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Lid and lacrimal disorders

Lid and lacrimal disorders. Disorders of Lashes. Trichiasis Distichiasis. Disorders of Lashes. Treatment options for trichiasis. Epilation Electrolysis Cryotherapy Argon laser Surgery. Disorders of lashes. Madarosis Lid margin inflammation Tumor Cryotherapy, radiotherapy or burns

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Lid and lacrimal disorders

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  1. Lid and lacrimal disorders

  2. Disorders of Lashes • Trichiasis • Distichiasis

  3. Disorders of Lashes

  4. Treatment options for trichiasis • Epilation • Electrolysis • Cryotherapy • Argon laser • Surgery

  5. Disorders of lashes • Madarosis • Lid margin inflammation • Tumor • Cryotherapy, radiotherapy or burns • Alopecia • Syphilis • Leprosy • SLE • Poliosis • VKH • Sympathetic ophthalmia

  6. Entropion

  7. Entropion • Entropion, or inversion of the lid margin, may be congenital or acquired • The acquired variety can be the result of: • Ageing changes (involutional) • Cicatricial changes affecting the posterior lamella of the eyelid (cicatricial) • Spastic

  8. Entropion

  9. Entropion

  10. Entropion • Treatment • Lubrication • Taping the lid • Epilation • Horizontal lid tightening • Tarsal fracture procedure

  11. Ectropion

  12. Ectropion • Ectropion, or eversion of the lid margin, may be congenital or acquired • The acquired forms are the result of • Ageing changes (involutional) • Lumps (mechanical) • Scarring of the anterior lamella of the lid (cicatricial) • Burn • Infection/ inflammation • Trauma • Weakness of the orbicularis muscle (paralytic)

  13. Ectropion

  14. Ectropion • Treatment • Lubrication • Horizontal lid shortening or tightening • Punctal inversion

  15. Ptosis MARGIN-REFLEX DISTANCE INTERPALPEBRAL DISTANCE LID CREASE POSTION

  16. Ptosis

  17. Ptosis

  18. Ptosis

  19. Ptosis • Pseudoptosis • Orbital volume deficiency • Exophthalmos • Excess lid skin • Hypotropia

  20. Ptosis • Acquired or Congenital • Neurogenic • 3rd nerve palsy • 3rd nerve misdirection • Horner syndrome • Marcus Gunn jaw-winking syndrome • Myogenic • Myasthenia gravis • Myotonic dystrophy • Ocular myopathies • Levator dystrophy • Aponeurotic (levator dehiscence) • Mechanical • Traumatic

  21. Ptosis • Treatment • Ptosis crutch • Taping of the lid • Surgical • Levator advancement • Muller’s muscle resection • Frontalis suspension

  22. Eyelids inflammation • Blepharitis • Anterior • Posterior • Staphylococcal • Seborrhoeic • Meibomianitis • Treatment • Lid hygiene • Tears • Antibiotics • Warm compresses

  23. Eyelids inflammation • Allergy • Acute allergic blepharoconjuctivitis • Allergic dermatoblepharitis

  24. Eyelids inflammation • Chalazion • Focal inflammation of the eye lids which result from obstruction of the meibomian glands • Chronic lipogranulomatous inflammatory changes • Treatment • Warm compresses • Local antibiotic • Excision

  25. Eyelids inflammation • Hordeolum • Acute infection involving the meibomian glands (internal) or the glands of Moll or Zeis (external) • Overtime may evolve into chalazion • Treatment • Warm compresses • Topical antibiotic

  26. Benign eyelid lesions • Cysts • Cyst of Moll • Cyst of Zeiss • Sebaceous cyst • Hidrocystoma

  27. Benign eyelid lesions • Tumors • Viral wart( papilloma) • Actinic keratosis • Seborrheic keratosis • Keratocanthoma • Nevi • Junctional • Compound • Dermal • Capillary hemangioma • Xanthelasma • Pyogenic granuloma

  28. Benign eyelid lesions

  29. Malignant eyelid tumors • Basal cell carcinoma • Squamous cell carcinoma • Meibomian gland carcinoma • Melanoma • Kaposi sarcoma • Merkel cell carcinoma

