This document discusses disorders of the eyelids, including their structure, glands, and common inflammatory conditions like blepharitis. It describes the signs, symptoms, and management of blepharitis, as well as other eyelid conditions such as entropion, ectropion, and ptosis. For each condition, it provides details on causes, grading scales, and surgical procedures for correction. In particular, it outlines procedures for correcting senile entropion and ectropion like wedge resection and diamond excision, as well as ptosis correction surgeries including Fasanella-Servat operation, LPS resection, and frontalis sling.

1. Disorders of Eyelids
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2. The eyelids
• Mobile structures placed in front
of eyeballs.
• Protect eyes
• Spread tear film
• Help in tear drainage by lacrimal
pump system
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3. Structure of eyelids
• The skin- elastic and thin
• Subcutaneous areolar tissue-
very loose,
does not contain any
fat.
• Striated muscle layer-
orbicularis oculi
-- orbital, palpebral
and lacrimal portions.
• Sub muscular areolar tissue-
contains nerves and vessels.
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4. Structure of eyelids
• Fibrous layer- central
tarsal plate and
peripheral orbital
septum
• Layer of non-striated
muscle fibres
• Conjunctiva –
nonkeratinized
squamous epithelium
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5. Glands of eyelids
• Meibomian glands/Tarsal
glands
Modified sebaceous
glands(30 in no.)
• Glands of Zeis -
sebaceous glands
open into follicles of
lashes
• Glands of Moll -modified
sweat glands-open into
follicles/ducts of Zeiss
• Accessory Lacrimal glands
• Krause
• Wolfring
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6. INFLAMMATIONS OF THE EYELIDS
•Blepharitis
Subacute or chronic lid margin inflammation
1. Anterior blepharitis-bacterial,seborrhoeic
2. Posterior blepharitis-MGD,a/c acne rosacea
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7. INFLAMMATIONS OF THE EYELIDS
1. Anterior blepharitis
• Squamous/Seborrhoeic
White dandruff like scales on the lid margin among
eyelashes
• Ulcerative
Chronic staphylococcal infection- hard crusts and ulcers
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9. INFLAMMATIONS OF THE EYELIDS
• Posterior blepharitis
Meibomian seborrhoea
Meibomianitis
Symptoms-
Burning sensation
Grittiness
Mild photophobia
Redness of eyelid margins
Crusting
More in early morning
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10. 10

11. Management
• 1.)Lid hygiene
-Warm compresses
-Lid margin cleaning/scrubbing with cotton bud/baby
shampoo/sodium bicarbonate
-Vertical lid massage in meibomitis
2.)Antibiotics
-Topical ointment (chloramphenicol/bacitracin)
-Oral doxycycline 100 mg BD x 7 day f/b 100 mg OD x 6 weeks
(posterior blepharitis)
-Oral azithromycin 500mg OD x 3 day f/b 3 cycles at 1 week
interval(anterior blepharitis)
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12. Management
3.) Dry eyes
-Lubricants
-Topical steroids in active margin inflammation (0.1% fluorometholone)
4.)New theraphy
-Thermal pulsations
-Pulsed light theraphy
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13. Entropion
• Inward rolling and rotation of the
lid margin toward globe
Involutional/senile
Cicatricial (trachoma, burns,
SJ syndrome)
Spastic(lower lid)
Congenital
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14. • Involutional Entropion (age related)
 Horizontal lid laxity
 Vertical lid instability
 Over-riding of pretarsal plate
 Orbital septum laxity
• Cicatricial entropion
Due to conjunctival scarring
Causes:
Trachoma, chemical burns
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15. • Congenital entropion
Lower > upper eyelid
Lower eyelid congenital entropion –improper development of the lower lid
retractors
Upper eyelid congenital entropion-secondary to mechanical effects of
microphthalmos
• Mechanical entropion
• d/t lack of support provided by globe to the lids
• Occur in patients with phthisis bulbi,enophthalmos ,after enucleation or
evisceration
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16. Symptoms
• Foreign body sensation
• Irritation
• Lacrimation
• Photophobia
• d/t rubbing of cilia against cornea and conjunctiva
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17. Signs
1.)Inturning of lid margins-
Grade 1-only post lid border is inrolled
Grade 2 –inturning of intermarginal strip
Grade 3-whole lid inturned
2.)Signs of causative disease-
Scarring of palpebral conjunctiva in cicatricial entropion
Horizontal lid laxity in involutional entropion
3.)Signs of complications- recuurent corneal abrasions,corneal
opacities,ulcers
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18. Surgical procedures for congential entropion
• Congential entropion-hotz procedure
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19. Surgical procedures for senile entropion
•Transverse everting sutures (Quickert)
•Transverse blepharotomy with everting sutures-
Weis procedure
•Jones procedure- tucking of inferior lid retractors
(recurrences)
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20. Transverse everting sutures
• Prevents overriding and provide
temporary correction lasting
several months
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21. Weis procedure
• Full thickness horizontal lid
splitting and insertion of
everting sutures
• Scarring prevents overriding of
pre-septal and pretarsal parts of
orbicularis
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22. Jones procedure
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-Plication of lower lid retractors thus increasing their pull and creating
the barrier b/w preseptal and pretarsal portion of orbicularis
-performed in recurrent cases

