CLICK THIS LINK TO OPEN PRESENTATION

 Four main layers
 Skin
 Muscle
 Tarsal plate
 Conjunctiva

 Epidermis
 Keratin layer
 Granular cell layer
 Squamous cell layer
 Basal cell layer
 Dermis
 Sebaceous glands
 Blood vessels
 Lymphatics
 Nerve fibers

 Lid has four layer: 1. skin 2. muscle 3. tarsal
plate 4. conjunctiva. Skin of lid is very loose so
any fluid or blood into it results in boggy
edema of lid. It may be because of trauma or
excessive watering.

 Skin is furthur divided into epidermis and
dermis. Epidermis has keratin layer on top
followed by granular layer, squamous cell
layer and basal cell layer.

 Grey line is an anatomical and surgical mark
dividing lid into two parts, the skin and muscle
separated from tarsal plate and conjunctiva.
The conjunctiva starts at the mucocutaneous
junction at the lids. The eyelids contain both
sebaceous and sweat glands.

 Lid skin subcutaneous tissue does not contain
any fat. Lid muscle (orbicularis oculi) is
supplied by 7th nerve and help closing the eye
lid.

 Its antagonist muscle is levator palpebrae
superioris (LPS ) is supplied by 3rd nerve and
helps open the lid. LPS originate from the
lessor wing of sphenoid. It inserts into superior
lid skin to form lid crease and also inserts into
superior tarsal plate.

 The tarsal plate is fibrous structure containing
meibomian glands which are modified
sebaceous glands, Upper tarsus is 10mm long
while lower tarsus is 5mm long. There are 50
glands in upper tarsus and 25 glands in lower
tarsus.

 Protection
 Lubrication

 Congenital
 Acquired (In The Vampire Diary)
1. Infections
2. Inflammations
3. Degeneration
4. Vascular
5. Tumors
1. Benign
2. malignant
6. Trauma
7. Iatrogenic

 Naevus
 Epicanthic folds
 Telecanthus
 Blepharophimosis, ptosis and epicanthus inversus syndrome
 Epiblepharon
 Congenital entropion
 Coloboma
 Cryptophthalmos
 Euryblepharon
 Microblepharon
 Ablepharon
 Congenital upper lid eversion
 Ankyloblepharon

 An epicanthal fold is a skin fold of the upper
eyelid covering the inner corner of the eye.

 Epicanthus tarsalis: fold most prominent along
upper eyelid.
 Epicanthus inversus: most prominent along
lower eyelid.
 Epicanthus palpebralis: involves both upper
and lower eyelids.
 Epicanthus superciliaris: fold originates from
the brow and follows down to the lacrimal sac.

 increased distance between the inner corners of
the eyelids (medial canthi), while the inter-
pupillary distance is normal.
 This is in contrast to hypertelorism, in which
the distance between the whole eyes is
increased.

 Blepharophimosis, ptosis, and epicanthus
inversus syndrome (BPES) is a rare
developmental condition affecting the eyelids
and ovary. Typically, four major
facial features are present at birth:
1. narrow eyes
2. droopy eyelids
3. an upward fold of skin of the inner lower
eyelids and
4. widely set eyes.

 V-Y PLASTY
 DOUBLE Z PLASTY

 Epiblepharon is a condition in which the
eyelid pretarsal muscle and skin ride above the
eyelid margin to form a horizontal fold of
tissue that causes the cilia to assume a vertical
position

 INWARD TURNING OF EYE LIDS AT BIRTH

 An eyelid coloboma is a full-thickness defect
of the eyelid

 skin is continuous over the eyeball with
absence of eyelids.

 bilateral horizontal enlargement of the
palpebral fissure with vertically shortened
eyelids, lateral canthus malpositioning and
lateral ectropion.

CLICK THIS LINK TO OPEN PRESENTATION

 adhesion of the edges of upper eyelid with the
lower eyelid

 Eyelids are abnormally small

 Congenital
 Acquired (In The Vampire Duty)
1. Infections
2. Inflammations
3. Degeneration
4. Vascular
5. Tumors
1. Benign
2. malignant
6. Trauma
7. Iatrogenic

 bacterial
 Stye
 blephritis
Staphylococcal
seborrhoeic
 Viral
 POX (Moluscum contagiosum)
 Herpes simplex
 Herpes ophthalmicus

 Pathogenesis
 Staphylococcal infection of eye lid glands (zeis and
Moll)

