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Presentation on theme: "Disorders"— Presentation transcript:
Disorders of the eyelids
Švehlíková G.Department of Ophthalmology LF UPJS v KošiciachPrednosta: prof. MUDr. Juhás T., DrSc.
Examination –inspection of tarsal conj., fornix, the bulbar conj.
The eyelid malposition
The 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 tendom
Medial portion of the lower eyelid with lover punctum is evertedEpiphoraDermatitis – iritation by frequent rubbing
Facial nerve palsyAtony of the orbicularis muscleLagophthalmus Complications . secondary conjunctivitis, exposure keratopathy
Fibroma in the lover eyelid
Scarring or contraction of the skin
The eyelid is shortened by an excision of full-thickness wedge
- inward turning of the eyelid and contact of eyelashes with cornea and conjunctiva
correction of involutional entropion
1. 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.
ptosis - age – weakness of the aponeurosis of the levator muscle
ptosis – myastenia gravis – pac. activates the frontalis m., and backward position of the head
Eyelid allergic disorders
Sensitivity to topical medicationSevere itchingErytemaEdema of the eyelid skinChanges are restricted to the area of contact between skin and the noxious agentTh- steroid
uncommonbilat. upper and lower eyelids herpes simplex v. infectionsmall vesicles, rupture, crustsoccasionaly associated with conjunctivitisth – acyclovir cream
Skin lesions follows the first division of the trigeminal nerveAn involvement of the nasociliary nerve indicates ocular involvementTh – systemic and topical
The lid margin glands
Meibomian glands – modified sebaceous g., located in the tarsal plate – lipid layerGlands 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 margin
Acute inflamation of the gland of Zeis or Mollswelling, erytema, pain
chronic granulomatous inflamation of Meibomian glandpainless, roundish lesion in the tarsal platetreatment - incision
basal cell carcinoma
Squamous cell carcinoma
layers - epitelium, stromathe mucin secretors ( Goblet cells, crypts of Henle, glands of Manz)accessory lacrimal gl. of Krause and Wolfring
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 ointment
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 weeks
population with poor conditions of hygienechronic conj. inflam., keratitis, progressive conj. scarring.
scarring of upper tarsal conj.
Th – azitromycin + hygiene
– acute itchy watery eyes, sneezing, watery nasal dischargeoedema of the eyelidsmilky appearance of conj.Th – either a topical mast cells stabilizer (nedocromil ) or a topical antihistamine ( azelastin )
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 atopy
raretypically affects young patients with atopic dermatitischaracteristic skin changes + astma, urticaria, migraine, rhinitisocular symptoms similar to VKC
tear film – layers : a.- lipid – to retard evaporationb.- 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 surface
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
time test – assesse precorneal tear film stability
degenerative lesionconjunctiva grown over the limbus unknown etiologyTh- surgical
benign, usualy unilateralsigns of potential malignancy - -sudden increase in pigmentation or growth
raresolitary black or grey nodule which is fixed to episclera