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Transcript of The Eyelids
Mohammad Gharaybeh Objectives Anatomy of the eyelids Physiology and functions Lid Lumps ABNORMALITIES OF LID POSITION Inflammation of the lids The End 1- Anatomy of the eyelids
2- Physiology and functions
3- Disorders of the eyelids: 4 Layers: 1- Skin and subcutaneous tissue.
2- Muscular layer: the orbicularis oculi muscle (responsible for the closing of the lids).
3- Tarsal plate: a tough collagenous layer that houses meibomian gland.
4- Tarsal (palpebral) conjunctiva. The Orbital Septum The anatomic boundary between the lid tissue and the orbital tissue
It forms the fibrous portion of the eyelids
Orbital VS Periorbital cellulitis Blood Supply: Each lid is supplied majorly by an arch; which is formed by an anastomosis between the medial and the lateral palpebral arteries; branching off from the ophthalmic artery and lacrimal artery, respectively. Innervation: majorly by ophthalmic and maxillary branches of trigeminal nerve. 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. lids inflammation
lids position abnormalities Blepharitis It is a chronic inflammation of the eyelid margin
Sometimes associated with chronic staphylococcal infection
And it maybe associated with seborrhoeic dermatitis, atopic eczema and rosacea. Symptoms Signs tired, itchy, sore eye. worse in the morning.
Crusting of the lid margin two types Anterior Blepharitis Posterior Blepharitis When the inflammation is located in the outside surface of the lid margin, specifically in eyelash follicles signs: Redness and scaling of the lid margin.
Debris in the form of a collarette around the eyelashes.
Reduction in the number of eyelashes.
In severe cases: cornea is affected (blepharokeratitis).
In staph infection: some lash bases may ulcerate due to immune complex response to staph exotoxins. When the inflammation affects the meibomian glands. Called: meibomianitis, or meibomian gland dysfunction signs: 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. Treatment of Anterior Blepharitis Cleaning with a cotton bud wetted with bicarbonate or diluted baby shampoo to remove squamous debris from lash line .
In staph infections: Topical fusidic acid ± systemic antibiotic. Treatment of Posterior Blepharitis Hot compressors and lid massage.
Artificial tears to prevent dryness. Chalazion common painless condition in which an obstructed meibomian gland causes a granuloma within the tarsal plate it is painless Symptoms: Unsightly lid swelling
Heaviness of the eyelid
Increased tearing Treatment: Most cases are self limiting.
Usually managed by removing the associated eyelash and application of hot compresses.
Systemic antibiotics occasionally used.
If the lesion persists (>6 months) it can be incised and curetted from the conjunctiva. Hordeolum Internal Hordeolum External Hordeolum [Stye] Abcess in an obstructed meibomian gland Abcess in an eyelash follicle Painfull Painfull May respond to topical antibiotics but incision by be necessary Most cases are self limiting Treatment requires the removal of the associated eyelash and application of hot compresses Molluscum Contagiosum A viral infection of the skin or the mucous membranes, caused by pox virus.
Can be presented as umbilicated lesion on the lid margin.
It causes irritation and redness of the eye.
May be associated with follicular or papillary conjunctivitis.
Managed by excision of the lesion. Xanthelasma Lipid-containing bilateral lesions.
Usually associated with hyperlipidemia.
Excised for cosmetic reasons. Ptosis abnormally low position of the upper eyelid Pathogenesis Mechanical factors:
Large lid lesions pulling down the lid.
Tethering of the lid by conjunctival scarring.
Structural abnormalities including a disinsertion of the levator muscle aponeurosis, usually in elderly patients. Neurological factors:
Third nerve palsy.
Horner’s syndrome, due to a sympathetic nerve lesion
Marcus–Gunn jaw-winking syndrome. Myogenic factors:
Some forms of muscular dystrophy.
Chronic external ophthalmoplegia. Symptoms Cosmetic effect.
Symptoms and signs associated with the underlying cause [e.g. asymmetric pupils in Horner’s syndrome, diplopia and reduced eye movements in a third nerve palsy...]. Signs Reduction in the size of the interpalpebral aperture.
The upper lid margin [which usually overlaps the upper limbus by 1–2imm] 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 15–18imm]. 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. Management It is important to exclude an underlying cause whose treatment could resolve the problem [e.g. MG].
Ptosis otherwise requires surgical correction.
In very young children this is usually deferred but may be expedited if pupil cover threatens to induce amblyopia. Marcus Gunn Jaw-Winking syndrome Also called Trigemino-oculomotor Synkineses.
Congenital ptosis (Autosomal dominant)
Miswiring of the nerve supply to the pterygoid muscle of the jaw and the levator palpebral muscle; so that the eyelid moves in conjugation with movements of the jaw.
Treatment is usually unnecessary but in severe cases, it is corrected surgically. Dermatochalasis Formation of excessive and lax eyelid skin and muscles.
Factors: gravity, loss of elastic tissue in the skin, and weakening of the connective tissues of the eyelid.
Presents more commonly in the upper eyelids.
Patients complain usually from visual difficulties and cosmetic problems Causes normal aging phenomenon.
Severe periorbital edema.
Trauma can be associated with dermatochalasis.
Thyroid eye diseases.
Chronic renal insufficiency.
Genetics may play a role. Treatment Blepharoplasty is the procedure of choice Entropion and Ectropin Entropion 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 the orbcularis muscle becomes spasmed.
It may also be caused by conjuctival scarring distorting the lid (cicatrical entropion).
Treatment Short term:
application of lubricants.
taping of the eyelid.
surgery. Ectropion Eversion of the lid away from the globe.
Age related orbicularis muscle laxity.
Facial nerve palsy.
Scarring of periorbital skin.
Initial complaint is 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
Treated surgically Mohammad Gharaybeh