 Stye
 Sebaceous gland carcinoma

 SYMPTOMS
 Eye pain and swelling
 Signs
 Painful nodule on lid margin
 Pre-septal cellulitis

 NO investigations needed
 Diagnosis is mainly clinical

 Topical antibiotic massaged over lid margin at
night
 Oral antibiotics given for few days
 Tetracycline may be given to stop recurrence

 Inflammation of lid margine

 Anterior blepharitis
 Around the eye lash roots
 Posterior blepharitis
 Meibomian gland dysfunction
 Alteration in Meibomian gland secretions

 Staphylococcal
 Hard crusts around eye lashes
 seborrhoeic
 Mating of eye lashes

 They cause irritation and tear film disturbance.
 Burning,
 grittiness (sandy).
 mild photophobia
 crusting and redness of lid margins
 conditions are worse in the morning

 Anterior blephritis
 hard crusts
 Matting of eyelashes
 Posterior blepharitis
 Excessive meibomian gland secretions
 capping of meibomian gland orifices

 lid hygiene,
 warm compresses,
 lid massage,
 topical antibiotic eye drops and ointment at
night

 Mild steroid eye drops like fluorometholone
and
 Artificial tears
 Using diluted baby shampoo on eye lashes
when taking bath

 Caused by POX virus
 clinical features
 umbilicated nodule on lid margin
 disturb tear film and cause irritation

 treatment
 conservative spontaneous resolution
 shave excision
 cauterization
 chemical ablation
 cryotherapy

 SMALL YELLOW LESION ON UPPER LID

 RESPECTS MIDLINE ON FOREHEAD
 MACULOPAPULAR RASH

 Chalazion
 Acut allegic edema
 Atopic dermatitis

 Pathogenesis
 Lipogranulomatous inflammation of Meibomian
glands

 Symptoms
 Painless Eye swelling for some time
 Signs
 One or two nodules on eyelid skin
 Granuloma on conjunctival side

 A Secondarily infected Chalazion is called
internal hordeolum

 A recurrent chalazion should be biopsied and
sent for histopathological examination

 Conservative
 Warm compresses
 Intralesional steroid
 4mg/0.1ml
 Chalazion surgery
 Incision and curettage

 INSECT BITE
 ALLERGIES
 BILATERAL LID SWELLING

 RED ITCHY DRY IRRITATED SKIN
 TREATMENT: 1%HYDROCORTISONE
OINTMENT

 Dermatochlasis
 Xanthelasma

 EXCESS OF SKIN IN UPPER OR LOWER LID
 MAY RESEMBLE PSEDOPTOSIS

 It is slightly raised skin plaque of yellowish
white color on medial parts of both upper and
lower lids

 Young individuals hypercholesterolemia
should be checked
 Treatment:
 Surgical excision

 Capillary hemagioma
 Port wine stain
 Varices

 One of most common tumors of infancy.
 More common in boys.
 Presents after birth with raised bright lesion
which blanches on pressure and swell on
crying.
 Histologically there are varying sized vascular
channels in dermis.
 Treatment is intralesional steroid.

 It is congenital malformation of vessels in
dermis.
 Histologically these are vascular spaces
separated by thin fibrous septa.
 Clinically it presents as pink demarcated patch
usually on face which does not blanch on
pressure.
 It is related to ipsilateral glaucoma. The
screening glaucoma should begin in infancy

 Eyelid Varix is an abnormal dilatation of one
or more normal blood vessels.
 Varices of the eyelids are usually an extension
forward of the orbital varices into the eyelid.
 These probably are congenital or acquired
weakness of the affected vein, or to an
obstruction of the venous circulation

 Congenital
1. Infections
2. Inflammations
3. Degeneration
4. Vascular
5. Tumors and cysts
1. Benign
2. Pre-malignant
3. malignant
6. Trauma
7. Iatrogenic

 Cyst of zeis
 Cyst of moll
 Sebaceous cyst
 Epidermal inclusion cyst

 Non translucent cyst
 Anterior lid margin
 Obstructed sebaceous glands

 Translucent cyst
 Anterior lid margin

 Implantation of epidermis into dermis
 Following surgery or truama

 Squamous cell papilloma
 Basal cell papilloma (sebohrreic keratosis)
 Pyogenic granuloma
 Neurofibroma

 Arises from squamous cell of epidermis
 Clinical feature
 Skin tag
 Sessile broad based lesion
 Treatment
 Simple excision
 Cryotherapy
 Laser or chemical ablation

