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Transcript of D ISORDERS OF THE EYELIDS Švehlíková G. Department of Ophthalmology LF UPJS v Košiciach...
![Page 1: D ISORDERS OF THE EYELIDS Švehlíková G. Department of Ophthalmology LF UPJS v Košiciach Prednosta: prof. MUDr. Juhás T., DrSc.](https://reader036.fdocuments.net/reader036/viewer/2022081515/56649d0b5503460f949de0b2/html5/thumbnails/1.jpg)
DISORDERS OF THE EYELIDS
Švehlíková G.
Department of Ophthalmology LF UPJS v Košiciach
Prednosta: prof. MUDr. Juhás T., DrSc.
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EXAMINATION –INSPECTION OF TARSAL CONJ., FORNIX, THE BULBAR CONJ.
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THE EYELID MALPOSITION
Ectropion
Entropion
Ptosis
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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
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INVOLUTIONAL ECTROPION
Medial portion of the lower eyelid with lover punctum is everted
Epiphora
Dermatitis – iritation by frequent rubbing
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PARALYTIC ECTROPION
Facial nerve palsy
Atony of the orbicularis muscle
Lagophthalmus
Complications . secondary conjunctivitis, exposure keratopathy
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MECHANICAL ECTROPION
Fibroma in the lover eyelid
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CICATRICAL ECTROPION
Scarring or contraction of the skin
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SURGICAL TECHNIQUE
The eyelid is shortened by an excision of full-thickness wedge
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ENTROPION
- inward turning of the eyelid and contact of eyelashes with cornea and conjunctiva
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Surgical correction of involutional entropion
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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.
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Aponeurotic ptosis - age – weakness of the aponeurosis of the levator muscle
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Myogenic ptosis – myastenia gravis – pac. activates the frontalis m., and backward position of the head
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EYELID ALLERGIC DISORDERS
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CONTACT DERMATITIS
Sensitivity to topical medication
Severe itching Erytema Edema of the eyelid
skin Changes are
restricted to the area of contact between skin and the noxious agent
Th- steroid
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ACUTE ALLERGIC OEDEMA
Insect bites, angiooedema, urticaria
Bilateral, painless oedema
Th - systemic antihistamines
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INFECTIONS
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HS BLEPHARITIS
uncommon bilat. upper and
lower eyelids herpes simplex v. infection
small vesicles, rupture, crusts
occasionaly associated with conjunctivitis
th – acyclovir cream
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HERPES ZOSTER
Skin lesions follows the first division of the trigeminal nerve
An involvement of the nasociliary nerve indicates ocular involvement
Th – systemic and topical
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THE LID MARGIN GLANDS
Meibomian glands – modified sebaceous g., located in the tarsal plate – lipid layer
Glands of Zeis – modif. sebaceous g., associated with the lash follicles
Glands of Moll – modif. sweat g., ducts open either into lash follicle or onto the ant. Lid margin
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HORDEOLUM
Acute inflamation of the gland of Zeis or Moll
swelling, erytema, pain
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CHALASION
chronic granulomatous inflamation of Meibomian gland
painless, roundish lesion in the tarsal plate
treatment - incision
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EYELID TUMORS
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BINIGN TUMORS
Cyst of Zeis Xantelasmas
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Papilloma Hemangioma
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NevusSurgical approach for resection
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MALIGNANT TUMORS
Nodular basal cell carcinoma
Squamous cell carcinoma
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Malignant melanoma
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CONJUNCTIVA
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ANATOMY
layers - epitelium, stroma
the mucin secretors ( Goblet cells, crypts of Henle, glands of Manz)
accessory lacrimal gl. of Krause and Wolfring
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INFLAMMATION
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CONJUNCTIVITIS
Symptoms – lacrimation, irritation, burning, photophobia
Discharge- - watery- acute viral, acute
allergic inf.- mucoid – vernal conj.,
keratoconj. Sicca- purulent – acute bact. inf.- mucopurulent – mild
bact., chlamydial inf.
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CONJUNCTIVAL APPEARANCE
Viral inf. Chlamydial inf. Hypersensitivity to
topical medication
Follicular reaction
Hyperplasia of lymphoid tissue within the stroma
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Chronic blepharitis Allergic
conjunctivitis Bacterial inf. Contact lens-related
problems
Papillary reactionHyperplastic conj. epitelium
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Oedema - chemosis
Membranes – beta-haemolytic str., diphtheria
Pseudomembranes – severe adenoviral inf., gonococcal inf.
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BACTERIAL CONJUNCTIVITIS
Staph. epidermidis, Staph. aureus, Strep. pneumoniae, H. influenzae, Moraxella
presentation – acute redness, burning, discharge – mucopurulent,
on waking – the eyelids are stuck together
hyperemia – max. in the fornices
Th- ATB drops and ointment
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ADENOVIRAL KERATOCONJUNCTIVITIS
- Pharyngoconjunctival fever – children – respiratory tract inf.
- Epidemic keratoconj. – no system. sympt.
acute watering, redness,
photophobia follicular reaction,
hyperemia, oedema discharge – watery lymph node swelling risk of corneal involment Th- symptomatic, resolution
spontaneous within 2 weeks
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TRACHOMA
population with poor conditions of hygiene
chronic conj. inflam., keratitis, progressive conj. scarring.
Chlamydia Trachomatis scarring of upper tarsal conj.
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entropion, trichiasis, blindness
Th – azitromycin + hygiene
end-stage trachoma
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ALLERGIC CONJUNCTIVITIS
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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
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presentation – acute itchy watery eyes, sneezing, watery nasal discharge
oedema of the eyelids milky appearance of
conj. Th – either a topical
mast cells stabilizer (nedocromil )
or a topical antihistamine ( azelastin )
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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 role
¾ patients have associated atopy
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VERNAL KERATOCONJUNCTIVITIS
symptoms – ocular itching, lacrimation, photophobia, foreign body sensation, burning, mucus discharge
clinical types:- palpebral - limbal- mixed
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Palpebral VKCHyperemia, diffuse papillary hypertrophy
Limbal VKCMucoid nodules, composed predominantly of eosinophils
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TH- MAST CELL STABILIZERS , TOPICAL STEROIDS.
Punctate epitelopathy Macroerosion
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ATOPIC KERATOCONJUNCTIVITIS
rare typically affects
young patients with atopic dermatitis
characteristic skin changes + astma, urticaria, migraine, rhinitis
ocular symptoms similar to VKC
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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
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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 dysfunction
blockage 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
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SPECIAL TESTS
Break-up time test – assesse precorneal tear film stability
Schirmer test – mesuring the amount of secretion
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PTERYGIUM
degenerative lesion conjunctiva grown
over the limbus unknown etiology Th- surgical
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CONJUNCTIVAL NAEVUS
benign, usualy unilateral
signs of potential malignancy - -sudden increase in pigmentation or growth
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CONJUNCTIVAL MELANOMA
rare solitary black or
grey nodule which is fixed to episclera
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CONJUNCTIVAL PAPILOMA
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Squamous cell carcinoma
Conjunctival Kaposi sarcoma
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QUESTIONS AND DISCUSSION
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THANK YOU FOR YOUR ATTENTION !