INWHICH LID MARGIN ROLLS
OUTWARD.(usually lower lid)
 TYPES;
1. SPASTIC
2. MECHANICAL
3. CICATRICIAL
4. SENILE/ INVOLUTIONAL
5. PARALYTIC
6. CONGENITAL

12.  Due to blepharospasm (orbicularis oculi
contracts)
 Usually in children and young persons in
association with Purulent conjunctivitis.

13.  commonest form
 results from age-related tissue laxity( loss of
tone of orbicularis oculi)
 Mostly in lower lid

14.  Contractures due to burn, ulcers ,trauma, skin
diseases of eyelids, surgeries.

15.  Weakness of orbicularis oculi due to FACIAL
NERVE PALSY
 It affects lower lid only

16.  Due to weight of a mass in eyelid as in
 Tumor
 Or proptosis

17.  SYMPTOMS;
 constant epiphora
 dermatitis of eyelid
 irritation
 discomfort in eye

18.  lid margin rolled outward
 Punctum visible
 Conjunctival congestion
 Ling standing cases : conjunctiva becomes
dry and thickened
 Corneal ulcers due to exposure keratitis

19.  Spastic ectropion : treat the cause of
blepharospasm

20.  AIM ; to free lid margin from scar tissue and
restore normal position and function.
 V-Y surgery
 Skin grafting

21. Conservative ;
 Don’t rub eyes in downward motion
 SURGICAL :
 Electrocautery
 FULLTHICKNESS SHORTNESS OF LID
 KUHNT SZYMANOWSKI PROCEDURE

22.  Treat the cause ( facial palsy)
 Galvanism and massage of muscle
SURGICAL :Lateral tarsorrhaphy

23.  Chronic conjunctivitis
 Corneal ulcers
 Conjunctival hypertrophy
 Eczema and dermatitis of eyelids

24. PART 2

25.  ALLERGY
 EYE INFECTIONS
 STYE
 CHALAZION
 INJURIES
 BLEPHARITIS
 ORBITAL CELLULITIS
 OCULAR HERPES
 GRAVES DISEASE
 CONTACT LENS

26.  ACTIVE OR INFLAMMATORY EDEMA
I. External hordeolum
II. Internal hordeolum
III. Insect bite
IV. Dermatitis
 PASSIVE EDEMA
I. Congestive cardiac failure
II. Renal diseases
III. Cavernous sinus fistula
IV. Angioneurotic edema

27.  Acute suppurative inflammation of gland of
zeis.
CAUSE:
 Staphlococcal infection
 Associated with boils,carbuncles or acne over
face.
 Common in young and debilitated persons.
 Poor hygiene
 Diabetic patients

28.  SYMPTOMS : acute throbbing pain, sense of
heaviness on lid or swelling
 SIGNS : redness on affected lid
 Marked edema on lid
 Marked tenderness
 White pus visible
 Chemosis on bulbar conjunctiva
 Enlargement of pre auricular lymph nodes
 Sometimes multiple styes are present

29.  Maintain lid hygiene
 Hot fomentation
 Evacuation of pus via incision
 Antibiotic eye drops or ointment
 Sometimes systemic antibiotics are given
 Analgesics and anti-inflammatory drugs.

30.  Chronic granulomatous inflammation of the
meibomian gland characterized by localized
swelling mostly away from lid margin.
 ETIOLOGY;
 Chronic inflammation causes replacement of
glandular tissue to granulation tissue
containing giant cells that obstructs duct of
gland.
 Common in adults

31.  Symptoms : painless swelling
 Sense of heaviness in eyelids

32.  SITE : on lid away from lid margin
 SIZE: small
 COLOR: overlying tarsal conjunctiva is red
when lid is everted
 CONSISTENCY: cystic or hard
 TENDERNESS : absent
 MOBILITY: swelling is fixed to tarsus bt
overlying skin is mobile.

33.  It doesn’t project on lid margin
 Projects like a dome
 Painless until gets infected and then its called
as INTERNAL HORDEOLUM.

34.  Resolution
 Remains as it is
 Bursts on conjunctival tissue with granulation
tissue protruding
 Gets infected (internal hordeolum)
 Calcifies
 Cyst formation( tarsal or meibomian syst)
 Recurrence
 Meibomian carcinoma

35.  SMALL AND ASYMPTOMATIC : only
observed ,resolves itself .no treatment
required
 LARGE: incision and curettage
 MULTIPLE: combined excision of tarsus and
conjunctiva (fascenella servat operation)
 MARGINAL: puncture with a diathermy
needle
 Incision and curettage through tarsal plate

37. Acute suppurative infection of meibomian
gland due to staphlococus aureus
TYPES
Primary or secondary

38.  Symptoms : acute pain in lid and heaviness
 Signs : similar to stye except
 Point of maximum tenderness is away from
lid margin
 Pus points on tarsal conjunctiva not on root
of eyelash.

39.  Hot fomentation
 Topical or oral antibiotic
 Drainage of pus
 curettage is contraindicated in internal
hordeolum

40.  SUBACUTE OR CHRONIC INFLAMMATION
OF LID MARGINS.
 CAUSE :
 Follows Chronic conjunctivitis due to staphlococcus in poor
hygienic conditions
 Parasites

41.  SQUAMOUS BLEPHARITIS:
 abnormal metabolism and seborhea.
 Scalp Dandruff associated
 Painless ,associated with watering eyes and discomfort.
 Dandruff like scales
 ULCERATIVE BLEPHARITIS:
 Infective condition
 Sore eyes, glued eyelashes, small ulcers

42. Clinical features Squamous
blepharitis
Ulcerative
blepharitis
Scales or crusts White ,fine,dry Yellow,coarse,sticky
ulceration Absent Present
bleeding Absent Present
Loss of eyelashes Few &temporary Pernanent ,almost all
lashes are involved
course Mild Progressive
complications Occasional Usual and serious

43.  Trichiasis (misdirected lashes)
 Tylosis (thickened lid margins)
 Madarosis( scanty lashes)
 Ectropion(eversion due to scar tissue)
 Epiphora

44. Local : removal of crusts and diseased lashes
(3%sodium bicarbonate solution)
Epilation of eyelashes
Antibiotic drops and ointment
general : improve general health and diet
Maintain lid hygiene ( use baby shampoo)
Treat dandruff of scalp