LID

1. DISEASES OF THE LIDS
• Oedema of the Lids–
• Inflammatory Oedema
• Passive Oedema
• Inflammation of the Lids –
• Blephritis
• Molluscum contagiosum
Pre-septal cellulitis
Allergic Dermatitis
• Inflammation of the Glands of the
Lids
• Hordeolum Externum ( Stye)
• Hordeolum Internum
• Chalazion
• Anomalies in the Position of the
Lashes and Lids
• Blephrospasm
• Trichiasis
• Entropion
• Ectropion
• Symblephron
• PTOSIS

2. EYE LID
• Skin & Subcutaneous tissue – Thinnest of body
no subcutaneous fat
• Muscles of Protaction: Orbicularis(vii)lid close
• Orbital Septum –
• Orbital Fat
• Muscle of Retraction –
• UL-LPS,MULLER
• LL-Capsulopalpebral fascia, inferior tarsal
muscle
• Tarsus(Fibrous)
• Non Striated Muscle ( Muller)
• Conjuctiva

3. STRUCTURE OF EYELID
SKIN ( Thinnest of the body , no subcutaneous fat layer
SUBCUTANEOUS TISSUE
STRIATED MUSCLES
SUBMUSCULAR CONNECTIVE TISSUE
FIBROUS LAYER
NON STRIATED MUSCLE
CONJUNCTIVA

5. UPPER LID

6. LOWER LID

8. CONJUNCTIVA
• Posterior most layer
of eyelid
• Consists of non
keratinising
squamous
epithelium
• Contains openings of
glands of Krause and
Wolfring

9. • SENSORY NERVE SUPPLY-
• V1- FRONTAL
• V2- Maxillary
• MOTOR- III,VII. Sympathetic

10. • ECTROPION- It is an outward turning of the
eyelid margin .
• TYPES:-
1)Congenital
2) Involutional
3) Paralytic
4) Cicatricial
5) Mechanical
*Involutinal ectropion is more common, while
congenital ectropion is very rare.

11. SYSTEM FOR ACQUIRED ECTROPION

13. Symptoms
• Lower lid ectropion -> Inferior punctum displaced away from
globe -> Epiphora/ Excoriation of skin around lid.
• Chronic conjunctivitis -> Irritation/ discomfort.
• Lagophthalmos & corneal exposure.
• Lid laxity & loss of orbicularis tone eliminates the lacrimal
pump mechanism—FLACCID CANALICULAR SYNDROME.
• KERATINISATION of exposed conjunctiva

15. Signs:
• Lid margin is outrolled and depending on
outrolling ectropion can be classified as under:
- Grade I –only punctum is everted
- Grade II –lid margin is everted and palpebral
conjunctiva is visible
- Grade III –fornix is also visible

16. Case work up
• SNAP BACK TEST:-
• Pull the lower lid down and away from globe for
several seconds and wait. Without the patient
blinking, note the length of time required before the
lower lid returns to its original position; the lid, in
fact, may not return to its original position at all.
MILD – takes some time
MODERATE – goes back slowly without blink
SEVERE – doesnot go back even after a blink

17. MEDIAL CANTHAL LAXITY TEST:-
• Pull the lower lid laterally away from the
medial canthus and measure
displacement of medial punctum; the
greater the distance measured, the
greater the laxity.
• Normally, the displacement should only
be 0-1 mm.
The medial canthal laxity test is graded from 0-
IV, with a grade of 0 indicating normal laxity
and a grade of IV indicating severe laxity.

18. LATERAL CANTHAL LAXITY TEST:-
• Pull the lower lid medially away from the
lateral canthus and measure
displacement of the lateral canthal
corner; the greater the distance
measured, the greater the laxity.
• Normally, the displacement should only
be 0-2 mm.
The lateral canthal laxity test is graded from 0-
IV, with a grade of 0 indicating normal laxity
and a grade of IV indicating severe laxity.

19. • Schirmer's test: to rule out dry eye.
• Fluorescein test of cornea: to assess the
corneal damage.
• Slit lamp examination
• Assessment of Bell’s phenomenon.
• Examination of 7th cranial/facial nerve.

20. Medical therapy
• Provide medical therapy if surgical therapy is not
warranted or not possible.
• Symptomatic therapy with artificial tear ointment
or drops;
• Lower lid taping.
• If there is chronic dacryocystitis, performing a
dacryocystorhinostomy alone or in combination
with an ectropion procedure may produce better
results than treating the ectropion alone.

