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.
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7.
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.
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 .
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
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
33.
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.
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.
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.
