THE EYELIDS

Husam Salhab

Objectives

• Anatomy of the eyelids• Function of the eyelids• Diseases of the eyelids

الرحمن الله بسمالرحيم

Modified sebaceous gland, oily secretions

Ciliary glands (glands of moll)

Modified sweat glands open b/n adjacent lashes

Function of the eyelids:• The eyelids provide physical

protection to the eye .• Prevent drying of the eyes.• Ensuring normal tear film and

drainage.• Secrete the oily part of the tear film.

Diseases of the eyelid

Abnormal positionInflammation

Lumps(masses)

Abnormalities of the lashes

ABNORMAL LID POSITION

PtosisEntropion

Ectropion

Ptosis: Abnormal low position of the upper eyelid

Causes:• 1-Mechanical factors• (a) large lid lesions.• (b) lid edema.• (c) tethering of the lid by

conjunctival scaring.• (d) structural abnormalities. (disinsertion of aponeurosis of the lavator

muscle)

Ptosis

2-neurological factors (a) 3rd nerve palsy (oculomotor) (b) horner’s syndrome (c) marcus-gunn jaw-winking syndrome 3-myogenic factors (a) myasthenia gravis (b) some forms of muscular dystrophy (c) chronic external opthalmoplegia (ocular myopathy).

• Symptoms: -cosmotic effect. - vision impairment. -symptoms associated with the underlying cause (diplopia, reduced eye movment).

• signs : -Reduction in size of interpalpebral opening. -Abnormal function of the levator muscle. -Increasing ptosis after repeated elevation and

depression of the lid . -others(miosis, lack of sweating..).

• Treatment : -Treat the underlying cause -surgical correction.

• Entropion: It is an inturning of the lid.

(usually the lower lid).

• Causes: -Weakness of the orbicularis muscle -Conjuctival scarring• Symptoms and signs : -Irritation of the eye -Redness• Treatment : -Lubricants or taping of the eyelid for short term treatment. -Surgery for permanent treatment

• Ectropion: an outwards turning of the lid from globe.

-Frequently associated with epiphora and chronic conjunctivitis.

Causes: -Orbicularis muscle laxity -Scarring of the periorbital skin -7th nerve palsy (facial)

• Treatment: surgical.

INFLAMMATION OF THE EYELIDS

• Blepharitis -Chronic eyelid inflammation. -sometimes associated with

staphylococcal infection. -It causes squamos debris, inflammation of the lid margin, skin and eyelash

follicles. - the meibomian gland may be affected.

Blepharitis

squamos debris, inflammation of the lid margin, skin and eyelash follicles

• Signs and symptoms : -Tired eyes (worse in the morning) -Crusting -Scaling -debris around the eyelash -Reduction in number of eyelash -Obstructon,plugging and cloudy

secretions of meibomian ducts.

• Treatment : -Lid toileting or diluted baby shampoo. (anterior blepharitis) -lid massage after a hot bath to

remove the abnormal meibomian gland secretions -topical or systemic antibiotic for

staph. Infection. -topical steroids. -artificial tears.

DISORDERS OF THE EYELID GLANDS

Chalazion : Common painless condition Meibomian gland obstruction cause chronic

granulomatous inflammation within the tarsal plate.

Symptoms: lid swelling,usually resolves within 6 months.

If not resolved :surgical incision Complications: - painful abscess within the meibomian gland -stye.(abscess in the eyelash follicle)

Chalazion

BENIGN LUMPS

• Ductal Cysts :1. Cyst of Moll: translucent cyst on the lid margin

caused by sweat gland obstruction

2. Cyst of Zeis: opaque cyst on the eyelid margin

caused by accessory sebacous gland blockage

Rx: excision for cosmetic reasons

• Squamous cell papilloma: frond-like lid lesion ( الشجر with fibrovascular (ورق

core and thickened squamous epithelium. Usually asymptomatic but can be excised for

cosmotic reasons with cautery to the base.

• Naevus: Lesions derived from naevus cells(altered

melanocytes) Can be pigmented or non pigmented. No treatment is necessary.

Xanthelasma: Bilateral soft yellow lipid containing plaques

Associated with hypercholesterolaemia

MALIGNANT TUMORS

• Basal cell carcinoma :90% of eyelid malignancies1. Nodular ,sclerosing or ulcerative(rodent ulcer) lesions2. Pale pearly margins3. Painless4. Slow growing5. Non metastatising6. Locally invasive

Rx : the earlier it is detected the easier to be removed

1. excision biopsy with a margin of healthy tissue.2. cryotherapy3. radiotherapy

Pale, Ulcerated, Nodule

• Squamous cell carcinoma:1. 2nd most common

2. More malignant

3. Metastatize to regional LNs

4. Rapidly growing

5. Hard nodules or scaly patches

Rx: complete surgical removal.

Hard nodules or scaly patches

ABNORMALITIES OF THE LASHES

• Trichiasis :• Condition in which eyelashes turn inward toward

the globe.• Corneal irritation and abrasion .• Presentation : irritation and tearing.

• Rx : pluck(قص) eyelash ; recurrence can be treated

with electrolysis.

THANK YOU

بحمد تمVتالله