Trichiasis is a condition characterized by misdirected eyelashes that rub against the cornea. It can be caused by entropion due to conditions like trachoma or scarring. Symptoms include irritation, pain, and blurred vision. Treatment options include epilation, cryotherapy, or electrolysis to remove misdirected eyelashes. Lagophthalmos is incomplete eye closure that can result from lid paralysis or contraction. It puts the cornea at risk for drying and infection if not treated with lubricants, taping, or tarsorrhaphy surgery. Ptosis refers to drooping of the upper eyelid and can be congenital, neurogenic, myogenic, or involutional in nature. The

1. Trichiasis

2. Trichiasis
Misdirected eye lashes are called trichiasis.
Eyelashes (cilia) emerging normally i.e. from
anterior border of lid margin are misdirected
backward towards the ocular surface (cornea).
Tarsal plate remains normal in position.
Any condition causing entropion (involutional,
cicatricial as in Trachoma or spastic entropion) will
cause misdirected lashes (Trichiasis) to rub
against cornea

3. Causes of Trichiasis
1. Secondary to chronic inflammatory
conditions like Trachoma, Stevens-
Jhonson Syndrome, Pemphigus,
Blepharitis, traumatic or operative scar,
blepharitis (Ulcerative) and chemical burns
2. It may be idiopathic

4. Traumatic Scar causing
Trichiasis

5. Trichiasis in Trachoma Stage IV

6. Trichiasis with Corneal Opacity

7. Trichiasis associated with Ivolutional
Entropion

8. Trichiasis associated with spastic
entropion

9. Trichiasis associated with operative scar

10. Symptoms
► Foreign body sensation
► Irritation
► Pain
► Redness
► Inability to open eyes
► Watering

11. Signs
► Misdirected eyelash(s)
► Conjunctival congestion
► Lacrimation/ blepharospasm
► Recurrent corneal erosions / superficial
corneal opacity(ies)
► Corneal vascularization
► Recurrent corneal ulcer/ Non-healing
corneal ulcer

12. Trichiasis with corneal abrasion

13. Trichiasis

14. Trichiasis with Stevens Jhonson
Syndrome

15. Treatment
1. Epilation of affected eyelash, but they grow in 4-
6 weeks
2. Diathermy: 30 mA current is passed in the root of
affected eyelash for 10 seconds then epilated
3. Electrolysis: done under local anaesthesia by
injecting lignocaine along the lid margin to
anaesthetize root of eyelashes. Positive pole is
applied temple. Negative pole is introduced in
hair follicle and current of 2 mA is used (bubble
is seen at root of eyelash then) eyelash is then
epilated

16. Epilation Forceps

17. Treatment
4. Cryotherapy: used for treating portion of lid.
This procedure is done under local
anaesthesia. Temperature of -20 deg. C ,
two cycles then eyelashes are epilated

18. Distichiasis
► In this condition there is an extra row of
eyelashes emerging from the duct of the
meibomian glands
► It may be a congenital (autosomal
dominant) condition or acquired following
chronic inflammatory condition of the
eyelids, conjunctiva or trauma
► Treatment- epilation/
electrolysis/cryotherapy

20. Trichiasis

21. Symblepharon
► Symblepharon is adhesion between the
bulbar and palpabral conjunctiva due to raw
opposing surfaces
► Causes: opposing surfaces of palpabral and
bulbar conjunctiva becomes raw and
inflamed in cases of:
a. Chemical burn (Alkali / Acid burn)
b. Stevens- Johnson syndrome
c. Pemphigus

22. Symblepharon
Types:
- Anterior
- Posterior
- Total

23. Posterior symblepharon in Stevens
Johnson Syndrome

24. Posterior and Anterior Symblepharon

25. Symptoms
► Irritation, foreign body sensation
► Restriction of ocular movements
► Diplopia

26. Treatment
► Prevention: Sweeping of glass rod and use
of topical steroids
► Treatment: surgical release + mucous
membrane or amniotic membrane grafting

27. Lagophthalmos

28. Lagophthalmos
Definition : Incomplete closure of the
palpabral aperture when attempt is made
to close the eyes.

29. Lagophthalmos in 7 nerve palsy
th

30. Lagophthalmos with neuroparalytic keratitis

31. Causes of Lagophthalmos
► Contraction of lids due to cicatrization or a
congenital deformity
► Ectropion
► Paralysis of Orbicularis
► Proptosis due to exophthalmic goitre, orbital
tumour/ inflammmation etc.
► Laxity of tissue and absence of reflex
blinking in patients who are extremely ill.

