Patologia Pleopelor
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PATOLOGIA PLEOPELOR
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I. AFECTIUNI CONGENITALE ALE PLEOAPELOR
A. ANOMALII ALE MORFOLOGIEI PLEOAPELOR
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1.COLOBOMUL PALPEBRALe o lipsa de substanta triunghiulara interesand toate straturile pleoapei, cu baza la nivelul marginii libere. Fiind situat in mijlocul pleoapei, lasa descoperita o mare parte a segmentului anterior al globului ocular. Suprafata corneo-conjunctivala descoperita se usuca.TratamentulTratamentul :-umectarea corneei si conjunctivei pana la efectuarea interventiei chirurgicale-lacrimi
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2. ABLEFARIA- lipsa completa a pleoapelor. Ele sunt inlocuite cu un plan membranos care inchide anterior orbita.
3.MICROBLEFARIA- dimensiunile mici ale pleoapelor, structura pleoapelor este normala. Daca afectiunea e marcanta apare imposibilitatea de inchidere a fantei palpebrale, deci lagoftalmia.
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B. ANOMALII ALE DESCHIDERII PALPEBRALE
1. CRIPTOFTALMIA –e lipsa deschiderii palpebrale, cele doua pleoape se continua fara demarcatie. In criptoftalmie spre deosebire de ablefarie exista o organizare structurala a pleoapei, chiar si rudimentara. In ablefarie pleoapa e inlocuita cu o membrana tegumentara.
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2. BLEFAROFIMOZA- deschidere insuficienta a fantei palpebrale, unghiurile palpebrale parand sudate. Se poate confunda cu ptoza palpebrala dar o examinare mai atenta a ridicatorului pleoapei elimina aceasta confuzie.
Se asociaza frecvent cu epicantul, microftalmia sau microblefaria.
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3. EPICANTUL- normal la populatia mongoloida. Este o cuta de piele semilunara verticala care coboara de la pleoapa superioara la cea inferioara,acoperind unghiul intern al fantei palpebrale.
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C. ANOMALII ALE MARGINILOR LIBERE
1. ENTROPIONUL CONGENITAL-rasfrangerea marginii pleoapei inferioare spre globul ocular, producand contactul si deci abraziunea cililor asupra corneei.
2. ECTROPIONUL CONGENITAL-rasucirea inspre exterior a marginii libere palpebrale.
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D. ANOMALII ALE CILILORDistichiazaDistichiaza-- existenta mai existenta mai
multor randuri de cilimultor randuri de cili
TrichiazaTrichiaza-deviatia cilior -deviatia cilior spre globul ocular ce irita spre globul ocular ce irita corneea ducand la aparitia corneea ducand la aparitia ulcerelor corneene.ulcerelor corneene.
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III. INFECTIILE PLEOAPELOR
INFECTIILE VIROTICE ALE PLEOAPELORZona zoster oftalmica-virusul varicelozosterian
●dureri frontale intense, febra, varsaturi.
●complicatii oculare: keratite, iridociclite, episclerite, nevrite optice
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-eruptie veziculoasa, unilaterala, ce respecta teritotiul nervului oftalmic asociata cu adenopatie regionala.Placardele eritematoase initiale se transforma in vezicule cu lichid clar care ulterior devine tulbure. Dupa uscarea continutului se formeaza o crusta.
TRATAMENT:-combaterea infectiei-stimularea imunitatii-calmarea durerilor
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INFECTIILE MARGINILOR LIBERE A PLEOAPELOR
Blefaritele-inflamatii ale marginii libere palpebrale.Factori generali: tulburari endocrine, boli infectioase, stari alergice.
Cauze locale: fum, praf, caldura, frig, cosmetice, medicamente.
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Se intalnesc 3 forme clinice:-blefarita eritematoasa-blefarita scuamoasa-blefarita ulceroasaBlefarita eritematoasa se manifesta printr-o hiperemie si edem discret al marginii libere a pleoapelor. Bolnavul acuza senzatie de prurit sau usturime.
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Blefarita scuamoasa-marginile libere ale pleoapelor sunt acoperite cu niste pelicule sau scuame.Dupa indepartarea scuamelor care se refac repede,pielea regiunii ramane rosie,iritata.
Blefarita ulceroasa se caracterizeaza prin localizarea unei infectii de natura stafilococica. Se manifesta prin ulceratii si microabcese ciliare.
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Tratament:Local:-eritematoasa-colire astringente
-rezorcina - cortison
-scuamoasa-dupa indepartarea scuamelor cu comprese cu borat de sodiu,unguent cu oxid galben de Hg,cortison.
-ulceroasa-dupa indepartarea crustelor se aplicaunguent antibiotic
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Orgeletul –inflamatia de natura stafilococica a glandelor sebacee ale lui ZEISS.Tratament:*local- coliruri cu antibiotice
*general: antibiotic
Chalazionul- inflamatia cronica a glandelor lui MEIBOMIUS
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DEVIATIILE PLEOAPELORENTROPIONUL-rasfrangerea inauntru a marginii palpebrale,cilii fiind orientati catre conjunctiva bulbara si cornee pe care le irita in permanenta.
*spastic*cicatricial
ECTROPIONUL-rasfrangerea in afara a marginilor ciliare ale pleoapelor de asa maniera incat conjunctiva tarsala este mai mult sau mai putin aerului.conjunctiva expusa agentilor iritanti se ingroasa si capata aspectul unui epiteliu pavimentos
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*spastic*cicatricial*paralitic*senil
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IV. TUMORILE PLEOAPELORTUMORI BENIGNE
a. Chisturileb. Tumorile benigne solide
-epiteliale (papilomul,keratoza seboreica)
-melanice benigne (plate sau nevi)
-tumorile glandelor sebacee-tumorile glandelor sudoripare-tumorile foliculilor pilosi-hemangiomul
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-Lipoame-Xantelasma
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TUMORI MALIGNE1. Epiteliomul cutanat-structura bazocelulara majoritatea, formele spinocelulare si mixte sunt mai rare si mai maligne putand determina metastaze limfoganglionare- nodul brun cenusiu situat in vecinatatea marginii ciliare. Ulterior ia un aspect muriform apoi se exulcereaza acoperindu-se de cruste.
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2. Epiteliomul glandular (adenocarcinomul)-rar dar extrem de malign poate proveni din oricare dintre glandele palpebrale dar cel mai frecvent din gld. Meibomius. Se localizeaza mai frecvent la nivelul pleoapei superioare putand fi confundat cu salazionul(DD)
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3. Melanomul malign (nevocarcinomul)- e o tumora rara care poate lua nastere fie dintr-un nev congenital fie dintr-o melanoza castigata-apare ca un nodul pigmentat sau roz inconjurat de un halou rosu cu vascularizatie anormala.- leziunea e pruriginoasa, are tendinta la exulcerare si invazie limfoganglionara
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4. Sarcomul palpebral- tumora maligna conjunctivala care se dezvolta sub forma unui nodul-evolutia e rapida-are tendinta la invadare si diseminare limfatica si hematogena- prognostic foarte grav
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Tratament: -excizie chirurgicala - chimioterapie - radioterapie
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Papiloma scuamos
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Keratoza seboreica
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Nev
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Hemangiom
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Xantelasma
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Carcinom cu celule bazale
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Melanom malign
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Carcinom glande sebacee
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Carcinom cu celule bazale