This document provides an overview of eyelid anatomy, infections, tumors, and deformities. It describes the layers of the eyelid, including skin, muscles and glands. Common eyelid infections like blepharitis, hordeolum and chalazion are explained. Eyelid tumors including nevus, hemangioma, papilloma and carcinomas are outlined. Various eyelid deformities such as entropion, ectropion, lagophthalmos and ptosis are also summarized, along with their causes and treatments.

1. Mrs Dipali Dumbre
Msc Nursing
Medical Surgical Nursing
SCON

3. INTRODUCTION
 EYELIDS: Two movable folds with eyelashes.
 Layers present are skin, aerolar tissue; muscles- orbicularis
 oculi, levator palpebrae superioris & Muller’s muscle; thin
 sheet of dense connective tissue, tarsal plate; thin lining of
palpebrae conjunctiva.
 2. EYELID MARGIN
 Covered with stratified squamous epithelium
 Anterior border is round, posterior is sharp & lies closely
in contact with the eyeball.
 Eyelashes originate anterior to the grey line and ducts of
meibomian are located posterior to the grey line.

8. GLANDS OF EYELIDS
 Zeis’s Gland: Sebaceous gland situated in close association with
cilia.
 Moll’s Gland : Sweat glands & lie between the cilia.
 Meibomian Gland : Enormously developed sebaceous gland
embedded in tarsal plate, secretes oily secretion that
lubricates the eye
 Palpebral Fissure: Space between the two lids when the eye
is open
 Outer Canthus: Outer or lateral angle of palpebrae fissure
 Inner Canthus: Inner or medial angle of the palpebral fissure
 Blood supply: Opthalmic & lacrimal arteries & opthalmic vein
 Nerve supply: 7th , 3rd & 5th cranial nerve.

10. EYELID INFECTIONS, TUMORS AND
DEFORMITIES

11. Infection
 DEFINITION =
 An eyelid infection is any abnormal condition that effect
eyelids.
 Infection of an oil gland on the surface of the upper and
lower parts of eyelids
 A bacterial infection of an oil gland, hair follicle or sweat
gland are caused drooping, twitching (F), inflammation ,
itching, burning, crustiness, redness , edema ,tearing,
irritation .

12. CLASSIFICATION OF EYELIDS
INFECTIONS
 CONGENITAL ANOMALIES
 EDEMA
 INFLAMMATIONS
 ANOMALIES & POSITION OF EYELIDS
 TUMORS

13. CONGENITAL ANOMALIES
 Able-pharon: Macrostomia syndrome Extremely rare,the
lid is not developed autosomal recessive genetic disorder .
• Micropharon : Rare, lids are abormally small
 Cryptopharon:: Rare anomaly in which a fold of skin passes
from the eyebrow over the malformed eye to the cheek.
 Ptosis: Common, drooping of eyelid

14.  Epicanthus : A vertical fold of skin on either side of the
nose sometime covering the inner canthus. (the outer or
inner cornea of the eye
 Distichiasis: an additional row of lashers occupies the position
of meibomian glands .abnormal growthof lashers.
Coloboma: condition where normal tissue in or around the
eye is missing from birth.

15. EDEMA
 A swelling eyelid occurs when there is inflammation or
excess fluid ( edema) in the connective tissue
surrounding the eye.
 Common due to looseness of tissues
 Inflammatory Edema: Found in conjunctivitis, tarsitis,(
infl of gland and lasher ) dacryo-cystitis, ( inflammation
of lacrimal sac )orbital cellulitis, ( infl of eye tissue ) drug
allergy(atropine).
 Passive edema: common feature of cavernous sinus
thrombosis ( formation of blood clot with in the
cavernoussinus a cavity at the base of the brain which
drains deoxygenated blood from the brain back to the
heart ),

16. INFLAMMATIONS
 It includes
1. Blepharitis
2. Hordeolum (stye)
3. Chalazion (tarsal or meimobian cyst)
4. internal . Hordeolum

17. BLEPHARITIS
 Is an inflammation of the eye lids in which they
become red, irritated and itching dandruff like scales
from on the eyelashes…

18. 1. Squamous blepharitis
 it is due to abnormal metabolism (abnormal chemical in
body ) & seborrhea usually associated with the dandruff of
the scalp.Numerous white coloured small scales
accumulate among the eyelashes.

19.  ULCERATIVE BLEPHARITIS
 it is an ineffective condition. The yellow crusts glue (
sticky) the lashes together. On removing the crust there
are small ulcersseen around the bases of lashes.
 Symptoms: itching, redness, soreness, lacrimation and
photophobia.

20.  Treatment
 Local: -removal of scales , crusts & diseased lashes is
done by bathing lid margin with 3% of NaHCO3 (
sodium bicarbonate ) lotion. - antibiotics & ointment
are applied.
 General : Improvement of general health & personal
hygiene.- Dandruff of the scalp is to be adequately
treated.

