DISORDERS OF EYELIDS

1. DISORDERS OF EYELIDS

2. CONGENITAL ANOMALIES

3. CONGENITAL PTOSIS
• It is associated with congenital weakness of levator palpebrae superioris.
• Characteristic features include:
Treatment-
• Tarso-conjunctivo-Mullerectomy (Fasenella-Servat operation).
• Levator resection.
• Frontalis sling operation( Brow suspension).
Drooping of one or both upper eyelids since birth.
Lid crease is easily diminished or absent.
Lid lag on downgaze(i.e. ptotic lid is higher than the
normal)

4. CONGENITAL COLOBOMA
• Rare condition
• Full thickness triangular gap in the tissues of the lid
• Usually in nasal side and in upper eyelid

5. EPICANTHUS
• Semicircular find of skin which covers medial canthus
• Bilateral Condition which may disappear with development
of nose
• Most common congenital anamoly of eyelids

6. DISTICHIASIS
• Extra row of cilia occupies the position of Meibomian gland
• These cilia are usually directed backwards
• Should be electroepilated or cryoepilated

7. CRYPTOPHALMOS
• Rare anomaly in which lids fail to develop
• Skin passes continuously from eyebrow to cheek hiding the
eyeball

8. MICROBLEPHRON
• Eyelids are abnormally small
• Ususally associated with microphthalmos or anopthalmos
• Ocasionally the lids may be very small or virtually absent-
Ablephron

9. EPIBLEPHRON
• Horizontal fold of tissue rides above the lower eyelid margin
• Usually disappears with growth of face

10. EURYBLEPHRON
• Unilateral or bilateral horizontal widening of palpebral fissure
• Associated with lateral canthal malposition and lateral
ectropian
• Usually involves lateral portion of lower eyelids

11. OEDEMA OF THE EYELIDS
Swelling of eyelids can be classified as
Inflammatory oedema • Inflammation of lid (dermatitis, stye, hordeolum )
• Inflammation of conjunctiva (conjunctivitis)
• Inflammation of lacrimal sac (acute dacrocystitis)
• Inflammation of lacrimal glands (acute
dacroadenitis)
• Inflammation of eye ball( iridocyclitis)
Solid oedema of the lids Chronic thickening if the lids usually follows
recurrent attacks of erysipelas.
Passive oedema of the lids o Due to cavernous sinus thrombosis
o Head injury
o Congestive heart failure
o Renal failure etc.

12. BLEPHARITIS

13. INTRODUCTION
• Chronic inflammation of lid margins.
• Appear as simple hyperaemia or as true
inflammation.
• 2 forms: Anterior – Suborrheic/Squamous &
Ulcerative
Posterior (Meibomitis)

14. AETIOLOGY
• Follows chronic conjunctivitis due to Staphylococci carried
to lid margins by infected fingers.
• Occasionally, parasitic infection.
Blepharitis acarica – due to Demodex follicurolum,
Phthiriasis palpebrarum
Crab louse
Head louse (Very rare)

16. ANTERIOR BLEPHARITIS
• SUBORRHOEIC/ SQUAMOUS BLEPHARITIS
• Small white scales accumulate among lashes which
readily fall out and are replaced without distortion.
• On removal of these scales, underlying surface is
hyperaemic, not ulcerated.
• . Metabolic condition, often associated with dandruff of
scalp ( Such etiology requires Rx)
• TREATMENT
• Daily cleaning with baby shampoo.
• Treat any supervening infection.

17. SUBORRHEIC BLEPHARITIS

18. • STAPHYLOCOCCAL/ULCERATIVE
BLEPHARITIS
• Yellow crusts or dry brittle scales glue the lashes together.
• Cause small bleeding ulcers around the base of the lashes
when removed.
(Different from conjunctival discharge, which mat the lashes
together but on removal they reveal normal lid margins.)
• CF – Soreness
Lacrimation
Itching
Redness of edges of lids
Photophobia

19. ULCERATIVE BLEPHARITIS

20. • TREATMENT
• Needs aggressive local treatment.
• Crusts must be removed first and loose, diseased lash epilated.
• Done by thorough bathing of eyes with 1:4 baby shampoo OR warm
3% bicarbonate of soda lotion.
This softens the deposits, so they can be picked or rubbed off with a
pledget of cotton wool.
• After removal, use Antibiotic drops based on sensitivity of the
organism.
After the infection resolves, a simple daily habit of swabbing the lid
margins with a warm bland lotion must be established.
• Avoid rubbing of the eyes or fingering the lids with unwashed hands.
• Proper treatment ensures a speedy recovery.

23. SEQUELAE OF BLEPHARITIS
• Ulcerative form has serious complications if
not treated properly.
• Chronic conjunctivitis.
• Madarosis.
• Trichiasis.
• Tylosis.
• Epiphora.
• Ectropion.

25. POSTERIOR BLEPHARITIS
• Leads to tear film instability and inferior punctate keratitis.
• Commonly presents in 2 ways.
1)Meibomian Seborrhoea: Oil droplets seen at the Meibomian
gland openings which can be expressed out like foam.
2)Meibomanitis: Diffuse rounded posterior lid margin & thickening
around Meibomian glands opening.
Lid massage expresses out an inspissated, toothpaste-like
material.
Cyst formation due to duct blockage may also be seen.
• TREATMENT
• Warm compression and lid massage.
• Simultaneous Doxycycline or Minocycline for 6 weeks.

