Disorders

Disorders - Description

. of. . the. . eyelids. . Švehlíková. G.. Department . of. . Ophthalmology. LF UPJS v Košiciach. Prednosta: prof. MUDr. Juhás T., DrSc.. Examination. –. inspection. . of. . tarsal. ID: 278916 Download Presentation

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Disorders

. of. . the. . eyelids. . Švehlíková. G.. Department . of. . Ophthalmology. LF UPJS v Košiciach. Prednosta: prof. MUDr. Juhás T., DrSc.. Examination. –. inspection. . of. . tarsal.

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Disorders




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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

Ectropion

Entropion

Ptosis

Slide4

Ectropion

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

Slide5

Involutional ectropion

Medial portion of the lower eyelid with lover punctum is evertedEpiphoraDermatitis – iritation by frequent rubbing

Slide6

Paralytic ectropion

Facial nerve palsyAtony of the orbicularis muscleLagophthalmus Complications . secondary conjunctivitis, exposure keratopathy

Slide7

Mechanical ectropion

Fibroma in the lover eyelid

Slide8

Cicatrical ectropion

Scarring or contraction of the skin

Slide9

Surgical technique

The eyelid is shortened by an excision of full-thickness wedge

Slide10

Entropion

- inward turning of the eyelid and contact of eyelashes with cornea and conjunctiva

Slide11

Surgical

correction of involutional entropion

Slide12

Ptosis

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.

Slide13

Aponeurotic

ptosis - age – weakness of the aponeurosis of the levator muscle

Slide14

Myogenic

ptosis – myastenia gravis – pac. activates the frontalis m., and backward position of the head

Slide15

Eyelid allergic disorders

Slide16

Contact dermatitis

Sensitivity to topical medicationSevere itchingErytemaEdema of the eyelid skinChanges are restricted to the area of contact between skin and the noxious agentTh- steroid

Slide17

Acute allergic oedema

Insect bites, angiooedema, urticariaBilateral, painless oedemaTh - systemic antihistamines

Slide18

Infections

Slide19

HS blepharitis

uncommonbilat. upper and lower eyelids herpes simplex v. infectionsmall vesicles, rupture, crustsoccasionaly associated with conjunctivitisth – acyclovir cream

Slide20

Herpes zoster

Skin lesions follows the first division of the trigeminal nerveAn involvement of the nasociliary nerve indicates ocular involvementTh – systemic and topical

Slide21

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

Slide22

Hordeolum

Acute inflamation of the gland of Zeis or Mollswelling, erytema, pain

Slide23

Chalasion

chronic granulomatous inflamation of Meibomian glandpainless, roundish lesion in the tarsal platetreatment - incision

Slide24

Slide25

Eyelid tumors

Slide26

Binign tumors

Cyst

of Zeis

Xantelasmas

Slide27

Papilloma

Hemangioma

Slide28

Nevus

Surgical

approach

for

resection

Slide29

Malignant tumors

Nodular

basal cell carcinoma

Squamous cell carcinoma

Slide30

Malignant

melanoma

Slide31

conjunctiva

Slide32

anatomy

layers - epitelium, stromathe mucin secretors ( Goblet cells, crypts of Henle, glands of Manz)accessory lacrimal gl. of Krause and Wolfring

Slide33

Inflammation

Slide34

Conjunctivitis

Symptoms – 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

stroma

Slide36

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 ointment

Slide39

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 weeks

Slide40

Trachoma

population with poor conditions of hygienechronic conj. inflam., keratitis, progressive conj. scarring.

Chlamydia Trachomatis

scarring of upper tarsal conj.

Slide41

entropion

,

trichiasis, blindness

Th – azitromycin + hygiene

end-stage

trachoma

Slide42

Allergic conjunctivitis

Slide43

Allergic rhinoconjunctivitis

hypersensitivity

reaction

to

specific

airborne

antigens

frequently

associated

nasal

symptoms

seasonal

allergens

are

pollens

perennial

allergens

house-dust

mites

,

animal

dander

symptoms

throughout

the

year

Slide44

presentation

– 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 )

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 atopy

Slide46

Vernal keratoconjunctivitis

symptoms – ocular itching, lacrimation, photophobia, foreign body sensation, burning, mucus dischargeclinical types:palpebral limbalmixed

Slide47

Palpebral

VKC

Hyperemia

, diffuse papillary hypertrophy

Limbal

VKC

Mucoid

nodules

,

composed

predominantly

of

eosinophils

Slide48

Th- mast cell stabilizers , topical steroids.

Punctate

epitelopathy

Macroerosion

Slide49

Atopic keratoconjunctivitis

raretypically affects young patients with atopic dermatitischaracteristic skin changes + astma, urticaria, migraine, rhinitisocular symptoms similar to VKC

Slide50

Keratoconjunctivitis sicca

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

Slide51

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

features

Slide52

Special tests

Break-up

time test – assesse precorneal tear film stability

Schirmer

test –

mesuring

the

amount

of

secretion

Slide53

Pterygium

degenerative lesionconjunctiva grown over the limbus unknown etiologyTh- surgical

Slide54

Conjunctival naevus

benign, usualy unilateralsigns of potential malignancy - -sudden increase in pigmentation or growth

Slide55

Conjunctival melanoma

raresolitary black or grey nodule which is fixed to episclera

Slide56

Conjunctival papiloma

Slide57

Squamous

cell carcinoma

Conjunctival

Kaposi

sarcoma

Slide58

Questions and discussion

Slide59

Thank you for your attention !

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