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By Dr.Ashraf " Md " , Ainshams university

Published in: Health & Medicine
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  1. 1. Eye lid anatomy Layers + S.c. tissue (no fat) 2.muscle layer 3.S.m space 4.fibrous layer 5.palpebral conj.
  2. 2. Sagittal section of the upper eye lid & SC tissue 2.Muscle layer 4.fibrous layer 3.sub muscular layer tarsus OO L.P.S Mullers m Orbital septum tarsus Orbital septum 5.conj.layer Lashes,Zeis,Molls
  3. 3. Eye lid anatomy Orbicularis oculi Levator palpebrae superioris Muscle layer
  4. 4. Eye lid anatomy Fibruos layer (orbital septum/tarsus)
  5. 5. Eye lid anatomy tarsus Palp.conj . Meibomian glands orfices
  6. 6. Eye lid anatomy
  7. 7. Lid margin - anterior lamella? -posterior lamella?
  8. 8. Inflammation of the lid margin (blepharitis) <ul><li>Anterior </li></ul><ul><li>seborrheic (scaly) </li></ul><ul><li>staphylocoocal </li></ul><ul><li>mixed </li></ul><ul><li>angular blepharoconj. </li></ul><ul><li>Parasitic blepharitis. </li></ul><ul><li>Posterior </li></ul><ul><li>Meibomian gland dysf. </li></ul><ul><li>Localized lid margin: </li></ul><ul><li>**Stye </li></ul><ul><li>**Chalazion </li></ul>
  9. 9. Anterior blepharitis <ul><li>1. Seborrheic (scaly) </li></ul>
  10. 10. Complications
  11. 11. Anterior blepharitis <ul><li>2 . staph.blepharitis </li></ul>Chronic irritation worse in mornings <ul><li>Scales around base of lashes </li></ul><ul><li>(collarettes) </li></ul><ul><li>Hyperaemia and telangiectasia of anterior lid margin (rosettes) </li></ul>
  12. 12. Anterior blepharitis <ul><li>2 . staph.blepharitis (m/I sign) </li></ul><ul><li>Upon removal of crusts ulceration is evident </li></ul>
  13. 13. Complications Anterior blepharitis
  14. 14. <ul><li>Local lid hygiene (the most important) </li></ul><ul><li>topical antibiotics eye ointment (tetracycline) in staph. inf. </li></ul>Anterior blepharitis Treatment
  15. 15. 4 . angular blepharoconjunctivitis <ul><li>Morax axenfeld diplobacilli. </li></ul><ul><li>> angles? </li></ul><ul><li>silver nitrate or zinc oxide.oin. </li></ul><ul><li>Oxytetracycline oin. </li></ul>
  16. 16. 5 . Parasitic blepharitis <ul><li>Pubic louse& its ova(nits). </li></ul><ul><li>Typically affects children with poor hyg.conditions. </li></ul><ul><li>Itching. </li></ul>Treatment - removal, destruction and delousing
  17. 17. Posterior blepharitis <ul><li>Oil globules over meibomian gland orifices </li></ul><ul><li>Oily and foamy tear film </li></ul>1 . Meibomian gland dysfunction
  18. 18. Posterior blepharitis
  19. 19. Posterior blepharitis <ul><li>Complications </li></ul><ul><li>treatment </li></ul><ul><li> *lid hyg. </li></ul><ul><li> *Tear subst. </li></ul><ul><li> *Systemic Tetracyclin or oxycyclin in severe cases. </li></ul>
  20. 20. Surgical conditions of the eye lids <ul><li>Malposition of eye lashes: </li></ul><ul><li>Distichiasis. </li></ul><ul><li>Trichiasis. </li></ul><ul><li>Malposition of the lid margin: </li></ul><ul><li>Entropion </li></ul><ul><li>Ectropion </li></ul><ul><li>Abnormal position of the lids: </li></ul><ul><li>Ptosis. </li></ul><ul><li>Lid retraction. </li></ul><ul><li>Anatomical deficiency : (coloboma) </li></ul>