 Arises from basal cells
 arises from basal cell of epidermis
 brown
 stuck on appearance
 treatment
 simple excision
 crotherapy
 laser or chemical ablation

 Actinic keratosis
 keratoacanthoma
 Acquired melanocytic naevus

 Wart like scaly lesion on lid margin
 low malignant potential for squamous cell
carcinoma
 treatmet
 biopsy followed by simple excision

 Risk factors
 chronic sun exposure
 fair skin
 immunosuppressive therapy

 pink dome increasing in size over weeks
 growth ceases in two to three months
 keratin filled crater may develop

 treatment
 surgical excision
 radiotherapy
 cryotherapy
 local chemotherapy

 Basal cell carcinoma
 Squamous cell carcinoma
 Sebaceous gland carcimoma
 Melanoma
 Kaposi sarcoma

 most common human malignancy. More
common on lower lid. Locally invasive but
non-metastatic.

 Risk factor
 fair skin.
 chronic sun exposure

 Clinical features
 may mimic a nodule
 rodent ulceration: rolled edges with surface
vessels
 sclerosing type spread underneath the skin

 Less common than BCC. Metastatic. May
spread to preauricular lymph nodes which
must be checked in any lid tumor

 risk factors
 chronic sun exposure
 fair skin
 immunocompromised patients

 may resemble nodule:
 ulceration: everted borders but surface vessels are
absent.

 Rare.
 more common on upper lid because of
increased number of meibomian glands in
upper lid.
 10% mortality

 yellowish material in tumor
 nodule in upper lid which may resemble chalazion
 spreading tumor under the skin may resemble
blepharitis

 Surgery
 Biopsy
 which may be incisional or excisional

 surgical excision
 conventional paraffin embedded specimen
 frozen section technique: margins are checked at the
time of surgery. if tumor free, reconstruction is done
same day
 Mohs micrographic surgery: lesion is mapped
histologically and excision is done at the place of
lesion

 After excision of tumor with some normal
healthy surrounding tissue
 For small defect: up to one third of lid, direct
closure is done.
 INTERMEDIATE: Up to half of lid defects,
semicircular flaps are done for example Tenzil
semicircular flaps
 LARGE: More than half defects free skin grafts
and flaps are done.

 Ptosis
 Ectropion
 Entropion
 Trichiasis
 Distichiasis
 Madarosis
 Poliosis
 Trichomegaly

 Drooping of upper eyelid is called ptosis

 Congenital
 Acquired
 Neurogenic
 Horner
 3rd nerve palsy
 Myogenic
 Myotonic dystrophy
 Myasthenia gravis

 Aponeurotic
 Mechanical
 Lid mass

 Some conditions mimic like ptosis
 Ocular volume deficit
 Enophthalmos
 Artificial eye
 Hypotropic eye
 Dermatochalasis
 Excess of skin on lids
 Contralateral lid retraction

 History
 Onset
 Sudden (3rd nerve palsy
 Duration
 Since childhood (congenital)
 Old photographs
 Variability with time of day (myasthenia)

 Levator function
 Normal > 15mm
 Good =12-14 mm
 Fair = 5 - 11mm
 Poor = 4 or less than 4

 First we ask the patient to look down
 It is checked by placing a thumb over forehead
thus negating the action of frontalis muscle
 Then we ask the patient to loop up
 The excursion of upper lid from down gaze to
upgaze is noted

 The distance between central corneal reflex and
upper lid margin when eyes are looking
straight ahead with head erect position.
 MRD 1: 4 mm are normal
 MRD 2: when lid crosses
pupillary axis

 The distance between upper and lower lid
when patient looking straight ahead
 Normal 10 mm

 It is distance between upper lid margin and
upper lid crease in primary position
 Normal lid crease 10 mm

 Marcus gunn jaw winking sign is blinking of
eyes when chewing and moving jaw from side
to side
 Misdirection of 5th nerve to lavator

 Extraocular movements
 Fatigueability
 Ask patient to look up for 30 seconds
 Drooping of upper lid is indicative of myasthenia
 Pupil
 Horner syndrome

 open the eyes of patient and ask the patient to
close the eyes
 The uprolling of eye ball shows good bells

 Conservative
 Eye lid crutches
 Surgical
 Fosanella servat procedure if good levator function
 Levator resection if fair levator function
 Frontalis sling if poor levator function

