Eyelid Disorders Lecture Notes 2024 PDF

EYELIDS & THEIR DISORDERS Assistant Professor Dr Arif younis Baletey College of medicine University of Duhok OBJECTIVES Anatomy Eye lashes disorders Inflammations of eyelids Abnormal directions and position of the eye lid Congenital anomalies an...

EYELIDS & THEIR DISORDERS Assistant Professor Dr Arif younis Baletey College of medicine University of Duhok OBJECTIVES Anatomy Eye lashes disorders Inflammations of eyelids Abnormal directions and position of the eye lid Congenital anomalies and ddx Tumors The eyes are probably the most important vital structures in the body. * They are covered by a protective thin layer of skin and soft tissue called the eyelids. Eyelids protect the eyeball from injury, * Control the amount of light that enters the eye *lubricate the eyeball with tears during blinking.  With the exception of the 80 prepuce and the labia minora , it has the thinnest skin in the body. **The human eyelid features a row of eyelashes which serve to heighten the protection of the eye from dust , foreign debris, perspiration. EYELID ANATOMY  The gray line divides eye lid margin into anterior and posterior parts Eye lashes, moll & zeiss 8 glands orifices takes place at the front part Meibomian gland orifices 0 are placed behind the gray line o  *The inter palpebral fissure is the exposed Interpalpabnel fissure zone between the upper Is 30in & the lower eyelids. width *The normal adult fissure width is ( 8-11)mm & long about 27-30 mm * Clinically important changes in the lid fissure occur in thyroid disease , horners synd , facial palsy ,III N.pal EYELID caoereye EYELID 0 tier  Orb.oculi muscle: * is a circular striated muscle ,several concentric bands around the fissure, I orbital portion (voluntary) acts as a sphincter & forceful lid closure palpebral (preseptal&pretarsal) acts vol & invol for normal & reflex blinking. Its fibers run around the eye within the eyelid. Contraction of this muscle leads to closure of the eye. Lid fold ( crease) is near the upper border of the tarsus where the levator aponeurosis establishes its first insertion on the ant.aspect of the tarsus. The gray line corresponds to the most superficial portion of orb.oculi m ( riolan ) muscle. Blinking voluntary and involuntary Average rate of 6linking The involuntary blinks -- spontaneous and reflex blinks. 15X1Mnv Spontaneous blinking - It is a common form of blinking that occurs e without any obvious external stimulus Spontaneous blinking does not occur or is very infrequent during the first few months of life Average rate: 15 times/ minute The blink rate is increased in: 1-Extremely dry conditions. 2. Strong air currents. 3. Certain emotional stress situations (surprise, anger, or fight). A decreased blink rate occurs during times of visual observations. EYELID evatorpalpabree sighted by superficial C  Tarsal plates : They are two plates of dense Dense fibrous tissue that forms th connective tissue, one for each lid skeleton of eyelids giving them give shape and firmness to the lids. shape and firmness 30mm long , 1mm thick , The upper and lower tarsal plates join with each other at medial and upper tarsus 10mm in ht , lateral canthi lower tarsus 5mm in ht Tarsal plates have rigid They attach to the orbital margins To attachments to periosteum via through medial and lateral palperable canthal tendons ligaments. The upper tarsus contains Meibomian glands are distributed in approximately 30 meibomian glands the tarsal plates in a parallel pattern lower tarsus contains rows. approximately 25. The oil-secretin glands are aligned verticallyy  - muller muscle; smooth nonstriated, originates just from under levator ** Smooth musculature of the muscle in the upper lid &from levator palpebrae which capsulopalpebral head of inf.rectus inserts in to the tarsal plate in the lower one. Attaches to the tarsi (tarsal muscle ) correspondingly. *The tarsal muscle (Muller ) is supplied by sympathetic sympathetically innervated nervous system , which ( dysthyroid ophth.& horners synd). E regulates the width of the palpebral fissure. T Iff High symp.tone contracts this muscle & widens the palp.fissure. info Low symp.tone relaxes the muscle and narrows the palp.fissure. enffese  Prffre palpebral conjunctiva : is firmly attached to the tarsal plate. With blinking it acts like a windshield wiper & uniformly distributes glandular secretions & tears over the conj. & cornea. Sebaceous glands ( meibomian ) : are tubular structures in the cartilage of the eyelid ( tarsal plates) lubricating the margin of the eyelid. Prevents the escape of tear fluid.  retainfaf ORBITAL SEPTUM Fibrous membranous sheet of connective tissue, which retains the orbital fat Is the anterior boundary of the orbit. Orbital septumThe orbital septum is located between the( tarsal plate & Free orbital margin ), Extends from orbital margin to the eyelids, Medially attaches to the lacrimal bone (post.crest) Separates eyelids from contents of orbital cavit Tiki olein Stronger on lateral side than medial I mornin do  Septum orbitale – arises from periosteum over superior and inferior orbital rim ue, Fuses with levator aponeurosis in upper eyelid and capsulopalpebral fascia in lower eyelid Separates the eyelids from the orbit serves as an important anatomic barrier to infection, hemorrhage, and edema. to barrier interlude edw IS  Dermatochalasis t is very common in elderly, The eye lids have baggy appearance with indistint lid creases. Treatment is blepharoplasty EYELID The septum is perforated by vessels & nerves which pass from the orbital cavity to the face & scalp Clin.significance : with age the septum weakens , as a result orb.fat e herniates forward ( blepharoplasty ) It is an important land mark in distinguishing Orbital from peri orbital cellulitis. 