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Disorders of the eyelids

Disorders of the eyelids. Švehlíková G. Department of Ophthalmology LF UPJS v Košiciach Prednosta: prof. MUDr. Juhás T., DrSc. Examination – inspection of tarsal conj ., fornix , the bulbar conj . The eyelid malposition. Ectropion Entropion Ptosis. Ectropion.

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Disorders of the eyelids

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  1. Disordersoftheeyelids Švehlíková G. Department ofOphthalmology LF UPJS v Košiciach Prednosta: prof. MUDr. Juhás T., DrSc.

  2. Examination –inspectionoftarsalconj., fornix, thebulbarconj.

  3. Theeyelidmalposition Ectropion Entropion Ptosis

  4. Ectropion Theeyelidisevertedawayfromtheglobe - Involutional – predisposingfactors – laxityofthepalpebral skin, laxityofeyelid, weaknesofthefascia and elongationofthemedialandlateralcantaltendom

  5. Involutionalectropion • Medialportionofthelowereyelidwithloverpunctumiseverted • Epiphora • Dermatitis– iritation by frequentrubbing

  6. Paralyticectropion • Facial nerve palsy • Atonyoftheorbicularismuscle • Lagophthalmus • Complications . secondaryconjunctivitis, exposurekeratopathy

  7. Mechanicalectropion • Fibroma in thelovereyelid

  8. Cicatricalectropion • Scarring or contractionofthe skin

  9. Surgicaltechnique • Theeyelidisshortened by anexcisionoffull-thicknesswedge

  10. Entropion - inwardturningoftheeyelidand contactofeyelasheswithcorneaandconjunctiva

  11. Surgicalcorrectionofinvolutionalentropion

  12. Ptosis • 1. neurogenic p. - acquired or cong. innervationdefect ( third n. palsy, Hornersy.) • 2. myogenic p. ( myasteniagravis, myotonicdystrophy ) • 3. aponeurotic p. ( involutional ) • 4. mechanical p.

  13. Aponeuroticptosis - age – weaknessoftheaponeurosisofthelevatormuscle

  14. Myogenicptosis– myasteniagravis – pac. activatesthefrontalis m., and backwardpositionofthehead

  15. Eyelidallergicdisorders

  16. Contactdermatitis • Sensitivity to topicalmedication • Severe itching • Erytema • Edemaoftheeyelid skin • Changes are restricted to theareaofcontactbetween skin and thenoxious agent • Th- steroid

  17. Acuteallergicoedema • Insectbites, angiooedema, urticaria • Bilateral, painlessoedema • Th - systemicantihistamines

  18. Infections

  19. HS blepharitis • uncommon • bilat. upper and lowereyelids herpes simplex v. infection • smallvesicles, rupture, crusts • occasionalyassociatedwithconjunctivitis • th – acyclovircream

  20. Herpes zoster • Skin lesionsfollowsthefirstdivisionofthetrigeminal nerve • Aninvolvementofthenasociliary nerve indicatesocularinvolvement • Th – systemic and topical

  21. Thelidmarginglands • Meibomianglands– modifiedsebaceous g., located in thetarsal plate – lipidlayer • GlandsofZeis– modif. sebaceous g., associatedwiththelashfollicles • GlandsofMoll– modif. sweat g., ductsopeneitherintolashfollicle or ontotheant. Lidmargin

  22. Hordeolum • AcuteinflamationoftheglandofZeis or Moll • swelling, erytema, pain

  23. Chalasion • chronicgranulomatousinflamationofMeibomiangland • painless, roundishlesion in thetarsal plate • treatment - incision

  24. Eyelidtumors

  25. Binigntumors CystofZeis Xantelasmas

  26. Papilloma Hemangioma

  27. Nevus Surgicalapproachforresection

  28. Malignanttumors Nodularbasalcellcarcinoma Squamouscellcarcinoma

  29. Malignantmelanoma

  30. conjunctiva

  31. anatomy • layers - epitelium, stroma • themucinsecretors ( Gobletcells, cryptsofHenle, glandsofManz) • accessorylacrimalgl. ofKrause and Wolfring

  32. Inflammation

  33. Conjunctivitis • Symptoms – lacrimation, irritation, burning, photophobia • Discharge- • watery-acuteviral, acuteallergicinf. • mucoid – vernalconj., keratoconj. Sicca • purulent – acutebact. inf. • mucopurulent – mildbact., chlamydialinf.

