lid margin anomalies and lid aperture disorders.ppt
- 1. Dr .Mamata Subhakar . R Assistant Professor A C S Medical college and Hospital . DISORDERS OF LID MARGIN
- 3. 1. The skin 2. The subcutaneous areolar tissue. 3. The layer of striated muscle. 4. Submuscular areolar tissue. 5. Fibrous layer. 6. Layer of non-striated muscle fibres. 7. Conjunctiva. ANATOMY
- 6. 1. Meibomian glands. In tarsal plate arranged vertically. These are modified sebaceous glands. Their ducts open at the lid margin. Their secretion constitutes the oily layer of tear film. 2. Glands of Zeis. These are also sebaceous glands which open into the follicles of eyelashes. GLANDS OF EYELIDS
- 7. 3. Glands of Moll. These are modified sweat glands situated near the hair follicle. They open into the hair follicles or into the ducts of Zeis glands. 4. Accessory lacrimal glands of Wolfring. These are present near the upper border of the tarsal plate.
- 8. Inflammatory edema Dermatitis, stye, insect bite, blepharitis Passive edema Renal disease, Cardiac failure, Cavernous sinus thrombosis EDEMA OF LIDS
- 9. Blepharitis 1. Anterior blepharits. 2. Posterior blepharitis. INFLAMMATIONS OF THE EYELIDS
- 10. INFLAMMATIONS OF THE EYELIDS
- 11. 1. Anterior blepharits Squamous Ulcerative Treatment Hot compress Lid hygiene, cleaning with diluted baby shampoo Topical : antibiotic, steroids, tear substitute Oral : Azithromycin 500 mg OD for 3 days. INFLAMMATIONS OF THE EYELIDS
- 12. Posterior blepharitis Meibomian seborrhoea Meibomianitis Treatment: Warm compress, lid hygiene & massage. Oral doxycyclin or minocyclin for 6 wks. INFLAMMATIONS OF THE EYELIDS
- 13. Hordeolum externum or stye Suppurative inflammation of gland of Zeis. Hordeolum internum Suppurative inflammation of meibomian gland Chalazion Chronic inflammatory granuloma of meibomian gland. INFLAMMATION OF GLANDS OF LIDS
- 15. It is an acute suppurative inflammation of gland of the Zeis. Causative organism commonly involved is Staphylococcus aureus. Predisposing factors. 1. Refractive error 2. Blepharitis 3. Habitual rubbing of eyelids 4. Diabetes Mellitus STYE (EXTERNAL HORDEOLUM)
- 16. Treatment 1. Hot fomentation 2. Antibiotic eye ointment 3. Anagesics 4. Oral antibiotics 5. Treatment of underlying cause
- 17. CHALAZION
- 18. It is also called a tarsal or meibomian cyst. It is a chronic non-infective granulomatous inflammation of the meibomian gland. Predisposing factors. 1. Refractive error 2. Blepharitis 3. Habitual rubbing of eyelids 4. Diabetes Mellitus CHLAZION
- 19. Clinical course and complications Complete spontaneous resolution may occur rarely. Occasionally, it may burst on the conjunctival side, forming a fungating mass of granulation tissue. Secondary infection leads to formation of hordeolum internum. Calcification may occur, though very rarely. Malignant change into meibomian gland carcinoma may be seen occasionally in elderly patients.
- 20. 1. Conservative treatment. 2. Intralesional injection of long-acting steroid. 3. Incision and curettage. 4. Diathermy. TREATMENT
- 22. It is a suppurative inflammation of the meibomian gland associated with blockage of the duct. It may occur as primary staphylococcal infection of the meibomian gland or due to secondary infection in a chalazion (infected chalazion). Treatment. It is similar to hordeolum externum, except that, when the pus is formed, it should be drained by a vertical incision from the tarsal conjunctiva. INTERNAL HORDEOLUM
- 23. Blepharospasm Trichiasis Entropion Ectropion Symblepharon Ankyloblepharon Blepharophimosis Lagophthalmos Ptosis. ANOMALIES IN POSITION OF THE LASHES AND THE LIDS
- 24. Blepharospasm Involuntary, sustained and forcible closure of lids. Essential blepharospasm Reflex blepharospasm Treatment: Botulinum toxin Facial denervation
- 25. Trichiasis Misdirection of cilia, directed backwards to rub cornea. Trachoma, blepharitis, scars, chemical burns, Steven-Johnson synd, Treatment: Epilation, Electrolysis, Cryosurgery, Argon laser application.
