Eyelid disorders

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EYELID DISORDERS
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Eye lid diseas

• The eye lid is made up of 4 layersg
• 1-skin - it is thin and characterized by
  absence of fat.
• 2-muscle layer
• a-orbiclaris oculi consist of horizontal
  concentric fibres. It is supplied by the facial
  nerve.
• b-levator palpebral superioris.
• c-Mullers muscle supplied by the sympathetic
  nerve

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. 3-Tarsus Consists of dense fibers -the
meibomian glands. 4-Mucous layer formed by the
palpebral conjuctiva.
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• Glands of the eye lids
• 1-Meibomian glands They are embedded in the
  tarsus and are modified sebaceous glands.
• They secret an oily secretion.They open thrugh
  vertically arranged ducts into the lid margin.
• 2-Glands of zies They are sebaceous glands.They
  are situated at the margin.
• 3-Glands of moll These are modified sweat glands.

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• The lid margin
• 1-Eye lashes-arranged in 2-3 rows anteriorly.
• 2-Opening of the ducts of the meibomian gland
  posteriorly.
• 3-Glands of zies and moll.

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• DISEASES OF THE LIDS
• Oedema of lids-this is common and owing to
  lossencess of the tissue may be so great as to
  close the eye.
• Causes
• a-Inflammatory oedema
• 1Inflammation of the lids allergic dermatitis
  due to atropine,cosmetics,insect bite.
• 2-Acute conguctivitis
• 3-Acute dacryocystitis
• 4-Acute iridocyclitis
• 5-panophthalmaitis
• 6-Obital cellulites
• b-Passive oedema due to circulatory obstruction.
• 1-Nephrotic syndrome
• 2-cardiac failure
• 3-Cavernous sinus thrombosis

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• INFLAMMATION OF THE LIDS
• BREPHARITIS
• It is a chronic inflammation of the margin of the
  lid. The lid margin becomes thickened and red.
• VARIETIES AND ETIOLOGY
• Squamous blepharitis There is encrustration of
  lid margin by white scales. It is of 2 types

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• -Ulcerativeblepharitis
• They is encrustation of the lid margin by yellow
  scales with underliing ulceration.The ulcers
  bleed on removing the scales.is an infective
  condition caused by staphylococci.

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• -Angular blepharitis
• The inflammation of the lid margin is associated
  with angular conguctivitis-foamy discharge .It is
  caused by Morax-AXenfeld bacillius

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• Symptoms
• Itching.
• Soreness.
• Lacrimation,
• photophobia.

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• Complications
• Occur especially in ulcerative blepharitis
• 1-Chronic conguctivitis
• 2-Marginal corneal ulcer
• 3-stye
• 4-Madarosis loss of lashes
• 5- Tylosis There is hypertrophy of lid border.
• 6-Trichiasis
• 7-Entropin
• 8-Ectrpion

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• Treatment
• Antibiotics such as chlormycetin, erythromycin,
  oxytetracycline ointment.

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• INFLAMMATION OF THE GLANDS OF THE LIDS
• 1-External hordeolum or stye
  
• Acute inflammation at the edge of the lid,caused
  by staphylococcal infection of the glands of
  zies,usually ending in suppuration.
• Symptoms and signs
• Red swelling appears in the lash line of the
  margin of the lid,pain,tendernessand oedemaof the
  lids,very soon a yellowish summit will be seen
  indicating suppuration.
• Treatment
• 1-Hot fomentation to hasten suppuration,the pus
  should be evacuated by a horizontal incision.
• 2-Antibiotics

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• 2-Hordeolum internum
• This is an acute suppurative inflammation of a
  miebomian gland due to staphylococcus.
• Symptoms and sings
• Symptoms are more violent than those of stye,very
  soon pus points on the palpebral conjuctiva.
• Treatment is the same as fore stye,the pus should
  be evacuated by a vertical incision.