21. Hordeolum (Stye):
 It is a localized infection or inflammation of the eye lid margin
involving hair follicles of eyelashers or meibomian gland
(supply of meibumian, an oily substance )
Etiology: Associated with staphylococci infection, .
 Common in young adults & debilitated persons( very
weekperson).
Symptoms: Ac. Pain & tenderness over inflamed Zeis’s gland.
Signs: Localized Pain, redness & edema near the lid margin.
Treatment: Hot fomentation,Evacuation of pus,
 antibiotic eye drop = tobramycin = it is killing or slow the
growth of certain type of bacteria.
 ointment & broad spectrum antibiotics is useful.
 Analgesics & anti-inflammatory drugs control pain &
inflammation.

22. Chalazion
 It is chronic granulomatous inflammation (produced in
response to infection, inflammation,) or the presence of a
foreignsubstance. of mei-bomian gland.
 Etiology: due to chronic irritation due to organism of
low virulence (The ability of bacteria to cause disease
)where the glandular tissue is replaced by granulation
tissue containing giant cells.
 - Occur in crops, more common in adults.
 Symptoms : No pain unless secondary infected

23.  Signs: Small non tender hard swelling slightly away from
and swelling lid margin ,swelling is red or purple, can be
grey in later stages, yellow when secondary infected with
pyogenic organisms.
Treatment:
 Inj. Triameinolone directly into the chalazion cause
complete resolution.
 It prevents the release of substances in the body that cause
inflammation.

24. Internal Hordeolum
 It is an acute Supportive inflammation ( formation of pus )of
mei-bomian glands
Etiology: Occurs due to secondary infection (occurs during or
after treatment for another infection.) of chalazion.
Symptoms : More violent than stye because the gland is larger &
embedded deeply in the dense fibrous tissue.
Sign : Yellow spot (pus) seen shining through the conjunctiva on
averting ( remaining) the lid;
TREATMENT
 Warm compresses an d massages of the lesions for 10
minutes 4 times per day
 Tropical anti biotic ointment
 Amoxicillin
 Doxycycline
 Erythromycin

25. ANOMALIES & POSITION OF
EYELIDS

26.  It includes
1.Trichiasis, abnormally positioned eyelashes
2.Entropion, the lid margin rolls inwards
3.Ectropion, lid margin rolls outwards
4. Symblepharon, the adhesions between lids and the
globe.
5. Ankyloblepharon, adhesion of the margins of two
eyelids
6. Lago-pthalamus, inability to close the eyelids
completely.
7. Ptosis. drooping of the upper lid

27. TRICHIASIS
Abnormally positioned eyelashes Few lashes or whole lid
margin involved.
Etiology: Recurrent stye, Ulcerative blepharitis, Tight
bandaging, Scars of lid following burn, injury or operation.
Symptoms
a) Foreign body sensation of photophobia due to corneal
involvement
b) Irritation, pain & lacrimation
Treatment
 Trichiasis treatment involves removing the eyelash, follicle
or both, or redirecting eyelash growth.

28. ENTROPION
 It is Conditions in which the lid margin rolls inwards.
Etiology
a) Spastic entropion: Due to the spasm of orbicularis oculi muscle as
may occur after tight bandaging after operation of following irritative
corneal condition
b) Cicatricial entropion :, ulcerative blepharitis, burns, operations,
diphtheritic membranous conjunctivitis.
Sign & symptoms : Same as for trichiasis
Treatment
A. Spastic: Basic cause of blepharospasm is treated If due to
prolonged & tight bandaging, discontinue it.
 Antibiotics
 Anti inflammatory - corticosteroids
 Botulinum toxin –using eyelid spasms

29. ECTROPION
 It is a condition in which lid margin rolls outwards
Symptom : Most common epiphora excessive watering of the
eyes
Signs
i) Conjunctiva become dry in appearance
ii) Chronic conjunctivitis & corneal ulcers.
TREATMENT
 Use of lubricating ointment or mild steroid several
day and weeks to ectropion repair corneal epithelium
,,,

30. SYMBLEPHARON
It is a condition of the adhesions between lids and the globe.
Etiology : due to - burns, ulcers, diphtheria, operation
Symptoms
1. Lagopthalamus: inability to close lids properly
2. Diplopia : double vision
Treatment
 Lysis and removal of subconjunctival scar tissue

31. ANKYLOBLEPHARON
It is a condition of the adhesion of the margins of two
eyelids. Adhesionmay be partial or complete,
Etiology - Congenital or acquired due to chemical burn i.e.
acid, alkali.
Treatment
 - Separation of lid margins along with mucus membrane or
conjunctival grafting is recommended