 Under correction
 Over correction
 Exposure keratopathy

 Outward turning of lid margin

 epiphora
 ocular disturbance
 dry eyes
 red inflamed keratinized conjunctiva

 Horizontal lid laxity: observed by pulling eye
lid more than 8 mm from globe and failure to
snap back without patient first blinking
 Lateral canthal tendon laxity: demonstrated by
pulling the lower lid medially more then 2 mm
 Lateral canthal tendon laxity: demonstrated by
pulling the lower lid laterally more then 2 mm

 Horizontal lid laxity by
 lateral tarsal strip: in whichlower canthal
tendon is tightened by shortening and
reattachment to lateral orbital rim
 excision of tarsoconjunctival pentagon

 medial ectropion: medial conjunctival
diamond excision
 medial canthal tendon laxity: stabilization
prior to horizontal shortening

 Caused scarring and contracture of skin which
pulls the lid outward

 Treatment is in mild cases excision of
offending scar tissue with procedures that
increase vertical skin deficiency
 In severe cases transposition flaps and free skin
grafts are used

 sources of graft are
 preauricular
 post auricular
 upper lids
 supraclavicular tissue

 Caused by 7th nerve palsy
 unable to close the eyes
 exposure keratopthy
 epiphora due to lacrimal pump failure

 Treatment:
 lubrication
 botulinum toxin to LPS
 temporary tarsorrhaphy

 medial canthoplasty
 lateral tarsal strip
 levator disinsertion
 gold weight implant
 small lateral tarsorrhaphy

 By a tumor near lid margin
 Treatment
 Treat the cause
 Remove tumor

 Clinical feature
 corneal epithelial defect
 irritation
 pannus
 ulceration

 causes
 horizontal lid laxity
 Overriding of pretarsal by preseptal orbicularis
 disinsertion of lower lid retractors
 orbital septum laxity

 Treatment
 lubrication
 taping
 soft bandage contact lens
 botulinum toxin
 Surgical
 weis procedure: full thickness horizontal lid splitting
and insertion of everting sutures

 scarring of palpebral conjunctiva
 causes
 ocular cicatricial pemphigoid
 trachoma
 chemical injury
 trauma

 treatment
 lubrication
 contact lens
 tapping
 surgery: tarsal fracture with anterior rotation of
lid margin in mild cases. In severe cases
removal of keratinized conjunctiva and
replacing it with grafts

 Trichiasis is inward misdirection of eyelashes
originating from normal site of origin
 Clinical features:
 They cause
 ocular irritation,
 disturbance of tear film and
 corneal epithelial defect.

 Treatment options are
 epilation,
 electrocautry,
 cryotherapy and
 argon laser.

 Distichiasis is extra row of eye lashes from
meibomian glands
 TYPES
 either congenital or acquired.

 PATHOGENESIS
 Acquired distichiasis is caused by metaplasia of
meibomian glands caused by chemical burns,
stephen johnson syndrome, trachoma and ocular
cicatricial pemphigoid

 TREATMENT:
 Separation of two lamella of lid and cryotherapy to
the base of abnormal lashes

 Premature whitening of eye lashes

 Ocular
 Chronic anterior blepharitis
 Sympathetic ophthalmitis
 Idiopathic uveitis

 Systemic
 Vogt–Koyanagi–Harada syndrome
 Waardenburg syndrome
 Vitiligo
 Marfan syndrome
 Tuberous sclerosis

 Premature loss of eye lashes as in chronic
anterior lid margin disease and
hypothyroidism

 Local
 Chronic anterior lid margin disease
 Infiltrating lid tumours
 Burns
 Radiotherapy or cryotherapy of lid tumours

 Skin disorders
 Generalized alopecia
 Psoriasis

 Systemic diseases
 Myxoedema
 Systemic lupus erythematosus
 Acquired syphilis
 Lepromatous leprosy

 Following removal
 Procedures for trichiasis
 Trichotillomania – psychiatric disorder of hair
removal

 Abnormal lengthening of eye lashes.
Bipatoprost is an FDA approved drug for
lengthening of eye lashes

 Congenital
1. Infections
2. Inflammations
3. Degeneration
4. Vascular
5. Tumors and cysts
1. Benign
2. Pre-malignant
3. malignant
6. Trauma
7. Iatrogenic
 Special conditions of lids

CLICK THIS LINK TO OPEN PRESENTATION

More Related Content

What's hot (20)

Similar to CLICK THIS LINK TO OPEN PRESENTATION (20)

Recently uploaded (20)

CLICK THIS LINK TO OPEN PRESENTATION