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• Chalazion
• This is achronic granulomatous enlargement of one
  of the meibomian glands
• Etiology,Pathology
• The meibomian duct becomes obstructed through
  proliferation of its epithelium and consequently
  the gland enlarges.The fatty secretion escapes
  into the surrounding tissue and exites a forign
  body reaction.
• Symptoms
• 1-Cosmetic disfigurement-lid swelling
• 2-conjuctival irritation
• Sings
• A circumscribed swelling which feel hard
• Treatment
• 1-Antibiotics
• 2-operation

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• Blepharospasm
• It is a condation in which there are involuntary
  and forcible eye lid closure
• 1-Reflex sensory stimulation through branches of
  5th cranial nerve commonest.
• a-phlyctenular keratoconjunctivitis
• b-foreign body on cornea
• c-Membranous and pseudomembranous conjunctivitis
• d-Acute iridocyclitis
• 2-Excessive stimulation of retina
• a-Bright light on sensitive eye
• b-Dilated pupil
• c- Albinism
• 3-Essential blepharospasm whithout any cause
• 4-Hysteria

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• Disorder of lashes
• Trichiasis
• an inversion of a varying number of eye lashes so
  that they rub against the conjuctiva or cornea
• Etiology same as entropion, secondry to
  chronic blepharitis,
• Sings and symptoms
• The misdirectionlashes cause mechanical
  irritation and injury to cornea with ulceration-
  pain, lacrimation, photophobia-blepharospasm,vascu
  larisation and opacities of cornea
• Treatment
• 1-Epilation
• 2-Electrolysis
• EYE

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• Distichiasis
• Congenital and acquired
• -variabal number of lashes which originate from
  meibomian gland orifices.
• Madarosis
• Is a decrease in number or complete loss of
  lashes
• Causes
• 1-local
• -chronic anterior lid margin diseas
• -infiltrating tumours
• -burns
• -radiotherapy or cryotherapy of lid tumours

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• Entropion
• Is a rolling in of the margin of the lid and
  with the lashes.
• Etiology and varieties
• a-Old case of trachoma
• b-Blepharitis
• c-Burns
• d-Operation upon the lids
• e-Atrophy or absence of eye ball
• f-Old persons
• g-Blepharosbasm.
• Symptoms and sings
• same as for trichiasis

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• Ectropion
• It is a rolling out of the margin of the lid.
• Etiolgy and varieties
• 1-Cicatrical due to cicatrical changes
  in the skin of the lid-
• 2-Senile
• 3-Paralytic -it occurs as a result of weakness
  of the orbicularis muscle due to facial nerve
  paralysis.
• Symptoms- Epiphora/Tearing due to eversion of
  lacrimal puncta.

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Complications 1-Xerosis of conjuctiva 2-Chronic
conjunctivitis and exposure keratitis.
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SYMBLEPHARON Is the attachment between the
conjuctiva of the lid and the eye ball. It may
affect both lids, but usually the lower,sometimes
it includes part of the cornea ETIOLOGY 1-injurie
s especially burns from lime,acide,and molten
metal 2-operation 3-trachoma
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Lagophthalmos This is the incomplete closure of
the palpebral aperture when an attempt is made to
shut the eyes. Causes Exophthalmos as in Graves
disease ,proptosis due to orbital tumour. 1- 2-
Facial nerve paralysis 3-Cicatrical ectropion of
upper lid 4-Symblepharon Complications 1-Xerosis
of conjuctiva. 2-Chronic conjunctivitis and
exposure keratitis
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Ptosis Is a drooping of the upper
lid. Etiology Classification 1-Congenital
ptosis 2-Acquired ptosis a- Neurogenic due to
lesion of 3rd nerve nucleus b-Myogenic Myasthenia
gravis c-Mechanical -due to increase weight of
lid tuomor d-Traumatic
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TUMOURS OF THE EYE LID 1-Benign tumours of the
lids a- Papilloma b-Molluscum contagiosum-is a
small umbilicated,nodular swelling,generally
multiple due to a large pox virus. c-Naevus d-Xant
helasma This is a raised yellow
plaque e-Haemangioma Malignant tumours a- rodent
ulcer or basal cell carcinoma b-Squamous cell
carcinoma It start as a small nodule which
ulcerates. c-Meibomian gland carcinoma
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• THE END..