32. LAGOPTHALAMOS
It is a condition of incomplete closure of palpebral aperture when
eyes
Lagophthalmos is defined as the inability to close the eyelids
completely. Blinking covers the eye with a thin layer of tear fluid,
Etiology
 Loss of function of the facial nerve inhibits eyelid closure as
well as the blinking reflex .
 - Congenital deformity of lids, ectropion ,proptosis (abnormal
protrusion or displacement of an eye , paralysis , absence of
reflex, blinking in extremely ill patient’s
Treatment
1. Application of antibiotic eye ointment & bandage during sleep
is recommended.
2. 2. Levofloxacin

34. PTOSIS
It is a condition in which there is drooping of the upper lid below its
normal position .
Etiology
1. Congenital Ptosis: Occurs in 80 % cases, due to maldevelopment of
levator muscle; congenital weakness of superior rectus muscle.
2. Acquired Ptosis :
a). Neurogenic : partial/ complete paralysis of 3rd Nerve
b) Mechanical : Due to increased weight of upper lid as a result of
edema, hypertrophy or tumor formation.
c) Myogenic : Due to trauma of levator muscle, muscular dystrophy (
increasing weakening or breakdown of muscle) & myasthenia gravis.(
neuromuscular disease weakness of skeleton muscle)

35.  Symptoms : Visual disturbance visible drooping of the
upper eyelid
TRETMENT
 high doses of opioid drugs such as morphine, Morphine
is a narcotic pain reliever used to treat moderate to severe
pain. ... 0.05 mg/kg IM, IV, or subcutaneously every 4 to 8
hours
 Oxycodone hydrochloride analgesic agents
 Heroin, or hydrocodone can cause ptosis.
 Pregabalin (Lyrica), an anticonvulsant drug,has also been
known to cause mild ptosis.

36. TUMORS

37.  Benign Tumors
 Nevus
 Heman-gioma
 Papilloma
 Xanthe-lasma ( jenthelasma)
 Neurofibroma
 Malignant Tumors
 Squamous cell carcinoma
 Basal cell carcinoma

38.  Nevus( mole on the skin red patches)
 A choroidal nevus is a flat, benign pigmented area that
appears in the back of the eye
 Heman-gioma
 Hemangioma is a non-cancerous (benign) tumor caused
by abnormal growth of blood vessels. cavernous
hemangioma occurs in the deeper layers of the skin or
aroundthe eye.

39. PAPILLOMA
 a benign tumor derived from epithelium. Papillomas may
arise from skin, mucous membranes, or glandular ducts
 Xanthelasma ( jenthelasma)
 are yellowish plaques that occur most commonly
 near the inner canthus of the eyelid, more often
 on the upper lid than the lower lid. Xanthelasma

40.  NEUROFIBROMA
 It is a generalized disease that may involve the lid & cause
mechanical ptosis. It is associated with unilateral infant
glaucoma.
 Small, multiple tumors are distributed along the
hypertrophied nerves.

41. Malignant Tumors
 Squamous cell carcinoma
 Basal cell carcinoma

42. Squamous cell carcinoma
 Seen at the edge of the lid (transition zone)
 where the epithelium changes. It starts as a nodule that
ulcerate.
 The preauricular lymph nodes are enlarged. It spreads
slowly the surrounding structures and are painless.
 Metastasis ( spread of cancer cells to new area of the body )
common,

43. Basal cell carcinoma
 It is most common seen in lower lid near the inner
canthus.
 It is locally malignant. Epithelial growth spreads under the
skin in all direction .

44. ETIOLOGY
 Environmental toxins such as exposure to radiation
 Genetics
 Diet – deficiency of minerals and vitamins
 Stress excessive stress cause blockingmutation in the
cells of their developing eyes
 Local trauma or injury- orbital trauma and bleeding
 Inflammation or infection

45. CLINICAL MANIFESTATION
 Bulging of one eye (protrusion)
 Complete and partial loss of sight
 Pain in or around the eye
 Blurred vision
 Change in the appearance of the eye
 Edema
 Redness
 Itching
 Burning

46. DIAGNOSIS
 Ultrasound scans
 CT SCAN
 MRI
 They show the size , location ,and shape of the tumors
and also show the enlarged or affected lymph node
around the eye.

47. MEDICAL MAANAGEMENT
1.Identify the cause & eliminate the cause
2. Achieve and maintain control of symptoms
3. Avoid adverse effects of medication.
4. to give antibiotics and anti inflammatory drugs .
5. Maintain normal activity level ,including exercise .
6, Prevention foreign particles enter in eye
 Use of sunglasses
 To keep the eye clan ,wipe away the drainage from around
the eye ‘moisten and clan cotton ball or wash cloth with
warm water, from inner to the outer part the eye.

48.  Chemotherapy eye drops
 Mitomycin C –are used to treat different types of
growths on the surface of the eye
 fluorouracil: Is used treatment pre-cancerous an
cancerous cell growth
 Radiation therapy uses high energy x- rays or other
types of radiation kill the cancer cell.