Eyelids @ APPLIEDANATOMY 2 @ DISORDERS OF LASHES 3 Trichiasis 3 Congenital distichiasis 4 ‘Acquired distichiasis 4 Phchiriass palpebrarum — § Poliosis 5 Madarosis 5 Hypertrichosis. 5 Eyolash ptosis 6 @ ALLERGIC DISORDERS 6 Acute allergic oedema 6 Coneact dermatitis 7 Acopic dermatitis 7 INFECTIONS 7. Herpes zoster ophthalmicus 7 Herpes simplex 8 | Impetigo 8 Erysipelas 8 Necrociaing fascitis 9 © CHRONIC MARGINAL BLEPHARITIS Pathogenesis 9 ‘Anterior blepharitis 9 Posterior blepharitis 11 BENIGN NODULES AND CYSTS 13. Chalazion 13 Incernal hordeolum — 13. External hordeolum — 14 Molluscum contagiosum 14 Xanthelasma 14 Gystof Moll 14 Eccrine sweat gland hidrocystoma 15 Cyst of Zeis 15, Sebaceous cyst 15 Mila 15 @BENIGNTUMOURS 16 Viralwart 16 Seborthoeic keratosis 16 Actinic keratosis. 16 Cutaneous horn 16 Pyogenic granuloma 16 Melanocytic naevus 17 Keratoacanthoma 17 Strawberry naevus 18 Port-wine stain 19 @ MALIGNANTTUMOURS — 20 Basal cell carcinoma 20 Squamous cell carcinoma 21 Sebaceous gland carcinoma 22 Melanoma 22 Kaposi sarcoma 24 Merkel cell carcinoma 24 Principles of treatment 25 @ECTROPION 27 Involutional ectropion 27 Cicatricil ectropion 28 Paralytic ectropion 28 Mechanical ectropion 30 @ENTROPION 30 Involutional entropion 30 CCleatricial entropion 31 Congenital entropion 32 @ ptosis 32 Classification 32 Clinical evaluation 32 Marcus Gunn jaw-winking syndrome 35 Third nerve misdirection 36 Simple congenital ptosis 36 Blepharophimosis syndrome 36 Aponeurotic ptosis 37 Mechanical ptosis 38 Principles of surgery 38 @ MISCELLANEOUS ACQUIRED DISORDERS 39 Dermacochalasis 38 Blepharochalasis. 39 Floppy eyelid syndrome 39 Lidretraction 40 @ MISCELLANEOUS CONGENITAL DISORDERS 40 Epicanthic folds 40 Telecanchus 41 Epiblepharon 41 Coloboma 423s... Ophthalmology @ Applied anatomy 1. The grey line is an important structure because it divides, the eyelids into an anterior lamella, composed of skin and orbicularis, and a posterior lamella consisting of tarsal plate and conjunctiva (Fig. 1.1) 2. Glands in the lid margin may be the source of eyst formation and occasionally tumours, 4. Meibomian glands are modified sebaceous glands located in the tarsal plate and secrete the outer lipid layer of the precorneal tear tlm. lands of Zeis are modilied sebaceous glands that are associated with lash follicles. ©. Glands of Moll are modified sweat glands the ducts of which open either into a lash follicle or directly onto the anterior lid margin between the lashes. 3. The lashes are slightly more numerous in the upper {approximately 100) than in the lower ld. The lash roots, lie against the anterior surface of the tarsus in the space between the pretarsal orbicularis ocull muscle and the muscle of Riolan, The lashes pass between the orbicularis ‘oculi and the muscle of Riolan and exit the skin at the ‘anterior lid margin, All lashes curve away from the globe ‘and are relatively parallel. Because they lack erectores| pilorum muscles, their position and direction are determined by the surrounding orbicularis oculi, musc of Riolan and tarsal plate, Thus, ifthe tarsus or orbicularis Is abnormal, lash position and direction may be affected, 4, Upper lid elevators (Fig. 1.2) ‘a. The levator aponeurosis fuses with the orbital septum about 4 mm above the superior border of the tarsus. Its posterior fibres insert into the lower third of the nterior surface of the tarsus. The medial and lateral hhorns are expansions which act as check ligaments, Surgically. the aponeurosis ean be approached through the skin or the conjunctiva. Grey ine uetot rmeibomian gland Gland of Mal Cilio Lashfaticle Gland of eis Sweat land | Figtat Cots tection of the lower lid levator muscle Inferior oblique ‘Anatomy of the levator complex and lower lid retraccors Db. Miller muscle is inserted into the upper border of the 5. Lower lid retractors 4. The inferior tarsal aponeurosis consists of the capsulo- Fig. 1.3 Lymphatic drainage of the ids ~ Preseptalobiculeis {tarsus and can be approached transconjunctivally palpebral expansion of the inferior rectus muscle and is, ‘analogous to the levator aponcurosis.Eyelids 1b. The inferior tarsal musele is analogous to Maller muscle, 6. Lymphatic drainage (Fig. 1.3). The upper lid and lateral ccanthus drain Into the preauricular nodes, whereas the lower lid and medial canthus drain into the sub- ‘mandibular nodes Disorders of lashes Trichiasis Trichiasis is a very common acquired condition which may ‘eeur in isolation or as a result of scarring of the lid margin secondary to chronic blephartis, herpes zoster ophthalmicus and trachoma Trichiasis should not be mistaken for pseudo trichiasis secondary to entropion because in some cases the ng of the eyelid may be intermittent and the condition may be mistaken for true trichiasis and inappropriately treated, lous Signs Posterior misdirection of lashes arising from normal sites of origin (Fg. 1). Trauma to the corneal epithelium may cause punctate epithelial erosions and ocular irritation made ‘worse on blinking. Corneal ulceration and pannus formation ‘ay occur in severe long-standing cases, Treatment 1. Epitation with forceps is simple and effect recurrences within 4-6 weeks are inevitable. 2, Electrolysis is useful for a few isolated lashes but is {edious and frequently multiple treatments are required to obtain a satisfactory result. An electrocautery needle is inserted down the shaft of the lash root and current applied until coagulated tissue bubbles to the surface (Pig. 1.5). The lash is then removed, Retreatment for AEE Fig. 15 ‘Treatment of trichiasis by electrolysis (Courtexy of Wimer nets) recurrences is required in about 40% of cases and ean 3. Cryotherapy is very eflective in eliminating many lashes (Fig. 1.6), With a special cryoprobe a double freeze-thaw cycle at -20°C is applied, Potential complications Include skin necrosis, depigmnentation in dark-skinned individuals, ‘damage to meibomian glands, which may adversely affect film, and shallow notching of the lid seful for a few scattered lashes ‘and is performed as follows: a, The initial settings are 50 ym, 0.2 seconds and 1000 mW . The laser is fired at the root of the lash and a crater formed mall Fig. 1.6 “Treatment of trichiasis by cryotherapy (Courey of Winer Inst)