  21. 21. Distichiasis cryotherapy
  22. 22. 2-Trichiasis <ul><li>Definition: abnormal direction of lashes </li></ul><ul><li>+ Normal lid margin position </li></ul><ul><li>( you can see the sharp posterior border.) </li></ul><ul><li>aetiology: </li></ul><ul><li>ttt </li></ul><ul><li>Temporary </li></ul><ul><li>-epilation </li></ul><ul><li>Permanent </li></ul><ul><li>-diathermy </li></ul><ul><li>-electrolysis </li></ul><ul><li>-cryosurgery </li></ul>
  23. 23. Malposition of the lid margin
  24. 24. 1-Entropion <ul><li>Classification </li></ul><ul><li>UL LL </li></ul><ul><li>*Involutional </li></ul><ul><li>*Spastic </li></ul><ul><li>*Congenital </li></ul><ul><li>Definition : </li></ul>Cicatricial *Cicatricial
  25. 25. Cicatricial Entropion Trachoma M/I CAUSE
  26. 26. Involutional (senile) entropion <ul><li>Redundancy of skin </li></ul><ul><li>weakness of lid retractors </li></ul><ul><li>resorption of orbital fat </li></ul>
  27. 27. Pathogenesis of involutional entropion <ul><li>Horizontal lid laxity </li></ul><ul><li>Canthal tendon laxity </li></ul><ul><li>Weakness of lower lid retractors </li></ul><ul><li>Overriding of preseptal over </li></ul><ul><li>pretarsal orbicularis during lid </li></ul><ul><li>closure </li></ul>
  28. 28. Congenital entropion <ul><ul><li>Hypertrophy of pretarsal orbicularis </li></ul></ul>
  29. 29. Treatment SURGICAL
  30. 30. UL cicatricial entropion <ul><li>TARSUS </li></ul>HEALTHY (thick&long) UN HEALTHY (thin &short) Snellen’s operation (tarsal wedge resection) Posterior lamellar advancement scheme
  31. 31. Snellen's operation (tarsal wedge resection)
  32. 32. Snellen's operation (tarsal wedge resection) tarsus Skin &muscle incision Wedge resection entropion
  33. 33. Posterior lamellar advancement 1 2 3 tarsus Ante.lam. Post lam. skin
  34. 34. LL involutional entropion Temporary Permanent Everting sutures Wies op. (trans. Bleph. & marginal rotation ) scheme
  35. 35. Everting sutures
  36. 36. Wies oper.(transverse blepharotimy & marginal rotation)
  37. 37. LL cicatricial entropion Severity Mild Moderate severe Weis op. (trans bleph & marginal rotation ) Tarsal fracture Tarsal graft scheme
  38. 38. Tarsal fracture
  39. 39. Congenital entropion Skin & muscle operation When ?
  40. 40. 2-Ectropion <ul><li>Definition: rare in UL </li></ul><ul><li>Causes: </li></ul><ul><li>*cicatricial </li></ul><ul><li>*senile </li></ul><ul><li>*paralytic </li></ul><ul><li>*mechanical </li></ul><ul><li>symptoms </li></ul><ul><li>Degrees </li></ul>
  41. 41. Cicatricial ectropion Area of scarring Z-plasty scheme localized Diffuse & extensive Free skin graft
  42. 42. Z-Plasty
  43. 43. Paralytic ectropion Neurological consultation Recent wait 6months +temporrary meas Lateral tarsorrhaphy Old Band support Lateral tarsal strip Does not improve scheme
  44. 44. Lateral tarsorrhaphy
  45. 45. LL Support Lateral tarsal strip
  46. 46. Involutional ectropion Site Medial part Diffuse scheme Punctal inversion Horizontal lid shortening
  47. 47. Horizontal lid shortening
  48. 48. Punctal inversion punctum Lid margin Palp conj .
