Podcast
Questions and Answers
What is the primary method for treating phthiriasis palpebrum, and how long should treatment be continued?
What is the primary method for treating phthiriasis palpebrum, and how long should treatment be continued?
The primary method is mechanical removal of lice and their nits, and treatment should be continued for 3 weeks.
What should be used to loosen nits in the treatment of phthiriasis palpebrum?
What should be used to loosen nits in the treatment of phthiriasis palpebrum?
Dilute acetic acid 2% can be used to loosen the nits.
How do Demodex mites contribute to the development of blepharitis?
How do Demodex mites contribute to the development of blepharitis?
Demodex mites can hide in the hair follicles and meibomian glands, leading to an infection that can cause blepharitis.
What should be used to ensure effective coverage while treating Demodex blepharitis?
What should be used to ensure effective coverage while treating Demodex blepharitis?
Which antibiotic ointment can be rubbed into the lid margin to aid in the treatment of Demodex blepharitis?
Which antibiotic ointment can be rubbed into the lid margin to aid in the treatment of Demodex blepharitis?
What is the role of zinc preparations in treating conditions related to Demodex?
What is the role of zinc preparations in treating conditions related to Demodex?
Why is prolonged treatment necessary for Demodex blepharitis?
Why is prolonged treatment necessary for Demodex blepharitis?
What is a recommended method to clean the eyelids in cases of blepharitis?
What is a recommended method to clean the eyelids in cases of blepharitis?
What is the main function of the upper and lower eyelids?
What is the main function of the upper and lower eyelids?
What distinguishes the anterior and posterior borders of the eyelids?
What distinguishes the anterior and posterior borders of the eyelids?
Describe the lacrimal portion of the lid margin.
Describe the lacrimal portion of the lid margin.
What role do Meibomian glands play in eyelid health?
What role do Meibomian glands play in eyelid health?
What is the significance of the grey line on the eyelid?
What is the significance of the grey line on the eyelid?
What anatomical components connect the eyelids medially and laterally?
What anatomical components connect the eyelids medially and laterally?
What can result from full thickness defects of the eyelid?
What can result from full thickness defects of the eyelid?
What term is used to describe the narrowing of the palpebral fissure?
What term is used to describe the narrowing of the palpebral fissure?
What is distichiasis and where does it occur?
What is distichiasis and where does it occur?
What is congenital ectropion and how does it manifest physically?
What is congenital ectropion and how does it manifest physically?
Describe the myogenic cause of ptosis.
Describe the myogenic cause of ptosis.
What are the symptoms associated with Horner's syndrome?
What are the symptoms associated with Horner's syndrome?
What is pseudo-ptosis and in which demographic is it most commonly suspected?
What is pseudo-ptosis and in which demographic is it most commonly suspected?
How can one differentiate between true ptosis and pseudo-ptosis during examination?
How can one differentiate between true ptosis and pseudo-ptosis during examination?
What are some causes of mechanical ptosis?
What are some causes of mechanical ptosis?
What is the clinical significance of asking about the age of onset and trauma history when assessing ptosis?
What is the clinical significance of asking about the age of onset and trauma history when assessing ptosis?
What is Wheeler's operation and what does it involve?
What is Wheeler's operation and what does it involve?
What are the common causes of ectropion affecting the lower eyelid?
What are the common causes of ectropion affecting the lower eyelid?
Describe the symptoms of ectropion.
Describe the symptoms of ectropion.
What complications may arise from lagophthalmous due to ectropion?
What complications may arise from lagophthalmous due to ectropion?
What is the purpose of the V-Y operation in ectropion treatment?
What is the purpose of the V-Y operation in ectropion treatment?
How is ectropion treated in cases with extensive scarring?
How is ectropion treated in cases with extensive scarring?
List the signs associated with mild, moderate, and severe ectropion.
List the signs associated with mild, moderate, and severe ectropion.
What should be the initial step in addressing blepharospasm caused by ectropion?
What should be the initial step in addressing blepharospasm caused by ectropion?
What clinical condition results from corneal exposure during sleep and what area is primarily affected?
What clinical condition results from corneal exposure during sleep and what area is primarily affected?
Identify two key treatment strategies for managing corneal exposure during sleep.