- 26. Trichiasis ABNORMALITIES OF THE LASHES
- 27. Entropion Inward rolling of lid margin. Involutional Cicatricial Spastic Congenital ENTROPION
- 28. ENTROPION
- 29. Involutional Entropion (age related) Horizontal lid laxity Vertical lid instability Over-riding of pretarsal plate Orbital septum laxity
- 30. Full thickness wedge excision/Bicks procedure Transverse everting sutures (Over-riding) Weis procedure (long standing correction) Jones procedure (recurrences)
- 32. WEIS PROCEDURE
- 33. JONES PROCEDURE
- 34. Cicatricial entropion Due to cunjunctival scarring Treatment : Tarsal fracture/ wedge resection
- 35. TARSAL FRACTURE
- 36. Spastic entropion Congenital entropion
- 37. Eversion of lid margins and lashes away from the globe. Acquired – Involutional Cicatricial Paralytic Mechanical Congenital ECTROPION
- 38. ECTROPION
- 39. Involutional Ectropion (Age Related) Horizontal lid laxity Medial canthal tendon laxity Lateral canthal tendon laxity Disinsertion of lower lid retractors
- 40. Treatment Wedge resection for horizontal lid laxity Diamond excision for medial ectropion Kuhnt-Szymanowski Procedure modified by Byron Smith for lateral ectropion
- 41. WEDGE RESECTION FOR HORIZONTAL LID LAXITY
- 42. DIAMOND EXCISION FOR MEDIAL ECTROPION
- 44. Cicatricial Ectropion Due to burn, trauma, chronic inflammation of skin or surgical scarring. Treated with Z/ V-Y Plasty or skin grafts.
- 45. V-Y PLASTY
- 46. Paralytic Ectropion Facial nerve palsy or Bell’s palsy. Tarsorrhaphy Medial canthoplasty Lateral canthal sling Upper lid lowering Mechanical ectropion (tumours)
- 47. SYMBLEPHARON
- 48. ANKYLOBLEPHARON
- 49. BLEPHAROPHIMOSIS
- 50. Drooping of the upper lid to a level that covers more than 2mm of the superior cornea. 1. Congenital Simple Complicated 2. Acquired Neurogenic Myogenic Aponeurotic Mechanical PTOSIS
- 51. PTOSIS
- 52. It is associated with congenital weakness (maldevelopment) of the levator palpebrae superioris (LPS). 1. Simple congenital ptosis – not associated with any other anomaly. 2. Congenital ptosis with associated weakness of superior rectus muscle. 3. Blepharophimosis syndrome, – which comprises congenital ptosis, blepharophimosis, telecanthus and epicanthus inversus . 4. Congenital synkinetic ptosis – (Marcus Gunn jaw winking ptosis). – In this condition there occurs retraction of the ptotic lid with jaw movements i.e., with stimulation of ipsilateral pterygoid muscle. CONGENITAL PTOSIS
- 53. 1. Neurogenic – Third nerve palsy – Third nerve misdirection – Horner syndrome 2. Myogenic 3. Aponeurotic 4. Mechanical 5. Neurotoxic ACQUIRED PTOSIS
- 54. Grading of severity EVALUATION OF PTOSIS ptosis 2mm : mild ptosis 3 mm : moderate ptosis or > 4 mm : severe ptosis
- 59. • It is determined by the lid excursion caused by LPS muscle (Burke’s method). – Patient is asked to look down, and thumb of one hand is placed firmly against the eyebrow of the patient (to block the action of frontalis muscle) by the examiner. – Then the patient is asked to look up and the amount of upper lid excursion is measured with a ruler held in the other hand by the examiner. – Levator function is graded as follows: • • • • Normal 15 mm Good 8 mm or more Fair 5-7 mm Poor 4 mm or less LEVATOR FUNCTION ASSESMENT
- 63. LPS Action Good > 8mm Fair 5-7 Poor 4mm ≤
- 65. Fasanella-Servat LPS action good Mild ptosis < 2mm Horner’s syndrome SURGICAL TREATMENT
- 66. LPS Resection (Cunjunctival approach) LPS action fair Any type of ptosis Moderate congenital or acquired ptosis SURGICAL TREATMENT
- 67. LPS Resection (Anterior approach) LPS action fair Any type of ptosis For larger resection in congenital or acquired ptosis. SURGICAL TREATMENT
- 68. LPS Resection with aponeurotic reinsertion LPS action fair Any type of ptosis Acquired ptosis. SURGICAL TREATMENT
- 69. Frontalis suspension LPS action poor Ptosis >2 mm Congenital ptosis SURGICAL TREATMENT
- 70. Benign growths Papilloma Xanthelasma Naevus or mole Haemangioma Neurofibromatosis TUMOURS OF LIDS
- 71. . Papillomas: These are the most common benign tumours arising from the surface epithelium. i. Squamous papillomas occur in adults, as very slow growing or stationary, raspberry- like growths or as a pedunculate lesion, usually involving the lid margin. ii. Seborrhoeic keratosis occurs in middle- aged & older persons. Their surface is friable, verrucous & slightly pigmented. TREATMENT: Simple excision
- 73. Xanthelasma: These are creamy-yellow plaque-like lesions which frequently involve the skin of upper & lower lids near the inner canthus. Xanthelasma represents lipid deposits in histiocytes in the dermis of the lid. These may be associated with diabetes mellitus or high cholesterol levels TREATMENT: Excision may be advised for cosmetic reasons; but recurrences are common
- 74. XANTHELASMA
