Lids and Adnexa Class 2 Part A - Ectropion and Entropion

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www.ophthalclass.blogspot.com has the complete class and MCQs on lids and adnexa for undergraduate medical students. Part A of the second class on lids deals with the palpebral fissure, eyelid retractors (levator aponeurosis and Muller’s muscle) and protractors (orbicularis oculi). It discusses the lid to globe apposition, factors responsible for vertical and horizontal tautness of the lids, including the canthal ligaments and tarsus. Horizontal lid laxity leading to entropion and ectropion is explained. A brief outline of management of involutional ectropion and entropion is given.

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Lids and Adnexa Class 2 Part A - Ectropion and Entropion

  1. 1. THE EYELID MUSCLES<br />How the lids are kept in place<br />Dr. Anupama Karanth<br />www.ophthalclass.blogspot.com<br />
  2. 2. The palpebral fissure<br />
  3. 3. What maintains the palpebral fissure?<br />The eyelid retractors<br />The eyelid protractors<br />
  4. 4. Eyelid protractors<br />
  5. 5. Eyelid rectractors<br />
  6. 6. Upper eyelid retractors<br />
  7. 7. Levatoraponeurosis<br />Wide insertion into various layers of the lid<br />Medial horn – posterior lacrimal crest<br />Lateral horn – lateral orbital tubercle<br />Anterior portion – skin<br />Posterior portion – anterior tarsus<br />Superior tarsal muscle – conjunctiva and tarsus<br />
  8. 8. Muller’s muscle<br />(superior tarsal muscle)<br />Posterior part of levator<br />2 mm lift to the upper lid<br />Insertion to tarsus and conjunctiva<br />Sympathetic supply<br />Horner’s syndrome – mild ptosis<br />
  9. 9. Loss of retractor function<br />Blepharoptosis – drooping of upper eyelid<br />
  10. 10. Lower eyelid retractors<br />
  11. 11. Lower eyelid retractors<br />Capsulopalpebral fascia analogous to levatoraponeurosis<br />From inferior rectus terminal fibres<br />Encircles inferior oblique <br />Inserts to inferior conjunctival fornix and inferior tarsal border<br />Inferior tarsal muscle <br />Poorly developed<br />Posterior to capsulopalpebralfascia<br />
  12. 12. The lid globe apposition<br />
  13. 13. The lid and the globe<br />Why do the eyelids not fall <br />outwards?<br />Why do the eyelids not turn <br />inwards?<br />
  14. 14. The eyelid in place<br />Horizontal <br /><ul><li> TARSUS - CANTHAL LIGAMENTS - BONE</li></ul>Vertical <br /><ul><li> ORBITAL SEPTUM - RETRACTORS - TARSUS</li></li></ul><li>The lid globe apposition-horizontal<br />TARSUS - CANTHAL LIGAMENTS - BONE<br /> Superior and inferior tarsus<br /> Medial and lateral canthal ligaments<br />Lacrimalcrests and lateral orbital tubercle<br />
  15. 15. The lid globe apposition-vertical<br />ORBITAL SEPTUM - RETRACTORS - TARSUS<br />Orbital septum<br />Levatoraponeurosis<br />Muller’s muscle<br />Tarsus <br />
  16. 16. Loss of lid-globe apposition<br />
  17. 17. Abnormal lid-globe relations<br />Ectropion<br />Eversion of eyelid margin<br />Entropion<br />Rolling inwards of eyelid margin<br />
  18. 18. Ectropion - Entropion<br />
  19. 19. Horizontal lid laxity<br />Ectropion<br />Entropion<br />
  20. 20. Age related lid laxity<br />
  21. 21. Involutionalentropion<br />
  22. 22. Managing laxity<br />

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