Identify two key treatment strategies for managing corneal exposure during sleep.
What is tarsorrhaphy and how can it be classified?
What is tarsorrhaphy and how can it be classified?
List two causes that can lead to adhesions between the bulbar and palpebral conjunctiva.
List two causes that can lead to adhesions between the bulbar and palpebral conjunctiva.
What are the four types of blepharitis mentioned?
What are the four types of blepharitis mentioned?
What predisposing factors may cause hyperemia of the lid margin?
What predisposing factors may cause hyperemia of the lid margin?
What is the purpose of a mucous membrane graft in ocular treatment?
What is the purpose of a mucous membrane graft in ocular treatment?
Describe a relevant surgical intervention for dense visually significant corneal opacity.
Describe a relevant surgical intervention for dense visually significant corneal opacity.
What is the primary cellular component found in a granuloma associated with chalazion?
What is the primary cellular component found in a granuloma associated with chalazion?
What are the common symptoms of a chalazion?
What are the common symptoms of a chalazion?
Describe the clinical signs that characterize a chalazion.
Describe the clinical signs that characterize a chalazion.
What treatment is typically recommended for moderate to large chalazia?
What treatment is typically recommended for moderate to large chalazia?
What distinguishes a marginal chalazion from other types?
What distinguishes a marginal chalazion from other types?
How can hordeolum externum be differentiated from hordeolum internum?
How can hordeolum externum be differentiated from hordeolum internum?
What is xanthelasma and who is it commonly associated with?
What is xanthelasma and who is it commonly associated with?
What factors contribute to blepharochalasis in young individuals?
What factors contribute to blepharochalasis in young individuals?
What underlying conditions might be associated with Meibomian Gland Dysfunction (MGD)?
What underlying conditions might be associated with Meibomian Gland Dysfunction (MGD)?
What is the composition of the oil produced by healthy Meibomian glands?
What is the composition of the oil produced by healthy Meibomian glands?
Describe a method for expressing oils from the meibomian glands.
Describe a method for expressing oils from the meibomian glands.
What is the recommended duration for applying warm, wet compresses to the eye?
What is the recommended duration for applying warm, wet compresses to the eye?
What appearance might abnormal meibomian glands exhibit during an examination?
What appearance might abnormal meibomian glands exhibit during an examination?
What is the primary goal of using diluted baby shampoo when caring for eyelid margins?
What is the primary goal of using diluted baby shampoo when caring for eyelid margins?
What are the potential consequences of blocked meibomian glands?
What are the potential consequences of blocked meibomian glands?
Which topical antibiotic creams may be prescribed for blepharitis treatment?
Which topical antibiotic creams may be prescribed for blepharitis treatment?
What are some common causes of cicatricial entropion?
What are some common causes of cicatricial entropion?
What treatment options are available for spastic entropion?
What treatment options are available for spastic entropion?
What factors contribute to the development of entropion in senile patients?
What factors contribute to the development of entropion in senile patients?
How does the presence of blepharospasm influence lid margin support?
How does the presence of blepharospasm influence lid margin support?
Describe a method used for correcting spastic entropion temporarily.
Describe a method used for correcting spastic entropion temporarily.
What is a common outcome of repeated corneal irritation from entropion?
What is a common outcome of repeated corneal irritation from entropion?
Which specific surgical operation is indicated for cicatricial entropion of the upper lid?
Which specific surgical operation is indicated for cicatricial entropion of the upper lid?
What role does excessive bandaging of the eyes play in entropion development?
What role does excessive bandaging of the eyes play in entropion development?
What is the significance of marking the brow position before and after elevating the eyebrows?
What is the significance of marking the brow position before and after elevating the eyebrows?
What are the implications of corneal anesthesia when considering surgical correction for ptosis?
What are the implications of corneal anesthesia when considering surgical correction for ptosis?
How is the condition of epicanthus associated with eyelid anatomy?
How is the condition of epicanthus associated with eyelid anatomy?
What does a marginal reflex distance (MRD) of less than 4 mm indicate?
What does a marginal reflex distance (MRD) of less than 4 mm indicate?
Describe the method used to assess levator function in a ptosis evaluation.
Describe the method used to assess levator function in a ptosis evaluation.