23. Surgical procedures for cicatricial entropion
• Anterior lamellar resection
• Tarsal wedge resection
• Transposition of tarsoconjunctival wedge(modified ketssey’s
operation)
• Posterior lamellar graft
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24. Tarsal wedge resection
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25. Transposition of tarsoconjunctival wedge
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26. Posterior lamellar graft
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27. ECTROPION
• Eversion of lid margins and lashes away from the globe.
Acquired – Involutional/senile-lower lid
Cicatricial- burns and injuries
Paralytic- 7th nerve paralysis
Mechanical-tumors/proptosis
Congenital
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29. • Involutional Ectropion (Age Related)
 Horizontal lid laxity
 Medial canthal tendon laxity
 Lateral canthal tendon laxity
 Disinsertion of lower lid retractors
• Cicatricial Ectropion
Due to burn, trauma, chronic inflammation of skin or surgical
scarring.
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30. • Paralytic Ectropion
Due to Facial nerve palsy
Treated by:
Tarsorrhaphy
Medial canthoplasty
Lateral canthal sling
Upper lid lowering
• Mechanical ectropion (tumours)- corrected by treating the underlying
cause.
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31. Symptoms
• Epiphora
• Irritation
• Discomfort
• Mild photophobia
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32. Signs
1.)Lid margin is outrolled
Grade 1- only punctum is everted
Grade 2-lid margin is everted & palpebral conjunctiva is visible
Grade 3-fornix also visible
2.)signs of the cause-
Skin scars in cicatricial ectropion
7th nerve palsy in paralytic ectropion
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33. Surgical procedures for senile ectropion
• Treatment
 Wedge resection for horizontal lid laxity
 Diamond excision for medial ectropion
 Kuhnt-Szymanowski Procedure modified
by Byron Smith for lateral ectropion
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34. Wedge resection for horizontal lid laxity
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35. Diamond excision for medial ectropion
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36. Modified Kuhnt-Szymanowski Procedure
for lateral ectropion
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37. Surgical procedures for cicatricial ectropion
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V-Y Plasty

38. PTOSIS
• Abnormal drooping of the upper lid to a level that covers more than 2mm
of the superior cornea.
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39. 1.Congenital ptosis
Simple -absence of lid crease,lid lag sign+ on downgaze
Complicated -blepharophimosis syndrome,double elevator
palsy,Marcus gunn jaw winking
2. Acquired ptosis
Neurogenic- 3rd Nerve palsy, Horner’s syndrome
Myogenic – Myasthenia , Myotonic dystrophy
Aponeurotic- Involutional, postoperative
Mechanical- lid tumors
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40. Examination
• Evaluation
• Measurement of amount(degree) of ptosis
• Margin reflex distance
• Assessment of levator function
• Special investigation
• Photographic record
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41. Evaluation
• Pseudoptosis (simulated ptosis) should be excluded on
inspection
• Points to be observed:
-Whether ptosis is unilateral or bilateral.
-Function of orbicularis oculi muscle.
-Eyelid crease is present or absent.
-Jaw-winking phenomenon is present or not.
-Associated weakness of any extraocular muscle.
-Bell's phenomenon up and outrolling of the eyeball during
forceful closure) is present or absent.
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42. Measurement of amount (degree) of
posis
• In unilateral cases, difference between the vertical height of the
palpebral fissures of the two sides indicates the degree of
ptosis.
• In bilateral cases it can be determined by measuring the
amount of cornea covered by the upper lid and then subtracting
2mm
• Ptosis is graded depending upon its amount as :
• Mild ptosis: 2mm
• Moderate ptosis: 3mm
• Severe ptosis: 4mm
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43. Margin reflex distance (MRD)
• Margin reflex distance (MRD) refers to the distance between
the upper lid margins and corneal light reflex
• Normal value of MRD is 4-5 mm.
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44. Assessment of levator function
• It is measured by the lid excursion caused
by LPS muscle (Burke's method)
• Patient is asked to look down, and thumb of
one hand is placed firmly against the
eyebrow of the patient by the examiner
• Then the patient is asked to look up and the
amount of upper lid excursion is measured
with a ruler held in the other hand by the
examiner
• Levator function is graded as follows:
• Normal: 15mm
• Good: 8mm or more
• Fair: 5-7 mm
• Poor: 4mm or less
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45. Special investigation
• Tensilon test is performed when myasthenia is suspected
• Phenylephrine test is carried out in patients suspected of
Horner's syndrome
• Neurological investigations may be required to find out the
cause in patient with neurogenic ptosis
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46. Photographic records
• Photographic records of the patient should be maintained for
comparison.
• Photographs should be taken in primary position as well as in
up and down gazes.
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47. SURGICAL TREATMENT
• Fasanella-Servat operation
LPS action good
Mild ptosis < 2mm
Horner’s syndrome
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48. SURGICAL TREATMENT
• LPS Resection (Conjunctival
approach)
LPS action fair
Any type of ptosis
Moderate congenital or
acquired ptosis
• LPS Resection (Skin approach)
• Most preferred surgery for
ptosis correction
LPS action fair
Any type of ptosis
For larger resection in
congenital or acquired ptosis.
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49. SURGICAL TREATMENT
• Frontalis Sling surgery (Brow suspension)
LPS action poor
Ptosis >2 mm
Congenital ptosis
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50. Thank You
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