The eyelids
The eyelids are the moving folds of skin that cover the outer portion of the eyeball. Which protect the eye from injury and excessive light, and prevent excessive dryness of the cornea and conjunctiva Macroscopic anatomy :- 1. The palpebral fissure 2.The canthiMicroscopic Anatomy
The eyelid is formed of 6 layers :- 1. Skin &Subcutaneous tissue 2. Muscular layer of protraction 3. Orbital septum 4. Orbital fat 5. Muscle of retraction 6. Palpebral conjunctivaThe lid margin
It is about 2mm broad it had external and internal portion divided by gray line. it is divided into 2 portions :- a. Lacrimal portion: in which content lacrimal papillae b. Ciliary portion: in which eyelashes are presentThe muscles of the lid
1. Orbicularis oculi muscle :-a. Orbital portion. b.Palpebral portionc. Horner’s muscle2. Lavator palpebrae superioris muscle(capsulopalpepral)3. Muller’s muscle(inferior tarsal muscle)The gland of the lid
Meibomian glandZeis glandMoll’s glandBlood supply of the eyelid
Arteries 1. Inernal carotid artery (ophthalmic & lacrimal ). 2. External carotid artery (temporal and angular). Branches from both systems anastomose to form tarsal arcadesVeins:-
ophthalmic vein. Lymphatic drainage :- Medial 1/3 drains to the sub maxillary lymph nodes Lateral 2/3 drain to the pre auricular and parotid lymph nodes
Nerve supply of eyelids
1. Sensory : ophthalmic division of the trigeminal nerve(V1) . maxillary(V2) .2. Motor : 3rd ,7th fibers supply the levator ,orbicularis respectively.3. Sympathetic Muller’s muscleDiseases of the lids
Congenital anomalies of the lids Inflammation of the lids Deformities of the lid margin and palpebral aperture Tumours of the lidsCongenital Anomalies of Eyelids
Ablepharon: Deficiency of the anterior lamellae of the eyelids Microblepharon characterized by small eyelids Cryptophthalmos: the lids are replaced by a layer of skin Ptosis abnormally low position of the upper lid which may be congenital or acquiredAblepharon Cryptophthalmos
5. Epicanthus: bilateral vertical folds of skin that extend from the upper or lower lids towards the medial canthi 6. Distichiasis: extra posterior row of cilia is present 7. Coloboma of the lid: a notch is usually situated at the junction of the middle third and the medial third 8. Entropion and EctropionLid Edema
Traumatic edema Inflammatory edema Non inflammatory edema a. Allergic angioneurotic edema b. Passive systemic edemaInflammations Of The Lid
A- Inflammations of the whole lid itself (cellulitis or lid abscess) B- Inflammations of the lid margin (blepharitis) C- Inflammations of the glands of the lid (external hordeolum, internal hordeolum and chalazion)A- LID ABSCESS
It is a localized suppurative inflammation of the lid Clinical picture: A painful, red, hot and tender swelling within the lid. Treatment: Systemic and local antibiotics Surgical drainage by a transverse incision at pointing point of pus (better cosmetically). Vertical incisions should be avoided as they may lead to shortening on fibrosisB- BLEPHARITIS
Blepharitis usually presents as a chronic blepharoconjunctivitis and it is the most common external eye disorder in clinical practice Types: Anterior blepharitis. Posterior blepharitis.1. Anterior Blepharitis
A- staphylococcal blepharitis - hard scales and crusting around the base of lashes. - mild papillary conjunctivitis. - scarring and notching of lid margin, madarosis, trichiasis and poliosis. - corneal marginal keratitis. - tear film instability and dry eye.B- Seborrhoeic Blepharitis
Hyperaemic and greasy anterior lid with sticking together of lashes. The scale are soft and located anywhere on the lid margin and lashes.Treatment
Lifelong treatment may be necessary and that a permanent cure is unlikely: 1- Lid hygiene. 2- Antibiotics: a- topical: like sodium fusidic acid, bacitracin or chloramphenicol b- oral: like azithromycin 500 mg for three days. 3- Weak topical steroid. 4- Tear substitute.Posterior Blepharitis
Is caused by meibomian gland dysfunction and alteration in meibomian gland secretion. - Excessive and abnormal meibomian gland secretion - Plugging of the meibomian gland orifices. Expression of meibomian fluid by pressure. Tear film is oily. Papillary conjunctivitis and inferior corneal punctate epithelial erosions.Treatment
Inform the patient that cure is unlikely 1- Lid hygiene. 2- Systemic antibiotic. Tetracycline for 6 -12 week. a- Oxytetracycline 250 mg b.d. b- Doxycycline 100 mg b.d. for one week then once. c- Minocycline Or Erythromycin in children 3- Topical therapy (A.B., steroid and tear substitute).Inflammation of eyelids glands1.Stye: (External Hordeolum)
Acute suppurative inflammation of Zeis gland and the lash follicle, forming a small abscess Treatment: topical antibiotic, hot compresses and epilation of associated lash.2. Internal Hordeolum
Acute suppurative inflammation of the meibomian gland caused by staphylococcus aureus. It may be primary or it may occur on top of a chronic inflammation of the meibomian gland (chalazion) Treatment: surgical drainage + A.B. .Chalazion (meibomian cyst)
It is chronic sterile granulomatous inflammatory lesion result from retained sebaceous secretions leaking from meibomian gland. Treatment:- Spotaneous resolution Surgery Steroid injection Systemic tetracycline (recurrent especialy in acne rosacea)Disorder of the lid and palpebral aperture
Trichiasis Distichiasis Entropion Ectropion Symblepharon Ankyloblepharon Blepharophimosis Lagophthalmos PtosisTRICHIASIS
Posterior misdirection of lashes arising from normal site. Etiology: isolated or as a result of margin scaring secondary to chronic blepharitis & herpes zoster ophthalmicus . (Differentiated from pseudotrichiasis)Distichiasis A partial or complete second row of lashes emerging at or slightly behind the meibomian gland orifices Congenital asymptomatic till 5 year old Acquired secondary to cicatrizing conjunctivitis
Entropion
Definition: is the inversion of lid margin. The whole row of the lashes will be rubbing against the cornea .Types:
Cicatricial entropion Spastic entropion Involutional (senile) entropion Congenital entropionECTROPION
Definition: outward turning of the eyelid margin. It usually affects the lower lid as it stands against gravity.Types: Involutional (senile) ectropion Cicatricial ectropion Paralytic ectropion Mechanical ectropion Congenital ectropion