- 75. Haemangiomas of the lids are common tumours i. Capillary haemangioma: Is the most common variety which occurs at or shortly after birth, often grows rapidly & in many cases resolves spontaneously by the age of 7 years. These may be superficial & bright red in colour or deep & bluish or violet in colour. They consists of proliferating capillaries & endothelial cells. TREATMENT: Excision, Intralesional steroid, Superficial radiotherapy ii. Naevus flammeus (port wine stain): It may occur side-by-side or more commonly as a part of Sturge-Weber syndrome. It consists of dilated vascular channels & does not grow or regress like the capillary haemangioma. iii. Cavernous haemangioma: Are developmental & usually occur after first decade of life. It consists of large endothelium-lined vascular channels & usually does not show any regression. HAEMANGIOMA:
- 78. Lids & orbits are commonly affected in neurofibromatosis (von Recklinghausen’s disease). The tumour is usually plexiform type NEUROFIBROMA:
- 80. Malignant tumours Basal cell carcinoma Squamous cell carcinoma Sebaceous cell carcinoma Malignant melanoma
- 81. . Basal-cell Carcinoma: It is the commonest malignant tumour of the lids (90%) usually seen in elderly people. It is locally malignant & involves most commonly lower lid (50%) followed by medial canthus (25%), upper lid (10-15%) & outer canthus (5-10%). TREATMENT: Surgery, Radiotherapy & Cryotherapy MALIGNANT TUMOURS
- 83. BASAL- CELL CARCINOMA It may present in four forms: Noduloulcerative basal cell carcinoma is the most common presentation. It starts as a small nodule which undergoes central ulceration with pearly rolled margins. The tumour grows by burrowing & destroying the tissues locally like a rodent & hence the name rodent ulcer. Other rare presentations include: non- ulcerated nodular form, sclerosing or morphea type & pigmented basal cel
- 84. It forms the second commonest malignant tumour of the lid. Its incidence (5%) is much less than the basal cell carcinoma. It commonly arises from the lid margin (mucocutaneous junction) in elderly patients. Affects upper & lower lids equally. TREATMENT: Treatment on the lines of basal cell carcinoma. SQUAMOUS CELL CARCINOMA:
- 85. It may present in two forms: An ulcerated growth with elevated & indurated margins is the common presentation. The second form, fungating or polypoid verrucous lesion without ulceration, is a rare presentation. Metastasis: It metastatises in preauricular & sub-mandibular lymph nodes CLINICAL FEATURES OF SQUAMOUS CELL CARCINOMA
- 87. It is a rare tumour arising from the meibomian glands. TREATMENT: Surgical excision with reconstruction of lids; recurrences are common. CLINICAL FEATURES: It usually presents initially as a nodule (which may be mistaken for a chalazion). Which then grows to form a big growth. Rarely, a diffuse tumour along the lid margin may be mistaken as chronic blepharitis SEBACEOUS GLAND CARCINOMA
- 89. It is a rare tumour of the lid (less than 1% of all eyelid lesions). It may arise from a pre-existing naevus, but usually arises from the beginning from the melanocytes present in the skin. TREATMENT: Surgical excision with reconstruction of lid MALIGNANT MELANOMA (MELANOCARCINOMA):
- 90. It often appears as a flat or slightly elevated naevus which has variegated pigmentation & irregular borders. It may ulcerate & bleed. Metastasis: The tumour spreads locally as well as to distant sites by lymphatics & blood stream CLINICAL FEATURES OF MALIGNANT MELANOMA (MELANOCARCINOMA):
- 92. Muller muscle which lies deep to the septum orbitale in both the lids is innervated by A. facial nerve. B. Occulomotor C. Sympathetic nervous system D. Trigeminal nerve
- 93. Fasaenella operation for ptosis is carried out in cases with: A.• Severe ptosis. Levator action less than 5 mm. B. • Moderate ptosis. Levator action 5-8 mm. C.• Mild ptosis. Levator action more than 8 mm. D. • None of above
- 94. Levator palpebrae is inserted into: A.• Upper border of the tarsus. B.• Skin of upper lid. C.• Upper fornix. D.• All of above
- 95. Tarrsorraphy is essential in: A.• Bacterial corneal ulcer B.• Viral corneal ulcer C. • Exposure keratopathy D.• Traumatic corneal ulcer
- 96. Lagophthalmos can be caused by the following except: A.• Hyperthyroidism. B. • Facial palsy. C. • Severe entropion D.• Lid coloboma
- 97. Lid splitting and everting sutures is an operation used for the correction of: A. • Pure trichiasis of the upper eye lid. B.• Trichiasis and entropion of the upper eye lid. C.• Ectropion of the lower eye lid. D.• Paralytic entropion of the lower eye lid
- 98. Recurrent chalazion should be subjected to histopathalogical examination to rule out A.Squamous cell ca B.Sabaceous ca C.Basal cell ca D.Malignant melanoma
- 99. Gold weights are placed pretarsally in upper eye lid in A.Ankyloblepheron B.Cicatricial entropion C.Lagophthalmos(vii cn palsy, bells palsy) D.Involutional ectropion
- 100. The most common carcinoma of eyelids is A.Squamous cell ca B.Basal cell ca C.Malignant melanoma D.Sabaceous ca
- 101. Thank You