Dr. Ayesha S Abdullah 10.09.2012

1. Review of clinical anatomy & physiology of the eyelids & common infective and inflammatory disorders of the eyelids Dr. Ayesha S Abdullah 10.09.2012

2. Learning objectives By the end of this lecture the students would be able to:- • Correlate the structure of the eyelids with their functions and clinical presentation in common infective and inflammatory disorders. • Define stye, chalazion, trichiasis & blepharitis. • Differentiate between stye & chalazion on the basis of clinical presentation and describe the treatment.

3. Important superficial anatomical landmarks Upper lid crease Palpebral fissure height (max) Lid margin Palpebral fissure length (max)

4. Structure of the lids The eyelid has five layers of different structures • Skin • Subcutaneous tissue • Muscular layer • Tarsal plate • Conjunctiva

5. Surgical anatomy Anterior Lamina • Skin • Orbicularis muscle Posterior Lamina • Tarsal plate • Conjunctiva

8. Anterior lamina Muscular layer Orbital part Palpebral Part Preseptal part Pretarsal part

9. Posterior lamina

10. Orbital Septum

13. Structures at the lid margin

16. HW msqheartline@hotmail.com • Nerve supply- sensory • Blood supply • Lymphatic drainage

17. Functions • Protect the anterior surface of the globe • Aid in regulation of light reaching the eye • Tear film maintenance; distribution & flow • Lipid/ oily layer of the tear film

18. Disorders of eyelids • Infective • Inflammatory • Neoplastic • Structural / disorders of malposition

19. Trichiasis • In-turned eyelashes

20. Complications

21. Treatment • Epilation- but recurrences within few weeks • Electrolysis - but frequently repeated treatments • Cryotherapy- for many lashes • Laser ablation- for few scattered lashes • Surgical correction- for resistant, localized crop • Ocular lubricants

22. Blepharitis • “ inflammation of the lid margin” • Anterior Blepharitis • Affects base of eyelashes • Associated with staphylococcal infection or Seborrhea • Complicated by recurrent stye ,scarring of the lid margin and loss of eyelashes • Posterior Blepharitis • Affects meibomian gland openings • Associated with meibomian gland dysfunction • Complicated by recurrent chalazia, tear film instability and scarring of the lid margin

23. Anterior Blepharitis Posterior Blepharitis

24. Management • Maintain lid hygiene • Apply warm compress • Gently massage posterior lid to express meibomian gland contents • Scrub lashes and lid margins with dilute baby shampoo • Wipe lid margins with warm cloth after scrubbing • Acute infectious flare-up (e.g. staphylococcal Blepharitis) • Antibiotic ophthalmic ointment • Meibomian gland dysfunction • Ocular lubricants ( artificial tears/ tear substitutes) • Tetracycline / Doxycyclineorally • Steriods for limited period

25. Stye “ Acute staphylococcal infection (abscess) of a lash follicle” • Common in children • Tender hot swelling at the lid margin • May spread to the entire lid causing prespetal or at time orbital cellulitis

28. Treatment • Hot compresses • Self-limiting; epilation of the infected lash hastens resolution • If spread of infection is likely with gross redness and swelling of the lid than topical and systemic antibiotics can be given along with analgesics/ NSAIDs

29. Chalazion “Chronic granulomatousinflammation of the Meibomian glands secondary to blockage of the gland orifice”. • Common in patients with posterior blepharitis • Non-tender swelling a little away from the lid margin

31. Treatment • Small – no treatment • Incision and curretage of the affected gland.

32. Summary • Important anatomical landmarks • Trichiasis • Blepharitis • Stye • Chalazion