What is the correlation between the degree of ptosis and the measurements provided for mild, moderate, and severe ptosis?
What is the correlation between the degree of ptosis and the measurements provided for mild, moderate, and severe ptosis?
Why should surgery be avoided for third cranial nerve palsy conditions before treating a squint?
Why should surgery be avoided for third cranial nerve palsy conditions before treating a squint?
What does the presence of a skin fold under the upper lid indicate in congenital ptosis cases?
What does the presence of a skin fold under the upper lid indicate in congenital ptosis cases?
What is the timing of surgery for congenital ptosis in cases of absent torticolis?
What is the timing of surgery for congenital ptosis in cases of absent torticolis?
What surgical choice is appropriate for severe ptosis with poor levator action?
What surgical choice is appropriate for severe ptosis with poor levator action?
What defines the criteria for surgical intervention in mild to moderate congenital ptosis?
What defines the criteria for surgical intervention in mild to moderate congenital ptosis?
Describe the role of diathermy in the treatment of lash follicles.
Describe the role of diathermy in the treatment of lash follicles.
What happens to a lash when the follicle has been successfully destroyed through cryo-coagulation?
What happens to a lash when the follicle has been successfully destroyed through cryo-coagulation?
What hereditary conditions are commonly associated with bilateral ptosis?
What hereditary conditions are commonly associated with bilateral ptosis?
What clinical sign is associated with Horner's syndrome?
What clinical sign is associated with Horner's syndrome?
In treating mild ptosis, what is the primary technique utilized in the frontalis operation?
In treating mild ptosis, what is the primary technique utilized in the frontalis operation?
How can one differentiate between myogenic and traumatic causes of ptosis?
How can one differentiate between myogenic and traumatic causes of ptosis?
What condition leads to the permanent destruction of lash follicles using electrolysis?
What condition leads to the permanent destruction of lash follicles using electrolysis?
What is the primary symptom of pseudo-ptosis?
What is the primary symptom of pseudo-ptosis?
What is the significance of understanding levator action in surgical choices for ptosis?
What is the significance of understanding levator action in surgical choices for ptosis?
What type of muscular disturbance causes mechanical ptosis?
What type of muscular disturbance causes mechanical ptosis?
What role do family history and trauma history play in assessing ptosis?
What role do family history and trauma history play in assessing ptosis?
What is the significance of the 2 mm threshold in eyelid position assessment?
What is the significance of the 2 mm threshold in eyelid position assessment?
What is chronic progressive external ophthalmoplegia (CPEO) and how does it relate to ptosis?
What is chronic progressive external ophthalmoplegia (CPEO) and how does it relate to ptosis?
What is the relationship between seborrhea of the scalp and blepharitis?
What is the relationship between seborrhea of the scalp and blepharitis?
What is the significance of ‘minute ulcers of the lid margin’ in diagnosing ulcerative blepharitis?
What is the significance of ‘minute ulcers of the lid margin’ in diagnosing ulcerative blepharitis?
How does Phthiriasis palpebrarum contribute to eyelid pathology?
How does Phthiriasis palpebrarum contribute to eyelid pathology?
What are the primary clinical features associated with angular blepharitis?
What are the primary clinical features associated with angular blepharitis?
Identify the key symptom of Demodex blepharitis that differentiates it from other types.
Identify the key symptom of Demodex blepharitis that differentiates it from other types.
What is the impact of crust removal in cases of ulcerative blepharitis?
What is the impact of crust removal in cases of ulcerative blepharitis?
How might a generalized itching of hair-bearing areas signal a potential diagnosis of phthiriasis pubis?
How might a generalized itching of hair-bearing areas signal a potential diagnosis of phthiriasis pubis?
Why is treatment for seborrhoea and eyelid hygiene important in managing various forms of blepharitis?
Why is treatment for seborrhoea and eyelid hygiene important in managing various forms of blepharitis?
What is the primary indicator for performing surgery on congenital ptosis in a patient who is 6 months old?
What is the primary indicator for performing surgery on congenital ptosis in a patient who is 6 months old?
Which surgical method is best suited for severe ptosis with poor levator action?
Which surgical method is best suited for severe ptosis with poor levator action?
