Eyelids Anatomy: Eyelids are thin movable curtains composed of skin on their anterior surface and mucus membrane (conjunctiva) on the posterior surface Eyelids The free margin of the eyelids contains:
1- The lashes (Cilia). 2- Grey line 3- Mucocutaneous junction. 4- Orifices of Meibomian glands. 5- Superior and inferior puncti ofNaso- lacrimal system. Muscles of the eyelids:
1- Orbicularis oculi muscle: 2- Levator palpebrae superiorismuscle: 3- Superior palpebral muscle(Mller's muscle or superior tarsalmuscle): Glands in the eyelids: 1- Meibomian glands (Tarsal gland):
2- Zeis glands: 3- Glands of Moll: Congenital anomalies of eyelids:
1- Ablepharon: 2- Ankyloblepharon: 3- Coloboma. 4- Blepharophimosis: 5- Epicanthus: Congenital anomalies of eyelids:
1- Ablepharon: 2- Ankyloblepharon: 3- Coloboma. 4- Blepharophimosis: 5- Epicanthus: Congenital anomalies of eyelids:
1- Ablepharon: 2- Ankyloblepharon: 3- Coloboma. 4- Blepharophimosis: 5- Epicanthus: Abnormalities in shape and position:
1- Entropion: a- Congenital: b- Senile c- Cicatricial d- Spastic 2- Ectropion: a- Congenital: b- Senile c- Cicatricial d- Paralytic 3- Blepharoptosis 3- Blepharoptosis 3- Blepharoptosis 3- Blepharoptosis: a- Congenital blepharoptosis: 3- Blepharoptosis: b- Neurogenic blepharoptosis:
i- Oculomotor nerve palsy: ii- Horner's syndrome iii- Marcus Gunn Jaw-winking syndrome iv- 3rd nerve misdirection: why it is severe in (i) and mild in (ii)? 3- Blepharoptosis: c- Myogenic blepharoptosis: i- Myasthenia gravis:
ii- Myotonic dystrophy. iii- Ocular myopathy iv- Simple congenital myogenic blepharoptosis v- Blepharophimosis syndromes 3- Blepharoptosis: d- Aponeurotic blepharoptosis:
i- Involutional (senile). ii- Post operative. 3- Blepharoptosis: e- Mechanical blepharoptosis:
i- Trachoma, VKC and eyelid tumor. ii- Cicatricial (due to LS and superior rectus fibrosis). iii- Trauma (collection of fluid). iv- Iatrogenic by surgeons. v- Lack of support (thisical or nanophthalmos 3- Blepharoptosis: Treatment of ptosis: The treatment is surgical exceptin myasthenia gravis, where the treatment is medical: a- Levator resection. b- Frontalis brow suspension (Sling operation). c- Tarso-conjunctival resection (Fasanella serveteprocedure). a- Levator resection. b- Frontalis brow suspension (Sling operation). c- Tarso-conjunctival resection 4- Trichiasis: a- Any cause leads to entropion of the eyelid Pseudo- trichiasis. b- Trachoma with or without entropion True or pseudo- trichiasis. c- Chronic blepharitis True trichiasis. Treatment: For isolated misdirection cilia (true trichiasis)
a- Epilation: Repeated every few weeks. b- Electrolysis: Destruction to hair follicles by cauterization. c- Cryosurgery: Destruction to hair follicles by freezing. d- Laser ablation: Destruction to hair follicles by laser. Treatment for pseudo-trichiasis
correction of entropion surgically. 5- Blepharospasm: Involuntary sustained closure of the eyelids whichoccurs spontaneously (essential) or by sensorystimuli (reflex). 6- Madarosis: Local Causes: chronic blepharitis, burns, radiationand infiltrating tumor. Systemic causes: generalized alopecia, psoriasis,SLE, syphilis and leprosy. The eyelids Benign nodules and cysts:- 1- Chalazion (Meibomian cyst): Chalazion (Meibomian cyst): 1- Chalazion (Meibomian cyst): 2- Internal Hordeolum: It is a small abscess caused by an acutestaphylococcal infection of Meibomian glands. 3- External hordeolum (Stye): Marginal Chronic Blepharitis
Types of chronic blepharitis: 1- Anterior: a- Staphylococcal infection. b- Seborrheic dysfunction. c- Mixed. 2- Posterior: a- Meibomianitis. b- Meibomian seborrhea. 3- Mixed Pathogenesis of chronic blepharitis:
1- Anterior chronic staphylococcal blepharitis: 2- Anterior chronic seborrhoeic blepharitis: Neutral lipids breakdown by mycobacterium acne in to Bacterial lipase andirritating fatty acids responsible for increase of symptoms. 3- Posterior chronic blepharitis Symptoms of chronic marginal blepharitis:
Burning grittiness mild photophobia crusting and redness of the lid margin. The symptoms are characterized by remissions andexacerbations. The symptoms usually worse inmornings. Signs of anterior blepharitis:
hyperaemia telangiectasia. intrafollicular abscess may be present(staphylococcal blepharitis). In longstanding cases the lid margin became scarredand hypertrophied, trichiasis, madarosis andoccasionally poliosis (whitening of the eyelashes) willoccur. scales: Two types of scales: i- Staphylococcal blepharitis: Are hard and brittleand are centered around the lashses (collarettes). Two types of scales: ii- Seborrhoeic blepharitis: Are soft and greasy andlocated anywhere on lid margin or on the lashes. Complications of anterior blepharitis:
a- External hordeolum (stye). b- Tear film instability c- Hypersensitivity to staphylococcal exotoxins papillary conjunctival reaction, punctuateepitheliopathy and marginal keratitis. Treatment: a- Lid hygiene:
b- Topical antibiotic ointment: fusidic acid orchloramphenicol. c- Weak topical steroids: d- Tear substitutes. Signs of posterior blepharitis
a- Tear film instability. b- Papillary conjunctivitis plus punctuateepitheliopathy. c- Internal hordeolum. Signs of posterior blepharitis Treatment: a- Systemic tetracyclines (as they affect Corynebacteriumacnes) for 6-12 weeks: c- Lid hygiene. d- Topical steroids. e- Tear substitutes. f- Warm compresses to melt solidified sebum andmechanical expression (to evacuate meibomian glands fromtheir contents).