26. POSTERIOR BLEPHARITIS

28. EXTERNAL HORDEOLUM (STYE)
Acute suppurative inflammation of lash follicle and its associated
glands of Zeil or Moll

29. ETIOLOGY
PREDISPOSING FACTORS
• Habitual rubbing of eyes
• Eye strain due to muscle imbalance or
refractive errors
• Chronic blepharitis, diabetes mellitus
• Excessive intake of alcohol and
carbohydrates.
CAUSATIVE AGENT :- Staphylococcus aureus

30. CLINICAL FEATURES
SYMPTOMS
• Acute pain with swelling of eyelid
• Mild watering
• Photophobia

31. SIGNS
STAGE OF CELLULITIS
• Localized, firm, red tender swelling of
eyelid margin with oedema
STAGE OF ABSCESS FORMATION
• Visible pus point on the lid margin in
relation to affected cilia

32. TREATMENT
• Cellulitis stage – Hot compresses given 2-3 times a day
• Abscess stage – Evacuation of pus by epiliating the involved cilia
Surgical incision to drain the large abscess
• Antibiotic eye drops
• Eye ointment
• Systemic anti-inflammatory and analgesics to relieve pain and reduce
edema.
• Systemic Antibiotics to control the infection

33. CHALAZION (TARSAL OR MEIBOMIAN CYST)
Chronic non infective, non suppurative lipogranulomatous
inflammation of Meibomian cyst.

34. CHALAZIONPATHOGENES
IS
SYMPTOM
S
SIGNS
CLINICAL
COURSE
TREATMEN
T

35. PATHOGENESIS
Mild grade infection of Meibomian gland by low virulence organism
Proliferation of epithelium and infiltration of wall of ducts causes
blockage of ducts
Retention of secretion in gland causes enlargement
Extravasated secretion (fatty) act like irritant and causes Chalazion

36. CLINICAL FEATURES
SYMPTOMS
• Painless swelling which is gradual
increasing in size
• Mild heaviness in the lid
• Watering (epiphora)
• Blurred vision occasionally

37. SIGNS
• Nodule present on the lid will be non tender and firm to
hard in consistency
• Reddish purple area is seen on palpebral conjunctiva
• Marginal chalazion present as the small reddish grey
nodule

38. CLINICAL COURSE AND COMPLICATION
• Complete spontaneous resolution may occur rarely.
• Often it slowly increases in size and becomes very large.
• A large chalazion of the upper lid may press on the cornea and cause blurred
vision.
• Fungating mass of granulation tissue may form due to bursting of the lesion.
• Secondary infection leads to formatin of hordeolum internum.
• Calcification may occur,
• Malignant change into meibomian gland carcinoma may be seen

39. TREATMENT
Conservative treatment
In a small, soft and recent chalazion, self-resolution may be helped by conservative
treatment in the form of hot fomentation, topical antibiotic eyedrops and oral anti-
inflammatory drugs.
Intralesional injection of long-acting steroid (triamcinolone)
It cause resolution in about 50 percent cases, especially in small and soft chalazia.
Diathermy
A marginal chalazion is better treated by diathermy.

40. INCISION AND CURETTAGE
• The conjunctiva and lid are anaesthetised.
• The lid is everted and chalazion clamp is fixed
• A small vertical incision is given with a sharp blade over the conjunctival side.
• The semifluid contents escape and walls of the cavity are thoroughly scraped with the
chalazion scoop.
• The cavity is cauterized with carbolic acid to avoid recurrence.
• Bleeding stops and usually no dressing is necessary.

42. INTERNAL HORDEOLUM

43. DEFINITION
• Suppurative inflammation of the Meibomian gland associated
with blockage of the duct.

46. ETIOLOGY
• PREDISPOSING FACTORS:
1.AGE: Children and young adults
2.Patients with eye strain due to muscle imbalance or refractive errors.
3.Habitual rubbing of eyes, fingering of lids.
4.Chronic Blepharitis
5.Diabetes Mellitus
6.Chronic debility
7.Excessive intake of carbohydrates and alcohol.
• CAUSATIVE MECHANISM
1.Primary Staphylococcal infection of the Meibomian gland
2.Secondary infection from an infected chalazion.

47. CLINICAL FEATURES
• SYMPTOMS
1.Acute pain and swelling of the eyelid.
2.Mild watering
3.Photophobia

48. SIGNS
1.Localised, firm, red, tender swelling of the lid.
2.Markedly edematous lid.
1.Pus point on the tarsal conjunctiva
2.Maximum point of tenderness and swelling is away from the lid
margin.

49. TREATMENT
• Hot Compresses
• Evacuation of pus – vertical incision on the tarsal conjunctiva
• Antibiotic eye drops and ointment
• Systemic anti inflammatory and analgesics
• Systemic antibiotics
• Treat the predisposing condition to prevent recurrence

50. MOLLUSCUM CONTAGIOSUM
• Viral infection of the lids caused by
molluscum contagiosum virus
(poxvirus).
• Common in children.
• Typically multiple, small, white
umbilicated swellings scattered over
the skin near the lid margin.

51. • Substance resembling sebum can be expressed from the swelling.
• Histologically- large intracytoplasmic inclusion bodies within the
acanthotic epidermis.

52. COMPLICATIONS
• Chronic follicular conjunctivitis
• Superficial keratitis
• INTRACTABLE TO TREATMENT, unless the primary
lesions are dealt with.

53. TREATMENT
• Incise and express the lesions,
• Interior cauterized with tincture of iodine or pure carbolic
acid.