Which technique involves excising Muller’s muscle and part of the upper tarsus?
Which technique involves excising Muller’s muscle and part of the upper tarsus?
What is a crucial factor for determining the surgical intervention for moderate ptosis?
What is a crucial factor for determining the surgical intervention for moderate ptosis?
Which of the following describes a condition where 4 lashes or fewer misdirect against the cornea?
Which of the following describes a condition where 4 lashes or fewer misdirect against the cornea?
What intervention must be taken after using diathermy to destroy lash follicles?
What intervention must be taken after using diathermy to destroy lash follicles?
Which materials can be used for upper lid suspension in severe ptosis cases?
Which materials can be used for upper lid suspension in severe ptosis cases?
What is a common misconception regarding the treatment of hair follicles affected by trichiasis?
What is a common misconception regarding the treatment of hair follicles affected by trichiasis?
What is the typical measurement for marginal reflex distance (MRD) in millimeters?
What is the typical measurement for marginal reflex distance (MRD) in millimeters?
In evaluating levator function, which range indicates excellent function?
In evaluating levator function, which range indicates excellent function?
Which type of ptosis is indicated for surgical correction according to the guidelines?
Which type of ptosis is indicated for surgical correction according to the guidelines?
What is the consequence of corneal anesthesia in relation to surgical correction?
What is the consequence of corneal anesthesia in relation to surgical correction?
Which movement is associated with upward and outward motion of the globe during sleep?
Which movement is associated with upward and outward motion of the globe during sleep?
What criterion is used to classify mild ptosis?
What criterion is used to classify mild ptosis?
What is the key factor in measuring the skin fold in the upper lid?
What is the key factor in measuring the skin fold in the upper lid?
What is the surgical aim if there is an absent upward movement of the globe?
What is the surgical aim if there is an absent upward movement of the globe?
What is a primary characteristic of the oil produced by Meibomian glands in the case of Meibomian Gland Dysfunction (MGD)?
What is a primary characteristic of the oil produced by Meibomian glands in the case of Meibomian Gland Dysfunction (MGD)?
Which of the following is NOT a sign typically associated with Meibomian Gland Dysfunction?
Which of the following is NOT a sign typically associated with Meibomian Gland Dysfunction?
What is the role of warm, wet compresses in the treatment of MGD?
What is the role of warm, wet compresses in the treatment of MGD?
What could potentially result from improper use of diluted baby shampoo during eyelid washing?
What could potentially result from improper use of diluted baby shampoo during eyelid washing?
What underlying skin condition is often associated with Meibomian Gland Dysfunction?
What underlying skin condition is often associated with Meibomian Gland Dysfunction?
Which of the following treatments is indicated to express oils from the meibomian glands?
Which of the following treatments is indicated to express oils from the meibomian glands?
What should be avoided to prevent complications during the cleaning of eyelids for blepharitis?
What should be avoided to prevent complications during the cleaning of eyelids for blepharitis?
In which area of the eyelid are the meibomian glands located?
In which area of the eyelid are the meibomian glands located?
What is the primary cause of acute suppurative inflammation of the Zeis gland?
What is the primary cause of acute suppurative inflammation of the Zeis gland?
Which of the following symptoms is typically associated with a stye?
Which of the following symptoms is typically associated with a stye?
In the treatment of a meibomian gland infection, what is the recommended approach for draining pus when localized?
In the treatment of a meibomian gland infection, what is the recommended approach for draining pus when localized?
What is a significant predisposing factor for infections of the Zeis gland?
What is a significant predisposing factor for infections of the Zeis gland?
What indicates chronic non-specific inflammatory granuloma of a meibomian gland?
What indicates chronic non-specific inflammatory granuloma of a meibomian gland?
Which treatment method can be used to manage acute inflammation in patients with ocular inflammation?
Which treatment method can be used to manage acute inflammation in patients with ocular inflammation?
What does a 'diffuse red-yellowish swelling' near the lid margin indicate?
What does a 'diffuse red-yellowish swelling' near the lid margin indicate?
What is an appropriate hygiene practice to prevent stye formation?
What is an appropriate hygiene practice to prevent stye formation?
What surgical procedure is typically chosen for severe ectropion affecting the lateral half of the lower lid?
