Disorders - PowerPoint Presentation

Slide1

Disorders of the eyelids

Švehlíková G.Department of Ophthalmology LF UPJS v KošiciachPrednosta: prof. MUDr. Juhás T., DrSc.Slide2

Examination –inspection of tarsal

conj., fornix, the bulbar conj.Slide3

The eyelid malposition

EctropionEntropionPtosisSlide4

EctropionThe eyelid

is everted away from

the

globe

-

Involutional

–

predisposing

factors – laxity of the palpebral skin, laxity of eyelid, weaknes of the fascia and elongation of the medial and lateral cantal tendomSlide5

Involutional ectropionMedial

portion of the lower eyelid with lover

punctum

is

everted

Epiphora

Dermatitis

– iritation by frequent rubbingSlide6

Paralytic ectropionFacial nerve

palsyAtony of the orbicularis muscle

Lagophthalmus

Complications

.

secondary

conjunctivitis

, exposure keratopathy Slide7

Mechanical ectropionFibroma in

the lover eyelidSlide8

Cicatrical ectropionScarring or

contraction of the skinSlide9

Surgical techniqueThe

eyelid is shortened by an excision of full-thickness

wedgeSlide10

Entropion- inward

turning of the

eyelid

and

contact

of

eyelashes with cornea and conjunctivaSlide11

Surgical correction of

involutional entropionSlide12

Ptosis1. neurogenic p.

- acquired or cong. innervation defect ( third n. palsy,

Horner

sy.)

2.

myogenic

p.

(

myastenia gravis, myotonic dystrophy )3. aponeurotic p. ( involutional )4. mechanical p.Slide13

Aponeurotic ptosis - age –

weakness of the aponeurosis of the

levator

muscleSlide14

Myogenic ptosis – myastenia

gravis – pac. activates the frontalis m., and backward position

of

the

headSlide15

Eyelid allergic disordersSlide16

Contact dermatitisSensitivity to

topical medicationSevere itchingErytemaEdema of

the

eyelid skin

Changes

are

restricted

to

the area of contact between skin and the noxious agentTh- steroidSlide17

Acute allergic oedema

Insect bites, angiooedema, urticariaBilateral, painless oedema

Th

-

systemic

antihistaminesSlide18

InfectionsSlide19

HS blepharitisuncommonbilat

. upper and lower eyelids herpes simplex v. infectionsmall

vesicles

,

rupture,

crusts

occasionaly

associated

with conjunctivitisth – acyclovir creamSlide20

Herpes zosterSkin lesions follows

the first division of the trigeminal nerve

An

involvement

of

the

nasociliary nerve indicates ocular involvementTh – systemic and topicalSlide21

The lid margin glands

Meibomian glands – modified sebaceous g., located

in

the

tarsal

plate –

lipid

layer

Glands of Zeis – modif. sebaceous g., associated with the lash folliclesGlands of Moll – modif. sweat g., ducts open either into lash follicle or

onto

the

ant

.

Lid

marginSlide22

Hordeolum

Acute

inflamation

of

the gland of Zeis or Mollswelling, erytema, painSlide23

Chalasionchronic granulomatous

inflamation of Meibomian glandpainless, roundish

lesion

in

the

tarsal

plate

treatment

-

incisionSlide24
Slide25

Eyelid tumorsSlide26

Binign tumors

Cyst of Zeis

XantelasmasSlide27

Papilloma

HemangiomaSlide28

Nevus

Surgical

approach

for

resectionSlide29

Malignant tumors

Nodular basal cell carcinoma

Squamous

cell

carcinomaSlide30

Malignant

melanomaSlide31

conjunctivaSlide32

anatomylayers - epitelium,

stromathe mucin secretors ( Goblet cells, crypts

of

Henle,

glands

of

Manz)accessory lacrimal gl. of Krause and WolfringSlide33

InflammationSlide34

ConjunctivitisSymptoms

– lacrimation, irritation, burning, photophobiaDischarge-

watery

-

acute

viral

,

acute allergic inf.mucoid – vernal conj., keratoconj. Siccapurulent – acute bact. inf.mucopurulent – mild bact., chlamydial inf.Slide35

Conjunctival appearance

Viral inf.Chlamydial inf.

