13.10.10-Eyelid and Adnexal Disease 2,Ppt Presentasi 23 Okt 2009

8/11/2019 13.10.10-Eyelid and Adnexal Disease 2,Ppt Presentasi 23 Okt 2009

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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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13.10.10-Eyelid and Adnexal Disease 2,Ppt Presentasi 23 Okt 2009

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