What surgical procedure is typically chosen for severe ectropion affecting the lateral half of the lower lid?
Which treatment is recommended to aid in the nerve regeneration following paralysis of the orbicularis oculi muscle?
Which treatment is recommended to aid in the nerve regeneration following paralysis of the orbicularis oculi muscle?
What is the primary role of lateral tarsorraphy in the context of facial nerve paralysis?
What is the primary role of lateral tarsorraphy in the context of facial nerve paralysis?
What condition could lead to incomplete closure of the palpebral fissure during eyelid closure?
What condition could lead to incomplete closure of the palpebral fissure during eyelid closure?
Which factor is NOT considered a cause of ectropion?
Which factor is NOT considered a cause of ectropion?
Which treatment option primarily aims to correct ectropion by creating cicatricial bands along suture tracks?
Which treatment option primarily aims to correct ectropion by creating cicatricial bands along suture tracks?
What is the purpose of performing a wedge resection in the treatment of ectropion?
What is the purpose of performing a wedge resection in the treatment of ectropion?
Which of the following is considered a common cause of lower motor neuron lesions that impact the eyelids?
Which of the following is considered a common cause of lower motor neuron lesions that impact the eyelids?
Which characteristic is primarily associated with a marginal chalazion?
Which characteristic is primarily associated with a marginal chalazion?
In cases of hordeolum externum, which drainage point is primarily involved?
In cases of hordeolum externum, which drainage point is primarily involved?
What is the typical treatment approach for recurrent chalazia from the same gland?
What is the typical treatment approach for recurrent chalazia from the same gland?
What is a common clinical sign of a chalazion when the lid is everted?
What is a common clinical sign of a chalazion when the lid is everted?
Which condition is most directly characterized by the presence of cholesterol deposits in the medial canthus?
Which condition is most directly characterized by the presence of cholesterol deposits in the medial canthus?
What is most accurate about the resolution of a chalazion?
What is most accurate about the resolution of a chalazion?
What distinguishes hordeolum internum from externum regarding associated glands?
What distinguishes hordeolum internum from externum regarding associated glands?
Which statement correctly describes the nature of blepharochaalasis?
Which statement correctly describes the nature of blepharochaalasis?
Flashcards
Lid hygiene & Phthiriasis
Lid hygiene & Phthiriasis
Treatment for insect infestation on the eyelids, characterized by frequent massage to evacuate meibomian secretions and meticulous removal of scales.
Scale Removal
Scale Removal
Removal of scales on the eyelids can be achieved by using 3% sodium bicarbonate lotion, diluted baby shampoo, or gentle scrubbing.
Treatment Duration
Treatment Duration
Treatment for eyelid infestations like Phthiriasis usually lasts 2-3 weeks due to hidden organisms.
Demodex Blepharitis
Demodex Blepharitis
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Tea Tree Oil Cleanser
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Zinc Sulphate
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Antibiotic Treatment
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Prolonged Treatment
Prolonged Treatment
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Eyelid Structure
Eyelid Structure
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Lid Margin Border
Lid Margin Border
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Tarsal plates
Tarsal plates
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Palpebral Fissure
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Ectropion
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Entropion
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Telecanthus
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Ptosis
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Distichiasis
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Congenital Ectropion
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Congenital Entropion
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Neurogenic Ptosis
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Myogenic Ptosis
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Ptosis
Ptosis
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Symptoms of Ptosis
Symptoms of Ptosis
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Diagnosis of Ptosis
Diagnosis of Ptosis
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Wheeler's Operation
Wheeler's Operation
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Ectropion Causes (Empty Socket)
Ectropion Causes (Empty Socket)
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Ectropion (Lower Lid)
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Epiphora
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Ectropion Complications
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Blepharospasm Ectropion
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Scarring Ectropion
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Chalazia Ectropion
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Chalazion
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Acute Chalazion
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Hordeolum Externum
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Hordeolum Internum
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Xanthelasma
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Blepharochalasis
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Treatment of Chalazion
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Marginal Chalazion
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Exposure Keratopathy
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Tarsorrhaphy
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Types of Corneal Adhesions
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Blepharitis
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Squamous Blepharitis
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Predisposing Factors (Blepharitis)
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Treatment for Exposure Keratopathy
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Corneal Involvement (Vision)
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Distichiasis
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Congenital Ectropion
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Congenital Entropion
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Neurogenic Ptosis
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Myogenic Ptosis
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Ptosis Symptoms
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Ptosis Diagnosis
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Ptosis
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Frontal Muscle Elevation
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Congenital Ptosis Skin Fold
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Corneal Anesthesia & Surgery
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Ptosis Visualization Technique
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Levator Muscle Function Assessment
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Marginal Reflex Distance (MRD)
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Ptosis Severity Assessment
