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HALIMAH PAGARRA
DEPARTMENT OF OPHTHALOMOLGY
FACULTY OF MEDICINE
HASANUDDIN UNIVERSITY
2009
EYELID AND ADNEXAL DISEASE
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EYELIDDISORDERS
CONGENITAL
ACQUIRED
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Congenital anomalies
Blepharophimosis Syndrome
Euryblepharon
Ankyloblepharon Epicanthus
Coloboma
Ectropion Entropion
Distichiasis
Ptosis
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Acquired Eyelid Disorders
- Chalasion
- Hordeoulum- Eyelid Edema
Periocular malposition
-Entropion
-Ectropion
-Ptosis
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CLASSIFICATION OF EYELID
DISORDERS
A. CONGENITAL ANOMALIES
- Associated with other eyelid, facial, or
systemic anomalies.- Occur during the 2nd month of gestation
failure of fusion or an arrest of
development
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ANATOMY of the EYELIDS
7 Structural layers:1. Skin & subcutaneous tissue
2. Muscle of protraction (Orbicularis Oculi)
3. Orbital septum
4. Orbital fat
5. Muscle of retraction (levator)
6. Tarsus
7. Conjunctiva
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CONGENITAL..
2. Congenital Ptosis of the Upper Eyelid
- Ptosis drooping or inferodisplacement of
the upper eyelid.
- Caused by maldevelopment of the levator
muscle is characterized- by decreased levator function, eyelid lag,
and sometimes lagophthalmos.
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CONGENITAL .
3. Congenital Ectropion
- Caused by a vertical insufficiency of
the anterior lamella of the eyelid.
- Characterized by eversion of the
eyelid margin, if severe may give rise tochronic epiphora and exposure keratitis.
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CONGENITAL..
4. Euryblepharon
- Enlargement of the lateral part of the palpebra
aperture with downward displacement of the
temporal half of the lower eyelid.- Very wide palpebral fissure or a droopy lower
eyelid.
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CONGENITAL.
5. Ankyloblepharon- Partial or complete fusion of the eyelids by
webs of skin.
- A variant is ankyloblepharon filiforme
adnatum, in which the eyelid margins are
connected by fine strands.
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CONGENITAL..
6. Epichantus
- is a medial canthal fold that may result fromimmature midfacial bones or a fold of skin and
subcutaneous tissue.
- 4 types of epicanthus :
epicanthus tarsalis if the fold is most
prominent in the upper eyelid
epicanthus inversus if the fold is most
prominent in the lower eyelid
epicanthus palpebralis if the fold is equally
distributed in the upper and
lower eyelids
epicanthus supraciliaris if the fold arises
from the eyebrow region running
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CONGENITAL..
7. Epiblepharon
- the lower eyelid pretarsal muscle and skin ride
above the lower eyelid margin to form a horizontal
fold of tissue that causes the cilia to assume a
vertical position.
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CONGENITAL..
9. Congenital Distichiasis
- A partial or complete accessory row ofeyelashes growing
out of or slightly posterior to the meibomian
gland orifices.
- Occurs when embryonic pilosebaceous units
improperly
differentiate into hair follicles.
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CONGENITAL..
10. Congenital Coloboma
- An embryologic cleft that is usually an isolatedanomaly
when it occurs in the medial upper eyelid.
- The eye of an infant with a congenitalcoloboma should be
observed for exposure keratopathy,which
uncommon.
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CONGENITAL.
11. Congenital Eyelid Lesions
a. Capillary hemangioma- Usually appear over the first weeks or
months of life
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b. Cryptophthalmos
- is a rare condition that presents with partial
orcomplete absence of the eyebrow,
palpebra fissure,
eyeleshes and conjunctiva. May be
unilateral or
bilateral.
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1. Chalazion- a type of focal inflammation of the eyelids,
can result
from an obstruction of the meibomian
glands.
- usually first appears as a firm, tender,
erythematous
lump in the tarsal plate.- painless
B. ACQUIRED EYELID DISORDERS
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Chalazion
R/
- Management is generally hot
compresses and good eyelid hygiene.- If do not resolve can be managed by
incision and
curretage.
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. Hordeolum
- An acute infection (usually
staphylococcal) can involve thesebaceous secretions in the glands of
zeis,molle and wall palpebra(external
hordeolum or stye) or the meibomian glands
(internal ordeolum).External Hordeoum Internal Hordeolum
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2. Hordeolum
- Spontaneous resolutions often occurs.
- Hot compresses and topical
antibiotic ointment is usually curative.
- May progress to true superficial
cellulitis, or even abscesses of the
eyelid.
