Download lids lecture

Review of clinical anatomy &
physiology of the eyelids & common
infective and inflammatory disorders
of the eyelids
Dr. Ayesha S Abdullah
10.09.2012
Learning objectives
By the end of this lecture the students would be
able to:• Correlate the structure of the eyelids with their
functions and clinical presentation in common
infective and inflammatory disorders.
• Define stye, chalazion, trichiasis & blepharitis.
• Differentiate between stye & chalazion on the
basis of clinical presentation and describe the
treatment.
Important superficial anatomical
landmarks
Upper lid crease
Palpebral fissure height
(max)
Lid margin
Palpebral fissure length (max)
Structure of the lids
The eyelid has five layers of different structures
1. Skin
2. Subcutaneous tissue
3. Muscular layer
4. Tarsal plate
5. Conjunctiva
Surgical anatomy
Anterior Lamina
 Skin
 Orbicularis muscle
Posterior Lamina
 Tarsal plate
 Conjunctiva
Anterior lamina
Muscular layer
Preseptal part
Pretarsal part
Palpebral Part
Orbital part
Posterior lamina
Orbital Septum
Structures at the lid margin
• Nerve supply- sensory
• Blood supply
• Lymphatic drainage
HW
[email protected]
Functions
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Protect the anterior surface of the globe
Aid in regulation of light reaching the eye
Tear film maintenance; distribution & flow
Lipid/ oily layer of the tear film
Disorders of eyelids
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Infective
Inflammatory
Neoplastic
Structural / disorders of malposition
Trichiasis
• In-turned eyelashes
Complications
Treatment
• Epilation - but recurrences within few weeks
• Electrolysis - but frequently repeated
treatments
• Cryotherapy - for many lashes
• Laser ablation - for few scattered lashes
• Surgical correction - for resistant, localized
crop
• Ocular lubricants
Blepharitis
• “ inflammation of the lid margin”
• Anterior Blepharitis
– Affects base of eyelashes
– Associated with staphylococcal infection or Seborrhea
– Complicated by recurrent stye ,scarring of the lid
margin and loss of eyelashes
• Posterior Blepharitis
– Affects meibomian gland openings
– Associated with meibomian gland dysfunction
– Complicated by recurrent chalazia, tear film instability
and scarring of the lid margin
Anterior Blepharitis
Posterior Blepharitis
Management
– Maintain lid hygiene
• Apply warm compress
• Gently massage posterior lid to express meibomian gland
contents
• Scrub lashes and lid margins with dilute baby shampoo
• Wipe lid margins with warm cloth after scrubbing
– Acute infectious flare-up (e.g. staphylococcal
Blepharitis)
• Antibiotic ophthalmic ointment
– Meibomian gland dysfunction
• Ocular lubricants ( artificial tears/ tear substitutes)
• Tetracycline / Doxycycline orally
• Steriods for limited period
Stye
“ Acute staphylococcal infection (abscess) of a
lash follicle”
• Common in children
• Tender hot swelling at the lid margin
• May spread to the entire lid causing prespetal
or at time orbital cellulitis
Treatment
• Hot compresses
• Self-limiting; epilation of the infected lash
hastens resolution
• If spread of infection is likely with gross
redness and swelling of the lid than topical
and systemic antibiotics can be given along
with analgesics/ NSAIDs
Chalazion
“Chronic granulomatous inflammation of the
Meibomian glands secondary to blockage of
the gland orifice”.
• Common in patients with posterior blepharitis
• Non-tender swelling a little away from the lid
margin
Treatment
• Small – no treatment
• Incision and curretage of the affected gland.
Summary
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Important anatomical landmarks
Trichiasis
Blepharitis
Stye
Chalazion