The document discusses various eyelid conditions including entropion, ectropion, and eyelid swellings. Entropion involves inward turning of the eyelid and can cause corneal abrasions. It has several types including spastic, cicatricial, and involutional. Ectropion is outward turning of the eyelid and can also have multiple causes such as blepharospasm or aging. Eyelid swellings may be due to infections like styes, cysts like chalazia, or inflammatory conditions such as blepharitis. The presentation provides details on symptoms, signs, and treatments for these various eyelid abnormalities.

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