32. Clinical Picture
Symptoms:
1. Inability to close eye(s)
2. Symptoms of dry eye
3. Blurring of vision
4. Foreign body sensation
5. Photophobia

33. Clinical Picture
Signs
1. Incomplete closure of lid
2. Exposure of conjunctiva and cornea
3. Dryness, congestion
4. Haziness of cornea, punctate infiltration
Complications
1. Corneal ulcer (Non-healing)

34. Treatment
Medical Treatment
1. Lubricating Eye drops
2. Control of infection
3. Protection of ocular surface
4. Close affected eye and tape upper lid or
application of suture
Surgical Treatment:
Tarsorrhaphy (Lateral or paramedian)

35. PTOSIS

36. Ptosis
► Definition: Drooping of upper lid usually due
to paralysis or defective development of the
levator palpebrae superioris (LPS)

38. Types
► Congenital
1. Simple
2. Complicated
► Acquired
1. Neurogenic
2. Myogenic
3. Aponeurotic
4 Mechanical

39. Types
► Pseudoptosis – in Phthisis bulbi and
anophthalmos
► Condition may be Unilateral or Bilateral
► Partial or complete

40. Measurement
► Normal position of lids
► Abnormal – Margin Reflex Distance (MRD)-
Normal MRD is 4 mm +/- 1 mm
► Ptosis of less than 2 mm – Mild
► Ptosis of 3 mm – moderate
► Ptosis of 4 mm or more – severe

41. Compensatory Mechanism
► Overaction of frontalis
► Throwing back the head
► Assessment of LPS function –
Excursion of 8 mm or more – good action
Excursion of 5-7 mm – Fair action
Excursion of 4 mm or less – poor
► Look for Bell phenomenon

42. Congenital Ptosis
► Commonest form of ptosis
► Usually bilateral / Heriditary
► Due to defective development of LPS
► Simple congenital ptosis is an isolated
abnormality

43. Ptosis of left eye

44. Marcus Gunn Phenomenon

45. Blepharophimosis syndrome

46. Congenital Ptosis
► Complicated – when associated with
developmental abnormality of surrounding
structures
Associated Sup rectus palsy
Abnormal synkineses – Marcus Gunn ptosis
Dystrophy of the LPS
Blepharophimosis syndrome (Ptosis, horizontal
shortening of palp aperture, epicanthus
inversus, telecanthus lat ectropion of the lower
lids)

47. Treatment of Congenital Ptosis
► Age (3-5 years), early surgery when pupil is
covered
► Fasanella –servat operation (indicated when
ptosis is 1.5 – 2 mm – excision of 4-5 mm
upper tarsus)
► LPS resection – 10 mm resection is
minimum (resection ranges from 12 – 24
mm)
► Conjunctival (Blaskovics operation) or skin
(Everbusch operation) route for surgery

48. Treatment of Congenital Ptosis
► Frontalis suspension- intact LPS with poor
function (3 mm or less)
4-0 Supramid suture or fascia lata is used
Complications associated with this
operation

49. Acquired Ptosis
► Usually unilateral
Types
1. Neurogenic – Third nerve paralysis or due to
reduced sympathetic innervation (Horner
syndrome – ptosis, anhydrosis and miosis)
Treatment – of cause, crutch spectacle, surgery –
LPS resection/ Frontalis suspension

50. Left Eye 3 nerve Palsy
rd

51. Left Eye 3 nerve Palsy
rd

52. Acquired Ptosis
2. Myogenic – gradual onset, bilateral
condition, symmetrical
Myotonic dystrophy
Chronic progressive exophthalmoplegia
Mysthenia gravis ( damage to acetyl-cholin
receptor at postsynaptic membrane with
presence of antiacetylcholine receptor
antibodies)

53. Acquired Ptosis
Mysthenia Gravis-
Symptoms – variable
Signs – bilateral ptosis, increases by
prolonged fixation or attempt to look up ,
external ophthalmoplegia – partial or
complete
Conformation by prostigmin or edrophonium
injection test

54. Acquired Ptosis
Aponeurotic Ptosis
Is involutional is due to weakness or
disinsertion of LPS aponeurosis from ant
surface of tarsal plate
High lid fold with good LPS function
Treatment – reinsertion of LPS and
resection of LPS
Mechanical Ptosis - Tumour or
inflammation weigh down the lid

56. Contusions
► Black Eye – swelling and ecchymosis of lids
and conjunctiva
► Cryptophthalmos – rare condition
characterized by presence of skin passing
continuously from brow over the eye to the
cheek.

57. Cryptophthalmos