0  affrig Orbital cellulitis o STRUTURES & ADNEXI OF THE EYELIDS ** lacrimal puncti , tiny openings in both eyelids ,in the free margins ** both eye lids meet at the angles ( canthi ) ** Hair in the free ends ( eyelashes ) cilia, arranged in irregular rows , projecting from the anterior aspect of the margin Upper eye lid/ 150 eyelashes are arranged in 3-4 rows Lower eyelid / 75 in two rows ** prevent dust & sweat from entering the eye  ARTERIAL SUPPLY A network of vessels derived from the internal and the external carotid arteries, richly vascularizes the eyelids Collateralization between the internal and external systems contributes to the rapid wound healing and the low incidence of infection following eyelid surgery. As the vessels approach the eyelids, branches of the ophthalmic artery from the internal carotid artery and branches of the facial arteries off of the maxillary branch of the external carotid artery form the marginal and peripheral vascular arcades of the eyelids  VENOUS DRAINAGE Divided into pretarsal and postarsal Pretarsal drains into angular e vein medially and superficial temporal vein laterally jugular veins Postarsal drainage is into orbital veins &cavernous sinus i  LYMPHATIC DRAINAGE NERVES Lymphatic vessels serving Motor nerves – urges medial side of eyelid drain to facial nerve innervates the submandibular lymph orbicularis oculi muscle I openers nodes oculomotor nerve innervates levator palp.superior Those lymphatic vessels Sensory nerves : Ii derived from V1 and V2 which are serving lateral Supraorbital , supratrochlear , portions of eyelids drain into infratrochlear ,lacrimal ,infraorbit preauricular deep cervical al ,infratrochlear lymph nodes Sympathetic nerves –----------- Mullers muscle Initiation of lid EYELID I  DISORDERS OF THE EYE LASHES Trichini Trichiasis : Posterior misdirection of eye lashes from their normal sites of origin. Metaplastic lashes: which originate from the meibomian gland orifices Oistichinis  Distichiasis: in which partial or complete second row of lashes arises from or behind the meibomian gland orifices Mador  Madarosis :is decrease in number or complete loss of lashes Poliosis: Premature whitening of lashes sometimes may involve eye brows points BLEPHARITIS Common bilateral symmetrical condition Anterior form is usually because of staphylococcal infection in seborrheic patients Posterior form is associated with meibomian gland dysfunction SDE (ocular rosacea) outer p É ENTROPION Entropion or inversion of the lid margin Types: acquired and congenital The acquired variety can be the result of aging changes (involutional entropion) or the cicatricial changes (cicatricial entropion)  Ectropion The eversion of the lid margin can be congenital and acquired. The acquired forms are the result of either aging changes (involutional ectropion), or mechanical reasons (caused by tumors) or the scarring of the anterior lamella (cicatricial 1 ectropion) or weakness of the orbicularis muscle (paralytic ectropion)  Blepharoptools Blepharoptosis Abnormally low position (drooping) of the upper lid. Types: Neurogenic oculomotor Third nerve palsy Horner syndrome si Marcus Gun jaw-winking ie syndrome Third nerve misdirection  developmental CONGENITAL PTOSIS dystrophyefftfi This is caused by a developmental dystrophy of the levator muscle. It can be bilateral or unilateral In down gaze the ptotic eye lid is slightly downgo higher than the fp.fi.IE normal eye lid as a result of poor relaxation iEannoriii Frequently there is absence of the upper eye lid crease ii Usually levator function is poor Sometimes weakness of the superior rectus muscle may accompany  yfunction levator is not the Involutional and aponeurotic cause ptosis: In this condition levator function is mostly good *The pathology is the detachment of the levator muscle from the upper border of the tarsus detachmentof pairfromtorrent levator * we just attach the levator back to the upper tarsal border.  a Myogenic Myasthenia gravis Myotonic dystrophy Of Ocular myopathy Simple congenital Blepharophimosis syndrom  Epicanthal folds These are very common, Bilateral vertical skin folds that overhangs from the upper or lower lid towards the medial canthus. They may give rise to a pseudo- esotropia. 00  Telecanthus distance Telecanthus between Medial This is an uncommon 6m40 condition. There is increased distance between the medial canthi as a result of abnormally long ii medial tendons. It should not be confused with hypertelorism in which there is wide separation of the orbits. Coloboma Partnittifying This is uncommon colobond PYI.INT ddetelt congenital partial or full- thickness eye lid defect. The upper lid coloboma is Heric not associated with systemic anomalies The lower lid coloboma is frequently associated with g systemic anomalies such as Treacher Collins Syn  STURGE-WEBER /PORTWINE HEMANGIOMA 1styearof life Isp common during resolvesbyage Capillary hemangioma STEROID Unilateral, red, raised lesion Most common during first year of life Resolves spontaneously by the age 4-7 Steroid injections can be given for vision threatening cases  Pyogenic granuloma refined Fast growing granulomatous hemangioma which is usually after surgery or trauma  mn Keratoacanthoma Uncommon benign but rapidly growing tumor Most common in immunosuppressive patients O Basal cell carcinoma Most comman human malignancy 90% cases occur in head and neck, 10% of these involve eye lid. Slow growing, locally invasive but non metastasizing  Squamous cell carcinoma It ranges from 5-10 % of eye lid malignancies Potentially more aggressive tumour than BCC There are 3 main clinical types 1. Plaque like 2. Nodular m 3. Ulcerating ulcer Thank you for the attention