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Ptosis Indications
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Congenital Ptosis Timing
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Surgical Choices for Ptosis
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Muller's Muscle Excision
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Lash Follicle Destruction
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Simple Epilation
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Timing for Congenital Ptosis (Pupil Blocked)
Timing for Congenital Ptosis (Pupil Blocked)
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Surgical Choices for Severe Ptosis
Surgical Choices for Severe Ptosis
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Mal-direction of lashes (treatment)
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Traumatic Entropion
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Iatrogenic Entropion
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Post-inflammatory Entropion
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Post-traumatic Entropion
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Spastic Entropion
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Senile Entropion
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Temporary Entropion Treatment
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Permanent Entropion Treatment
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Squamous Blepharitis
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Demodex Blepharitis
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Angular Blepharitis
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Ulcerative Blepharitis
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Phthiriasis Palpebrarum
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Conjunctivitis
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Treatment of Seborrhea
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General Health Attention
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Demodex Blepharitis
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Blepharitis
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Meibomian Gland Dysfunction (MGD)
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Warm Compresses (Blepharitis)
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Lid Margin Washing
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Eyelid Massage
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Treatment for MGD
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Treatment Duration (Blepharitis)
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Frontal Muscle Elevation
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Congenital Ptosis Skin Fold
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Marginal Reflex Distance (MRD)
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Ptosis Visualization Technique
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Levator Muscle Function Assessment
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Ptosis Severity Assessment
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Ptosis Indications
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Corneal Anesthesia & Surgery
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Congenital Ptosis (Timing)
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Surgical Choices for Ptosis (Mild)
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Surgical Choices for Ptosis (Severe)
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Muller's Muscle Excision
Muller's Muscle Excision
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Lash Follicle Destruction
Lash Follicle Destruction
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Simple Epilation
Simple Epilation
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Timing for Ptosis (Pupil Blocked)
Timing for Ptosis (Pupil Blocked)
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Mal-directed Eyelashes (Treatment)
Mal-directed Eyelashes (Treatment)
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Ectropion Cause
Ectropion Cause
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Ectropion Treatment
Ectropion Treatment
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Bell's Palsy
Bell's Palsy
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Treatment for Facial Nerve Paralysis
Treatment for Facial Nerve Paralysis
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Lid Ectropion Location
Lid Ectropion Location
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Treatment for Severe Lower Lid Ectropion
Treatment for Severe Lower Lid Ectropion
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Entropion
Entropion
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Incomplete Lid Closure
Incomplete Lid Closure
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Meibomian Gland Dysfunction (MGD)
Meibomian Gland Dysfunction (MGD)
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Warm Compresses for Blepharitis
Warm Compresses for Blepharitis
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Lid Margin Washing
Lid Margin Washing
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Eyelid Massage
Eyelid Massage
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Demodex mites
Demodex mites
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Treatment Duration (Blepharitis)
Treatment Duration (Blepharitis)
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Warm Compresses (Blepharitis)
Warm Compresses (Blepharitis)
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Lid Hygiene
Lid Hygiene
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Chalazion Definition
Chalazion Definition
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Acute Chalazion
Acute Chalazion
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Hordeolum Externum
Hordeolum Externum
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Hordeolum Internum
Hordeolum Internum
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Xanthelasma Treatment
Xanthelasma Treatment
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Blepharochalasis Definition
Blepharochalasis Definition
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Chalazion Treatment (Moderate or Large)
Chalazion Treatment (Moderate or Large)
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Marginal Chalazion Treatment
Marginal Chalazion Treatment
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Oral Antibiotics for Posterior Blepharitis
Oral Antibiotics for Posterior Blepharitis
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Short Courses Topical Steroids
Short Courses Topical Steroids
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Acute Suppurative Zeis Gland Infection (Stye)
Acute Suppurative Zeis Gland Infection (Stye)
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Acute Suppurative Meibomian Gland Infection
Acute Suppurative Meibomian Gland Infection
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Chronic Meibomian Gland Inflammation (Chalazion)
Chronic Meibomian Gland Inflammation (Chalazion)
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Stye Treatment - General
Stye Treatment - General
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Stye Treatment - Local
Stye Treatment - Local
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Chalazion Treatment
Chalazion Treatment
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Study Notes
Gross Anatomy of the Eyelid
- Eyelids are two mobile muco-cutaneous folds covering the orbital contents.
