-It is a granuloma within the tarsal plate caused by

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EYELID DISORDERS

• DONE BY DANA SAIF

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Anatomy

• The eyelid is consist of four layers
• 1- An anterior layer of skin and subcutaneous
  tissue.
• 2- Muscular layer that comprises the
  orbicularis oculi muscle, which is responsible
  for the closing of the lids.
• 3- Tarsal plate which is a tough collagenous
  layer that houses meibomian gland.
• 4- Tarsal (palpebral )conjunctiva.
• The orbital septum represents the anatomic
  boundary between the lid tissue and the orbital
  tissue.
• Innervations majorly by ophthalmic and maxillary
  branch of trigeminal nerve.
• Blood supply majorly by ophthalmic and lacrimal
  artery.  

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FUNCTION

• It offers mechanical protection to anterior globe
• Spread the tear film over the conjunctiva and
  cornea with each blink.
• Contain the meibomian oil gland which provide the
  lipid component of the tear film.
• Prevent drying of the eyes.
• Contain the puncta through which the tears flow
  into the lacrimal drainage system.

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• ABNORMALITIES OF LID POSITION

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ptosis

• This is an abnormally low position of the upper
  eyelid.
• PATHOGENESIS
• It may be caused by
• Mechanical factors
• (a) Large lid lesions pulling down the lid.
• (b) Lid oedema.
• (c) Tethering of the lid by conjunctival
  scarring.
• (d) Structural abnormalities including a
  disinsertion of the aponeurosis of the levator
  muscle, usually in elderly patients.

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• 2.Neurological factors
• (a)Third nerve palsy
• (b)Horners syndrome, due to a sympathetic nerve
  lesion
• (c)MarcusGunn jaw-winking syndrome.
• 3.Myogenic factors
• (a)Myasthenia gravis
• (b)Some forms of muscular dystrophy.
• (c)Chronic external ophthalmoplegia.

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• SYMPTOMS
• Patients present because
• they object to the cosmetic effect
• vision may be impaired
• there are symptoms and signs associated with the
  underlying cause
• (e.g. asymmetric pupils in Horners syndrome,
  diplopia and reduced eye movements in a third
  nerve palsy).

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• Signs
• There is a reduction in size of the
  interpalpebral aperture.
• The upper lid margin, which usually overlaps the
  upper limbus by 12imm, may be partially covering
  the pupil.
• The function of the levator muscle can be tested
  by measuring the maximum travel of the upper lid
  from upgaze to downgaze (normally 1518imm).
  Pressure on the brow (frontalis muscle) during
  this test will prevent its contribution to lid
  elevation.
• If myasthenia is suspected the ptosis should be
  observed during repeated lid movement. Increasing
  ptosis after repeated elevation and depression of
  the lid is suggestive of myasthenia

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MANAGMENT

• It is important to exclude an underlying cause
  whose treatment could resolve the problem (e.g.
  myasthenia gravis). Ptosis otherwise requires
  surgical correction
• In very young children this is usually deferred
  but may be expedited if pupil cover threatens to
  induce amblyopia.

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Marcus Gunn Jaw-Winking syndrome

• - Also called Trigemino-oculomotor Synkineses
• Autosomal dominant
• In this congenital ptosis there is miswiring of
  the nerve supply to the pterygoid muscle of the
  jaw and the levator of the eye so that the eyelid
  moves in conjugation with movements of the jaw.
• Treatment
• Treatment is usually unnecessary but in severe
  cases, surgery with a bilateral levator excision
  and frontalis brow suspension may be used.

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dermatochalasis

• excessive and lax eyelid skin and muscle is known
  as dermatochalasis. Gravity, loss of elastic
  tissue in the skin, and weakening of the
  connective tissues of the eyelid frequently
  contribute to this lax and redundant eyelid
  tissue. These findings are more common in the
  upper eyelids but can be seen in the lower
  eyelids as well.
• The patients who complain of dermatochalasis
  frequently complain of visual difficulties
• Causes
• The most common cause of dermatochalasis is the
  normal aging phenomenon
• Patients with severe periorbital edema may
  develop dermatochalasis
• Trauma can be associated with dermatochalasis
• Chronic dermatitis
• Thyroid eye disease
• Chronic renal insufficiency
• Amyloidosis
• Genetics may play a role in some patients who
  develop dermatochalasis
• Treatment
• Blepharoplasty is the procedure of choice for
  upper and/or lower eyelid dermatochalasis

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Entropion

• It is an inturning, usually of the lower lid
  towards the globe.
• - Patients present with irritation caused by
  eyelashes rubbing on the cornea.
• - more common in elderly, because orbcularis
  muscle become spasm.
• it may also caused by Conjuctival scarring
  distorting the lid (cicatrical entropion)
• Treatment
• Short term include the application of lubricants
  to the eye or taping of the eyelid.
• Permenant surgery

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Ectropion

• Eversion of the lid away from the globe.
• Causes-
• -age related orbicularis muscle laxity.
• -facial nerve palsy.
• -scarring of periorbital skin.
• - initial complaint of watery eye, because the
  mal position of the lids everts the puncta and
  prevents drainge of the tears leading to
  epiphora(overflow of the tears over the cheeks )
• -it also exposes the conjuctiva leading to
  irratable eye.
• treatment surgical

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LID INFLAMMATION
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Blepharitis

• Inflammation of the eyelid margins.
• It is a chronic disease.
• Symptoms
• tired, itchy, sore eye, worse in the morning.
• Crusting of the lid margin.
• Classified into anterior and posterior .
• Both forms are strongly associated with
  seborrhoeic dermatitis, atopic eczema and acne
  rosacea.

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Anterior Blepharitis

• Is when the inflammation is located in the
  outside surface the lid margin, specifically in
  lash line.
• Signs are
• -Redness and scaling of the lid margin.
• -Debris in the form of a collarette around the
  eyelashes.
• -Reduction in the number of eyelashes.
• -Some lash bases may ulcerated- sign of
  staphylococcal infection.
• In severe diseasesthe cornea is affected
  (blepharokeratitis)
• Small infiltrate ulcers may form in the
  peripheral cornea (marginal teratitis)due to
  immune complex response to staphlococcal
  exotoxins .

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Posterior blepharitis

• Have another name which is meibomian gland
  dysunction.
• Signs are
• - Obstruction and plugging of the meibomian
  orifices.
• - Thickened , cloudy, expressed meibomian
  secretion.
• - Injection of the lid margin and conjuctiva.
• - Tear film abnormalities and punctate keratitis.

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Treatment

• Anterior blepharitis
• Cleaning with a cotton bud wetted with
  bicarbonate or diluted baby shampoo to remove
  squamous debris from lash line .
• Topical steroid used infrequently.
• Topical (fusidic acid) - systemic antibioticin
  staphylococcal lid disease .
• Posterior blepharitis
• Hot compressors and lid massage.
• Oral tetracycline.
• Artificial tears to prevent dryness

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• LID LUMPS

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Chalazion

• -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

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Internal hordeolum

• an abscess in meibomian gland.
• -Painful.
• -May respond to topical antibiotics but incision
  by be necessary.

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External Hordeolum (Stye)

• - 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.

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Molluscum Contagiosum

• -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.

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Xanthelasma

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

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• THANX FOR LISTENING
• DONE BYDANA SAIF