21. INVOLUTIONAL( SENILE ) ECTROPION
• MC ,
• LOWER LID
• With horizontal eyelid laxity usually in the medial or lateral
canthal tendons.
• Mild- Medial spindle procedure
• Severe- Plication of Inferior Lid Retarctors
• Tarsal strip procedure ( Lateral Canthoplasty )
• Bick procedure - Horizontal Eyelid Shortening –Full
thickness Eyelid Excision

25. SYSTEM FOR ACQUIRED LOWER LID ENTROPION

26. Blephrophimosis Ankyloblephron
LID DEVELOPMENT A. Eyelid
fusion—8 to 10 weeks gestation.
colobomas of the eyelid margin
B. Development of eyelid
structures—3 to 4 months
gestation.
congenital ptosis
C. Eyelid dysjunction—5 to 6
months gestation
ankyloblepharon,
blepharophimosis, epicanthus

27. Both meibomian glands and eyelashes differentiate
during the second month of gestation from a
common pilosebaceous unit.
• Congenital distichiasis.
• Acquired distichiasis

29. BLEPHRITIS
1. Anterior
a. Squamous
b. Ulcerative
2. Posterior
a. Meibomian seborrhoea
b. Meibomianitis

30. BLEPHRITIS
• It involves the outer parts of the eyelid
• It is commonly caused by bacteria
SEBORRHEIC/SQUAMOUS
• It is characterized by the deposition of scales
• Eyelashes fall
• Hyperemic lid margin
• Absence of ulcers

31. SQUAMOUS
• Burning, deposits /
crusting along lid
margins, grittiness ,
redness of lid margins,
photophobia
• Symptoms are worse in
the morning

32. ULCERATIVE
• infective materials such as
yellow crusts or scales
• There is matting of the
lashes
• Presence of ulcers
• Redness of lid margins,
burning, itching, watering
and photophobia
• Signs:
– Small ulcers at lid margins
on removal of discharge,
this features differentiate it
from conjunctivitis

33. • Treatment
–Lid hygiene
–Tears
–Antibiotics
–Warm compresses

34. POSTERIOR BLEPHARITIS
• It involves the inner
parts of the eyelids
• It is due to problems in
the oil glands

35. STYE( External Hordeolum)
• It is a tender, painful red bump
located at the base of an
eyelash or inside the eyelid
 It is due to infection of the oil
glands of the eyelid or from
an infected hair follicle at the
base of an eyelash- It is an
abscess in eyelash follicle.
 painful
 -Most cases are self
limiting .
 -Treatment requires the
removal of the associated
eyelash and application of
hot compresses.

36. Internal hordeolum
 Localised inflammation
abscess in meibomian
gland.
 -Painful.
 -May respond to
topical antibiotics but
incision by be
necessary.

38. Acute hordeola
• Staph. abscess of meibomian
glands
• Tender swelling within tarsal plate
• May discharge through skin
or conjunctiva
• Staph. abscess of lash follicle and
associated gland of Zeis or Moll
• Tender swelling at lid margin
• May discharge through skin
Internal hordeolum
( acute chalazion )
External hordeolum (stye)

39. Chalazion(Meibomian gland lipogranuloma)
 It is a granuloma within
the tarsal plate caused
by obstructed
meibomian gland.
 -Painless.
 -Symptoms are unsightly
lid swelling which
resolve within six months
if the lesion persist we
remove it surgically

40. Histology of chalazion
Multiple, round spaces previously
containing fat with surrounding
granulomatous inflammation
Epithelioid Multinucleated
cells giant cells

42.  -Is a viral infection of the skin or
the mucous membranes, caused
by pox virus.
 -Can be presented with
umbilicated lesion found on the
lid margin.
 -Cause irritation, redness,
follicular conjuctivitis(small
elevation of lymphoid tissue
found on tarsal conjunctiva)
 -Treatment requires excision of
the lid lesion.
• Chemical Cautry

43. Molluscum contagiosum
• Painless, waxy, umbilicated nodule• Chronic follicular conjunctivitis
• May be multiple in AIDS patients • Occasionally superficial keratitis
Signs Complications

44. Histology of molluscum contagiosum
• Lobules of hyperplastic epithelium
• Circumscribed lesion
• Surface covered by normal
epithelium except in centre
• Intracytoplasmic (Henderson-Patterson)
inclusion bodies
• Deep within lesion bodies are small and
eosinophilic
• Near surface bodies are larger and
basophilic

45.  - Lipid containing
bilateral lesions.
 - Usually associated
with hyperlipidemia .
 - Removed for
cosmetic reasons.

46. Xanthelasma
• Usually bilateral and located medially
• Common in elderly or those with
hypercholesterolaemia
• Yellowish, subcutaneous plaques
containing cholesterol and lipid