  49. 49. Abnormal lid positions
  50. 50. Ptosis <ul><li>Definition </li></ul><ul><li>causes </li></ul><ul><li>1-congenital </li></ul><ul><li>2- acquired </li></ul><ul><li>-Apneurotic </li></ul><ul><li>-neurogenic </li></ul><ul><li>-myogenic </li></ul><ul><li>-mechanical </li></ul>
  51. 51. Mechanical ptosis Causes Large tumors Severe lid edema Anterior orbital lesions
  52. 52. Apneurotic ptosis
  53. 53. Congenital ptosis
  54. 54. Marcus Gunn jaw-winking syndrome <ul><li>Accounts for about 5% of all cases of congenital ptosis </li></ul><ul><li>Retraction or ‘wink’ of ptotic lid in conjunction with </li></ul><ul><li>stimulation of ipsilateral pterygoid muscles </li></ul>Opening of mouth Contralateral movement of jaw
  55. 55. Blepharophimosis syndrome
  56. 56. Evaluation of a case of ptosis <ul><li>Exclude pseudoptosis </li></ul>
  57. 57. Causes of pseudoptosis Lack of lid support Contralateral lid retraction
  58. 58. 2-Examination <ul><li>Ocular motility </li></ul><ul><li>pupil </li></ul><ul><li>degree of ptosis </li></ul><ul><li>degree of levator function </li></ul>1-History
  59. 59. 3-Degree of ptosis
  60. 60. Marginal reflex distance <ul><li>Distance between upper lid </li></ul><ul><li>margin and light reflex (MRD) </li></ul><ul><li>Mild ptosis (4 mm) </li></ul><ul><li>Moderate ptosis (3 mm) </li></ul><ul><li>Severe ptosis (2 mm or less) </li></ul>
  61. 61. 4-Levator function
  62. 62. <ul><li>Reflects levator function </li></ul><ul><li>Normal (15 mm or more) </li></ul><ul><li>Good (10 mm or more ) </li></ul><ul><li>Fair (5-9 mm) </li></ul>Upper lid excursion <ul><li>Poor (4 mm or less) </li></ul>
  63. 63. <ul><li>Distance between upper and lower lid margins </li></ul><ul><li>Normal upper lid margin rests about 2 mm below upper limbus </li></ul><ul><li>Normal lower lid margin rests 1 mm above lower limbus </li></ul><ul><li>Amount of unilateral ptosis is determined by comparison </li></ul>5-Vertical fissure height
  64. 64. Surgical treatment <ul><li>Acc. to degree of levator function </li></ul>Levator resection Frontalis sling <ul><li>Muller's muscle affection </li></ul>> 5 mm < 5 mm Fasenella servat
  65. 65. Fasanella-Servat procedure Excision of upper border of tarsus, lower border of Muller muscle and overlying conjunctiva ..
  66. 66. Levator resection Shortening of levator complex Indicated for any ptosis provided levator function is at least 5 mm Amount determined by levator function and severity of ptosis
  67. 67. Frontalis brow suspension Attachment of tarsus to frontalis muscle with sling Main indications <ul><li>Severe ptosis with poor levator function ( 4 mm or less ) </li></ul>
  68. 68. lagophthalmos <ul><li>Definition : inability to close the palpebral fissure </li></ul>
  69. 69. <ul><li>Clinical picture: </li></ul><ul><li>* inability to close the lids </li></ul><ul><li>* dryness of the conjunctiva &the exposed part of </li></ul><ul><li>the cornea </li></ul><ul><li>complications </li></ul><ul><li>* exposure corneal ulcer </li></ul><ul><li>* perforation </li></ul><ul><li>*endophthalmitis </li></ul><ul><li>treatment </li></ul><ul><li>ttt of cause </li></ul><ul><li>lubricants eye drops&ointement. </li></ul>lagophthalmos