- Lid edges meet when the eye is closed.
- Anterior border: Rounded with rows of eyelashes (100 upper, 50 lower).
- Posterior border: Right-angled with orifices of Meibomian glands.
- Modified sebaceous and sweat glands are within the lash follicles.
Lid Fit on the Globe
- Upper lid: 2 mm below the upper limbus.
- Lower lid: Nearly on the lower limbus.
- Lacrimal portion of lid margin: medial to punctum, rounded with absent eyelashes.
Histology of the Eyelid
Skin
- Thin, loose, elastic, and distensible.
- Contains sebaceous and sweat glands, hair follicles, and pigment cells.
Sub-cutaneous Areolar Layer
- Loose connective tissue with major vessels, nerves, and lymphatics in the lids.
- Targeted for local infiltration anesthesia.
Muscle Layer
- Palpebral part of orbicularis oculi (7th cranial nerve).
- Insertion of levator palpebrae superioris (3rd cranial nerve).
- Müller's (superior tarsal) muscle (involuntary smooth muscle innervation).
Sub-muscular Areolar Tissue
- Dense connective tissue.
- Contains Meibomian glands (30 lower, 40 upper).
Tarsus
- Condensed fibrous tissue, forming the skeleton of the eyelids.
- Connected to orbital margins (medially) and lateral palpebral ligaments (laterally).
- Superior and inferior connections to the orbital septum.
Palpebral Conjunctiva
- Covers the inner surface of the eyelids.
Congenital Anomalies of the Eyelid
- Ankyloblepharon: Adhesion between both lid margins.
- Coloboma: Full thickness defect of lid and lid margin (surgical repair often required).
- Epicanthus: Skin fold at side of nose covering medial canthus and caruncle.
- Pseudo-convergent squint is a possible association
- Telecanthus: Increased distance between both medial canthi.
Blepharophimosis Syndrome
- Narrowing of the palpebral fissure (25-30 mm to 18-20 mm).
- Ptosis.
- Epicanthus inversus.
- Telecanthus.
- Lower lid ectropion.
Anomalies of Eyelashes
- Congenital ectropion.
- Congenital entropion.
- Distichiasis: Extra row of lashes in the site of Meibomian gland ducts.
Ptosis
- Dropping of the upper eyelid below its normal level.
- Congenital (usually bilateral and hereditary).
- Myogenic: poor levator muscle development.
- Neurogenic: poor nerve supply.
- Marcus Gunn phenomenon: re-elevation of dropped eyelid with jaw movement.
Acquired Ptosis
- Oculomotor (3rd) nerve palsy.
- Sympathetic paralysis (Horner's syndrome).
- Myasthenia gravis.
- Chronic progressive external ophthalmoplegia.
- Mechanical causes.
- Ipsilateral lack of lid support.
- Contralateral lid retraction.
- Trauma.
- Senile involvement.
Evaluation of Ptosis
- History: Age of onset, trauma, and family history.
- Visual acuity: To rule out visual deprivation amblyopia.
- Frontal elevation: evaluating for wrinkling and hyperaction of the frontalis muscle.
Abnormal Head Posture
- Lifting the head backwards allows better visualization.
Bell's Phenomena
- Upward and outward movement of the globe during sleep.
Associated Ocular and Congenital Anomalies
- Epicanthus
- Blepharophymosis
- Marcus Gunn phenomenon
Measurements for Ptosis
- Marginal reflex distance (MRD) measuring 4 mm.
- Vertical fissure height measuring 10 mm.
