DISORDERS OF EYELIDS

Upper Lid Ptosis

• Blepharoptosis or eye lid ptosis is an abnormally low position of the upper
eye lid
 CONGENITAL PTOSIS
• It is associated with congenital weakness oflevator
palpebrae superioris.
• Characteristic features include:

Drooping of one or both upper eyelids since birth.

Lid crease is easily diminished or absent.
Lid lag on downgaze(i.e. ptotic lid is higher
than the normal)
CONGENITAL COLOBOMA
• Rare condition
• Full thickness triangular gap in the
tissues of the lid
• Usually in nasal side and in upper eyelid
EPICANTHUS
• • Semicircular find of skin which covers medial canthus
• • Bilateral Condition which may disappear with
development of nose
• • Most common congenital anamoly of eyelid
MICROBLEPHRON
• Eyelids are abnormally small
• Ususally associated with microphthalmos or
anopthalmos
• Ocasionally the lids may be very small or virtually
absent- Ablephron
 EPIBLEPHRON

• Horizontal fold of tissue rides above the lower eyelid margin

• Usually disappears with growth of face
BLEPHARITIS
 INTRODUCTION

• Chronic inflammation of lid margins.

• 2 forms: Anterior ,Posterior (Meibomitis)
 AETIOLOGY
• Follows chronic conjunctivitis due to Staphylococci carried
to lid margins by infected fingers.
• Occasionally, parasitic infection.
Blepharitis acarica – due to Demodex follicurolum,
Phthiriasis palpebrarum
Crab louse
Head louse (Very rare)
ANTERIOR BLEPHARITIS
• SUBORRHOEIC/ SQUAMOUS BLEPHARITIS
• Small white scales accumulate among lashes which
readily fall out and are replaced without distortion.
• On removal of these scales, underlying surface is
hyperaemic, not ulcerated.
• . Metabolic condition, often associated with dandruff of
scalp ( Such etiology requires Rx)

.
SUBORRHEIC BLEPHARITIS
• STAPHYLOCOCCAL/ULCERATIVE
BLEPHARITIS
• Yellow crusts or dry brittle scales glue the lashes together.
• Cause small bleeding ulcers around the base of the lashes when
removed.
(Different from conjunctival discharge, which mat the lashes
together but on removal they reveal normal lid margins.)
• CF – Soreness
Lacrimation
Itching
Redness of edges of lids
Photophobia
ULCERATIVE BLEPHARITIS
POSTERIOR BLEPHARITIS

• Leads to tear film instability and inferior punctate keratitis.

• Commonly presents in 2 ways.
1)Meibomian Seborrhoea: Oil droplets seen at the Meibomian
gland openings which can be expressed out like foam.
2)Meibomanitis: Diffuse rounded posterior lid margin & thickening
around Meibomian glands opening.
• Lid massage expresses out an inspissated, toothpaste-like
material.
• Cyst formation due to duct blockage may also be seen.
• TREATMENT
• Warm compression and lid massage.
POSTERIOR BLEPHARITIS
EXTERNAL HORDEOLUM (STYE)
Acute suppurative inflammation of lash follicle and its associated
glands of Zeil or Moll
ETIOLOGY

• PREDISPOSING FACTORS
• Habitual rubbing of eyes
• Eye strain due to muscle imbalance or refractive errors
• Chronic blepharitis, diabetes mellitus
• Excessive intake of alcohol and carbohydrates.

• CAUSATIVE AGENT :- Staphylococcus aureus

CLINICAL FEATURES

• SYMPTOMS
• Acute pain with swelling of eyelid
• Mild watering
• Photophobia
TREATMENT

• Hot compresses given 2-3 times a day

• Antibiotic eye drops
• Eye ointment
• Systemic anti-inflammatory and analge
edema.

• Systemic Antibiotics to control the infection

CHALAZION (TARSAL OR MEIBOMIAN CYST)

• Chronic non infective, non suppurative lipogranulomatous

inflammation of Meibomian cyst.
PATHOGENESIS

Mild grade infection of Meibomian gland by low virulence organism

Proliferation of epithelium and infiltration of wall of ducts causes

blockage of ducts

Retention of secretion in gland causes enlargement

Extravasated secretion (fatty) act like irritant and causes Chalazion

CLINICAL FEATURES

• SYMPTOMS
• Painless swelling which is gradual increasing in size
• Mild heaviness in the lid
• Watering (epiphora)
• Blurred vision occasionally
SIGNS
• Nodule present on the lid will be non tender and firm to
hard in consistency
• Reddish purple area is seen on palpebral conjunctiva
• Marginal chalazion present as the small reddish grey
nodule
CLINICAL COURSE AND COMPLICATION

• Complete spontaneous resolution may occur rarely.

• Often it slowly increases in size and becomes very large.
• A large chalazion of the upper lid may press on the cornea and
cause blurred vision.
• Fungating mass of granulation tissue may form due to bursting of
the lesion.
• Secondary infection leads to formatin of hordeolum internum.
• Calcification may occur,
• Malignant change into meibomian gland carcinoma may be seen
TREATMENT

Conservative treatment
•In a small, soft and recent chalazion, self-resolution may be
helped by conservative treatment in the form of hot
fomentation, topical antibiotic eyedrops and oral anti-
inflammatory drugs.
Intralesional injection of long-acting steroid (triamcinolone)
• It cause resolution in about 50 percent cases, especially in
small and soft chalazia..
INCISION AND CURETTAGE

• The conjunctiva and lid are anaesthetised.

• The lid is everted and chalazion clamp is fixed
• A small vertical incision is given with a sharp blade over the conjunctivalside.
• The semifluid contents escape and walls of the cavity are thoroughly scraped with
the chalazion scoop.

• The cavity is cauterized with carbolic acid to avoid recurrence.

• Usually no dressing is necessary.
INTERNAL HORDEOLUM
 DEFINITION
• Suppurative inflammation of the Meibomian gland associated
with blockage of the duct.
ETIOLOGY

• PREDISPOSING FACTORS:
1. AGE: Children and young adults
2. Patients with eye strain due to muscle imbalance or refractive errors.
3. Habitual rubbing of eyes, fingering of lids.
4. Chronic Blepharitis
5. Diabetes Mellitus
6. Excessive intake of carbohydrates and alcohol.

• CAUSATIVE MECHANISM
1. Primary Staphylococcal infection of the Meibomian gland
2. Secondary infection from an infected chalazion.
CLINICAL FEATURES

• SYMPTOMS
• 1.Acute pain and swelling of the eyelid.
• 2.Mild watering
• 3.Photophobia
 SIGNS
• 1.Localised, firm, red, tender swelling of the lid.
• 2.Markedly edematous lid.

1. Pus point on the tarsal conjunctiva

2. Maximum point of tenderness and swelling is away from the lid
margin.
TREATMENT
• Hot Compresses
• Antibiotic eye drops and ointment
• Systemic anti inflammatory and analgesics
• Systemic antibiotics
• Treat the predisposing condition to prevent recurrence