Download - Dr. Ayesha S Abdullah 10.09.2012
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Review of clinical anatomy & physiology of the eyelids & common infective and inflammatory
disorders of the eyelids
Dr. Ayesha S Abdullah10.09.2012
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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.
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Important superficial anatomical landmarks
Lid margin
Upper lid creasePalpebral fissure height (max)
Palpebral fissure length (max)
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Structure of the lids
The eyelid has five layers of different structures 1. Skin2. Subcutaneous tissue3. Muscular layer4. Tarsal plate5. Conjunctiva
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Surgical anatomy
Anterior Lamina Skin Orbicularis muscle
Posterior Lamina Tarsal plate Conjunctiva
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Anterior lamina Muscular layer
Orbital part
Preseptal part
Pretarsal part
Palp
ebra
l Pa
rt
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Posterior lamina
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Orbital Septum
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Structures at the lid margin
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Functions
• 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
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Disorders of eyelids
• Infective• Inflammatory• Neoplastic• Structural / disorders of malposition
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Trichiasis
• In-turned eyelashes
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Complications
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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
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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
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Anterior Blepharitis
Posterior Blepharitis
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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
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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
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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
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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
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Treatment
• Small – no treatment• Incision and curretage of the affected gland.
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Summary
• Important anatomical landmarks• Trichiasis• Blepharitis• Stye• Chalazion