Assessment of Levator Function
- Patient is asked to look downwards and then upwards with pressure applied.
- Distance measured, categorizing as poor, fair, good, or excellent.
Surgical Repair of Ptosis
- Indications: Congenital and acquired ptosis, excluding myasthenic/hysterical/pseudo-ptosis.
- Contraindications: 3rd nerve palsy before squint treatment, absent Bell's phenomenon.
Timing of Surgery for Congenital Ptosis
- Preschool age (5 years): Mild/moderate cases, assessing if pupil is uncovered.
- Younger age (6 months): Assessing for eyelid blockages, potential amblyopia, and torticollis.
Surgical Choices
- Fasanella-Servat operation: Mild ptosis, good levator action.
- Levator resection: Moderate/severe ptosis, good levator action.
- Frontalis suspension: Severe ptosis, poor levator action.
- Technique: Transcutaneous/transconjunctival approach (Everbuch's/Blascovics).
Rubbing Lashes
- Mal-direction of lashes to rub against cornea or conjunctiva.
- Permanent destruction of follicles using Diathermy, Electrolysis, or Cryo-coagulation.
- Simple epilation is a temporary treatment.
Trichiasis
- Mal-direction of more than 4 lashes to rub against the cornea or conjunctiva, often associated with entropion.
- Common causes include trachoma, blepharitis (especially ulcerative), and prior lid surgery or injury.
- Treatment involves correcting entropion and replacing lashes.
Distichiasis
- One or more extra rows of eyelashes.
- Directed backward to rub against the cornea.
- May require removal to avoid epithelial erosion.
Poliosis
- Whitening of the lashes.
Madarosis
- Permanent absence of eyelashes due to destruction of the follicle.
- Causes can be local (inflammation, burns, iatrogenic causes, etc) or general (Alopecia, myxedema, syphilis, and leprosy).
Entropion
- Rolling of the lid margin and tarsal plate inward toward the eyeball
Cicatricial Entropion
- Scarring affects both upper and lower eyelids.
Spastic Entropion
- Weak lid support associated with blepharospasm in presence of enophthalmos and prolonged bandages.
Mechanical Entropion
- Increased weight of lower lid (multiple chalazia) which would cause lid to turn.
Infantile Entropion
- Bulging of subcutaneous fat in plump, chubby infants in the cheeks is a frequent cause.
Ectropion
- Rolling of the lid and/or marginal plate outward from the globe.
- Ectropion is commonly associated to an increased risk of complications to the cornea and conjunctiva
Lagophthalmos
- Incomplete closure of palpebral fissure.
- Causes include congenital deformities (coloboma) and acquired problems (ectropion and nerve palsy, e.g., facial nerve palsy).
- Important in preserving corneal health.
Symblepharon
- Adhesion between bulbar and palpebral conjunctiva.
- Often presented as a complication from chronic inflammation, trauma, or surgery.
Blepharitis
- Chronic inflammation of eyelid margin.
- Predisposing factors include external irritants (dust, smoke, wind), eye strain, and metabolic issues (DM, avitaminosis).
- Classifications can be squamous, ulcerative, parasitic, and others.
Hordeolum Externum (Stye)
- Acute suppurative inflammation of the Zeis gland.
- Causes: Staphylococcal infection, common in immunocompromised patients.
- Presentation: Painful swelling on lid margin, often close to an eyelash.
- Treatment generally involves hot compresses, antibiotics, and when needed, surgical drainage.
Hordeolum Internum
- Inflammation of the meibomian glands.
- Causes include retained secretions or other infections.
- Presentation: Painful swelling within the eyelid, often more internal than a stye.
- Treatment often requires antibiotic and topical agents and, possibly, surgical intervention.
Chalazion
- Non-specific inflammation of a meibomian gland.
- Often presents as a painless nodule.
- Causes could include blockage or retained material from the gland.
- Treatment may involve excision or surgical removal.
Miscellaneous Diseases
- Xanthelasma: Cholesterol deposits on the medial canthus.
- Dermtochalasis (Upper lid redundancy): Redundant skin and/or fat in the eyelid.
- Blepharocalasis (Chronic upper lid edema): Recurrent swelling, in the upper eyelid.
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