Hypersensitivity

to

topical

medication

Follicular

reaction

Hyperplasia of lymphoid tissue within the stromaSlide36

Chronic

blepharitisAllergic conjunctivitisBacterial inf.Contact

lens-related

problems

Papillary

reaction

Hyperplastic

conj. epitelium Slide37

Oedema

- chemosis

Membranes

–

beta-haemolytic str.,

diphtheria

Pseudomembranes

–

severe

adenoviral inf., gonococcal inf.Slide38

Bacterial conjunctivitis

Staph. epidermidis, Staph. aureus, Strep. pneumoniae, H. influenzae, Moraxella

presentation

–

acute

redness

,

burning, discharge – mucopurulent, on waking – the eyelids are stuck togetherhyperemia – max. in the fornicesTh- ATB drops and ointmentSlide39

Adenoviral keratoconjunctivitis

Pharyngoconjunctival fever – children – respiratory tract inf.

Epidemic

keratoconj

. – no

system

.

sympt

. acute watering, redness, photophobiafollicular reaction, hyperemia, oedemadischarge – waterylymph node swellingrisk of corneal involmentTh- symptomatic, resolution spontaneous within 2

weeksSlide40

Trachomapopulation with

poor conditions of hygienechronic conj. inflam., keratitis

,

progressive

conj

.

scarring

.

Chlamydia

Trachomatisscarring of upper tarsal conj.Slide41

entropion

, trichiasis, blindnessTh – azitromycin + hygiene

end-stage

trachomaSlide42

Allergic conjunctivitisSlide43

Allergic rhinoconjunctivitishypersensitivity

reaction to specific airborne antigensfrequently associated

nasal

symptoms

seasonal –

allergens

are

pollens

perennial

– allergens – house-dust mites, animal dander – symptoms throughout the yearSlide44

presentation – acute itchy

watery eyes, sneezing, watery nasal dischargeoedema

of

the

eyelids

milky

appearance

of conj.Th – either a topical mast cells stabilizer (nedocromil ) or a topical antihistamine ( azelastin )Slide45

Vernal keratoconjunctivitis

uncommon, recurent, bilateral inflamation affecting children and

young

adults, more

common

in

males

,

resolves around puberty, rarely persist beyond the age of 25y.cell-mediated immune mechanisms play important role¾ patients have associated atopySlide46

Vernal keratoconjunctivitissymptoms –

ocular itching, lacrimation, photophobia, foreign body sensation, burning

,

mucus

discharge

clinical

types

:

palpebral limbalmixedSlide47

Palpebral

VKC

Hyperemia

,

diffuse

papillary

hypertrophy

Limbal

VKCMucoid nodules, composed predominantly of eosinophilsSlide48

Th- mast cell stabilizers ,

topical steroids.

Punctate

epitelopathy

Macroerosion

Slide49

Atopic keratoconjunctivitisrare

typically affects young patients with atopic

dermatitis

characteristic

skin

changes

+ astma,

urticaria

,

migraine, rhinitisocular symptoms similar to VKC Slide50

Keratoconjunctivitis sicca

tear film – layers : a.- lipid – to retard

evaporation

b.-

aqueous

– to

supply

atmospheric oxygen to the avascular corneal epith., antibacterila f., wash away debrits c.- mucin – to convert the corneal epith. from a hydrophobic to a hydrophilic surfaceSlide51

atrophy and fibrosis of lacrimal

tissue – Sjogren sy – prim. or sec. ( associated

with

rheumatoid

arthritis

, SLE,

syst

.

sclerosis, psoriatic arthritis, juvenile chron. arthritis, polymyositis)destruction of lacrimal tissue ( tumors, chron. inflamm.)Meibomian gland dysfunctionblockage of the excretory ductules

as

a

result

of

severe

conj

.

scaring

Irritaion

, a

foreign

body

sensation

,

burning

,

transient

blurring

vision

,

tired

or

heavy

feeling

to

the

eyelids

Causes

of

a

dry

eye

Clinical

featuresSlide52

Special tests

Break-up

time

test –

assesse

precorneal

tear

film stability

Schirmer test – mesuring the amount of secretionSlide53

Pterygiumdegenerative

lesionconjunctiva grown over the limbus unknown

etiology

Th

- surgicalSlide54

Conjunctival naevus

benign, usualy unilateralsigns of potential malignancy

- -

sudden

increase

in

pigmentation

or

growthSlide55

Conjunctival melanoma

raresolitary black or grey nodule which is

fixed

to episcleraSlide56

Conjunctival papilomaSlide57

Squamous

cell carcinoma

Conjunctival

Kaposi

sarcomaSlide58

Questions and discussionSlide59

Thank you for your attention !