  34. Conjunctivalappearance Follicularreaction Hyperplasiaoflymphoidtissuewithinthestroma • Viralinf. • Chlamydialinf. • Hypersensitivity to topicalmedication

  35. Papillaryreaction Hyperplasticconj. epitelium • Chronicblepharitis • Allergicconjunctivitis • Bacterialinf. • Contactlens-relatedproblems

  36. Oedema - chemosis Membranes – beta-haemolytic str., diphtheria Pseudomembranes – severe adenoviralinf., gonococcalinf.

  37. Bacterialconjunctivitis • Staph. epidermidis, Staph. aureus, Strep. pneumoniae, H. influenzae, Moraxella • presentation – acuteredness, burning, discharge – mucopurulent, on waking – theeyelids are stucktogether • hyperemia – max. in thefornices • Th- ATB drops and ointment

  38. Adenoviralkeratoconjunctivitis • Pharyngoconjunctivalfever – children – respiratorytractinf. • Epidemickeratoconj. – no system. sympt. • acutewatering, redness, photophobia • follicularreaction, hyperemia, oedema • discharge – watery • lymphnodeswelling • risk ofcornealinvolment • Th- symptomatic, resolutionspontaneouswithin 2 weeks

  39. Trachoma ChlamydiaTrachomatis scarringofuppertarsalconj. • populationwith poor conditionsof hygiene • chronicconj. inflam., keratitis, progressiveconj. scarring.

  40. Th – azitromycin + hygiene end-stagetrachoma • entropion, trichiasis, blindness

  41. Allergicconjunctivitis

  42. Allergicrhinoconjunctivitis • hypersensitivityreaction to specificairborneantigens • frequentlyassociated nasal symptoms • seasonal – allergens are pollens • perennial – allergens – house-dustmites, animaldander – symptomsthroughouttheyear

  43. presentation – acuteitchywateryeyes, sneezing, watery nasal discharge • oedemaoftheeyelids • milkyappearanceofconj. • Th – either a topicalmastcellsstabilizer (nedocromil ) or a topicalantihistamine ( azelastin )

  44. Vernalkeratoconjunctivitis • uncommon, recurent, bilateralinflamationaffectingchildren and youngadults, more common in males, resolvesaround puberty, rarelypersistbeyondtheageof 25y. • cell-mediatedimmunemechanismsplayimportant role • ¾ patientshaveassociatedatopy

  45. Vernalkeratoconjunctivitis • symptoms – ocularitching, lacrimation, photophobia, foreign body sensation, burning, mucusdischarge • clinicaltypes: • palpebral • limbal • mixed

  46. Palpebral VKC Hyperemia, diffusepapillaryhypertrophy Limbal VKC Mucoidnodules, composedpredominantlyofeosinophils

  47. Th- mastcellstabilizers , topicalsteroids. Punctateepitelopathy Macroerosion

  48. Atopickeratoconjunctivitis • rare • typicallyaffectsyoungpatientswithatopicdermatitis • characteristic skin changes + astma, urticaria, migraine, rhinitis • ocularsymptomssimilar to VKC

  49. Keratoconjunctivitissicca • tear film – layers : a.- lipid– to retardevaporation b.- aqueous– to supplyatmosphericoxygen to theavascularcornealepith., antibacterila f., washawaydebrits c.- mucin – to convertthecornealepith. from a hydrophobic to a hydrophilicsurface

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