  30. Basal cell carcinoma • Most common malignancy(90%) of the eyelid • Usually located on the lower lid and medial canthus • Pearly nodules which ulcerate and have telangiectasias • Treatment • Surgical excision • Cryotherapy • Radiation therapy

  31. Basal cell carcinoma • Most common malignancy(90%) of the eyelid • Usually located on the lower lid and medial canthus • Pearly nodules which ulcerate and have telangiectasias • Treatment • Surgical excision • Cryotherapy • Radiation therapy • Orbital exenteration for deep invasive lesions

  32. Squamous cell carcinoma • Less common than BCC • May arise de-novo or from pre-existing actinic keratosis • May metastasize

  33. Orbital cellulitis • Preseptal cellulitis • Infection anterior to orbital septum • Orbital cellulitis • 90% secondary to sinusitis • Trauma • Insect bite • Endogenous bacteremia

  34. Orbital cellulitis • Organisms • Staphylococcus aureus • Streptococcus • Hemophilus influenza • Treatment • admission • Orbital CT • I.V antibiotics (3rd generation cephalosporin and clindamycin) • Drainage of orbital abscess

  35. Children Orbital cellulitis Pseudotumor Dermoid cyst Capillary hemangioma Lymphangioma Rhabdomyosarcoma metastasis Adults Thyroid orbitopathy Cavernous hemangioma Lymphangioma Pseudotumor Lymphoma Meningioma Lacrimal gland tumor Dermoid cyst metastasis Orbital disorders

  36. Thyroid orbitopathyGraves’ disease • Most common cause of exophthalmos in adult • Onset: 20-45 years • Clinical picture: • Unilateral or bilateral exophthalmos • Eyelid retraction • Lid lag • Diplopia • Periorbital edema • Chemosis • Optic neuropathy • 90% HYPER, 1% HYPO, 6%EUTHYROID

  37. Thyroid orbitopathy

  38. Thyroid orbitopathy • Complication: • Diplopia • Redness • Corneal exposure • Optic neuropathy • Treatment • Lubrication • Tape eyelids at night • Steroid • Radiation • Surgery • Decompression • Muscle surgery • Optic nerve fenestration

  39. Anatomy and physiology of the lacrimal system • Secretory apparatus • Lacrimal gland • Lacrimal ducts empty into superior cul-de-sac • Afferent pathway: V nerve • Efferent pathway: VII nerve (reflex tear) • Accessory lacrimal glands of Krause and Wolfring (basic tear) • Tear film • Inner layer: mucin • Middle layer: aqueous • Outer layer: meibomian

  40. Anatomy and physiology of the lacrimal system • Lacrimal excretory apparatus • Puncta • Canaliculi • Lacrimal sac • Nasolacrimal duct • Inferior meatus • VALVE OF HASNER

  41. Anatomy and physiology of the lacrimal system • Lacrimal evaluation • Dye disappearance test • Primary and secondary dye test • Lacrimal irrigation • Tear break up time • Schirmer test

  42. Lacrimal disorders • Congenital nasolacrimal duct obstruction • Membranous block at the valve of hasner • 2-4% of full term new baby • Usually resolve spontaneously within 4 to 6 weeks • Treatment • Topical antibiotics • Massage • Probing: 6 to 12 months

  43. Lacrimal disorders • Dacryocystocele • Combination of nasolacrimal duct obstruction and amniotic fluid or mucus trapped in the sac • Treatment • Antibiotics • Massage • probing

  44. Lacrimal disorders • Punctal stenosis • Dilation • Snip procedure • Canaliculitis • Irrigation with antibiotics • Oral antibiotics • Canalicular obstruction • Dacryoliths • Dacryocystitis Dacryocystorhinostomy

  45. Lacrimal sac tumors Squamous cell papilloma Transitional cell papilloma Squamous cell carcinoma Transitional cell carcinoma Adenocarcinoma Lacrimal gland tumors 70% of lacrimal gland masses are non-epithelial masses: Idiopathic inflammation Sarcoidosis, TB Lymphoid tumors 30% are epithelial Cyst Adenoid cystic carcinoma Pleomorphic adenoma(benign and malignant mixed tumor) Lacrimal disorders

  46. Thank you

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