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3. Eyelid Edema
- Caused by local conditions such as
cardiovascular disease,renal disease, certain collagen vascular
diseases, or graves
disease.- Cerebrospinal fluid leakage in to the orbit or
eyelids
following trauma may mimic eyelid edema.
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4. Floppy Eyelid Syndrom
- Characterized by chronic papillary
conjunctivities,easily everted, flaccid upper eyelids and
non spesific
irritative symptoms.
R/: Initial conservative treatment with viscous
lubrication and patching or an eyelid shield is
helpful.
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Ectropion
Defini t ion: Ectrop ion refers to the cond it ion in
which the margin of the eyelid is turned away
from the eyeball. This condition almost exclusively
affects the lower eyelid.
The following forms are differentiated according to
their origin :
Congenital ectropion.
Senile ectropion.Paralytic ectropion.
Cicatricial ectropion.
Mechanical
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Types of ectropion
Involutional
Cicatricial
Paralytic
Mechanical
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Preoperative assessment
Postition of maximal ectropion
Medial canthal tendon laxity Lateral canthal tendon laxity
Horizontal lid laxity
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Surgical procedures for involutional
ectropion
A, Medial spindle procedure:
outline of excision ofconjunctiva and retractors.
B, Lateral tarsal strip procedure:
anchoring of tarsal strip toperiosteum inside lateral orbital rim
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Entropion
Defin i t ion: Entropion is character ized byinward ro tat ion o f the eyel id margin .
The margin of the eyelid and eyelashes or even
the outer skin of the eyelid are in contact with the
globe instead of only the conjunctiva. The
following forms are differentiated according to
their origin
1. Congenital2. Acute spastic
3. Involutional
4. Cicatricial
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Involutional entropion
Affects lower lid because upper lid
has wider tarsus and is more
stable
If longstanding may result in corneal
ulceration
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Treatment options for involutional entropion
Transverse evertingsutures (temporary)
Weis procedure(permanent) (for recurrences)
Jones procedure
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Cicatricial entropion
Severe scarring of palpebral conjunctivawhich pulls lid margin towards globe
May affect lower or upper eyelid
Causes include cicatrizing conjunctivitis,
trachoma and chemical burns
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Treatment options for cicatricial entropionCorneal protection from lashes by epilation or contact lenses
Tarsal fracture procedure for mild cases
Mucous membrane grafts to replace contracted conjunctivaltissue for severe cases
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PTOSIS
Blepharoptosis
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Ptosis drooping/inferodisplacement of anyanatomic structure
BLEPHAROPTOSIS drooping/inferodisplacement of the upper eyelid
Pseudoptosisapparent eyelid droopingabnormally low: hypermetropia, enophthalmos,microphthalmos, phthisis bulbi, superior sulcus
defect (ec trauma), contralateral upper eyelidretraction, dermatochalasis
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PTOSIS
Blepharoptosis
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Ptosis drooping/inferodisplacement of anyanatomic structure
BLEPHAROPTOSIS drooping/ inferodisplacement of the uppereyelid
Pseudoptosisapparent eyelid droopingabnormally low: hypermetropia, enophthalmos,
microphthalmos, phthisis bulbi, superior sulcusdefect (ec trauma), contralateral upper eyelidretraction, dermatochalasis
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Cause myogenic
aponeurotic
neurogenic
mechanical
traumatic
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Acquired Ptosis
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Mechanical Ptosis
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Bilateral asymmetric congenital ptosis
Levator aponeurosis defect/aponeurotic ptosis
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Physical Examination
4 clinical measurement:
vertical interpalpebral fissure height
margin-reflex distance
upper eyelid crease positionlevator function (upper eyelid excursion)
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Distance between upper and lower lid margins
Normal upper lid margin rests about 2 mm below upper limbus
Normal lower lid margin rests 1 mm above lower limbus
Amount of unilateral ptosis is determined by comparison
Vertical fissure height
M i l fl di
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Marginal reflex distance
Distance between upper lidmargin and light reflex (MRD)
Mild ptosis (2 mm of droop)
Moderate ptosis (3 mm)
Severe ptosis (4 mm or more)
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Upper lid crease
Distance between lid margin andlid crease in down-gaze
Normals - females 10 mm;
- males 8 mm Absence in congenital ptosis
indicates poor levator function
High crease suggests an aponeuroticdefect
Distance between lash line and skinfold in primary position of gaze
Pretarsal show
crease fold
U lid i
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Upper lid excursion
Reflects levator function
Normal (15 mm or more)
Good (12 mm or more)
Fair (5-11 mm)
Poor (4 mm or less)
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THANK YOU
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