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Anatomi Palpebra
KELAINAN PALPEBRA
INFEKSI DAN PERADANGAN
- Externum
Chalazion Blepharitis : - Squamosa
- Ulcerosa
BLEPHARITIS SQUAMOSA
HERPES ZOSTER
DERMATITIS ALERGY
Hordeolum
HORDEOLUM
CHALAZION
GRANULOMA
DEFORMITAS PELPEBRA
Coloboma palpebra
Epicanthus
Blepharochalasis Enteropion involutional,cicatrical,congenital Ecteropion + paralytic orbicularis occuli Blepharoptosis : neurogenic ;myogenic &
mechanical
Ptosis
Koloboma
Enteropion
Tumor Palpebra
Benign Tumors
Nevus Papiloma squamosa & Keratosis sebhoroic Capillary haemangioma Xanthelasma Molluscum contagiosum
Malignant tumors
Basal cell carcinoma Squamous cell carcinoma Meibomian gland carcinoma Melanoma Kaposi sarcoma
XANTHELASMA
NEVUS
Terapi
operatif
Radiasi
Krio terapi
Treatment of chalazion
Insertion of clamp
Acute hordeola
Internal hordeolum ( acute chalazion ) External hordeolum (stye)
Staph. abscess of lash follicle and associated gland of Zeis or Moll Tender swelling within tarsal plate Tender swelling at lid margin May discharge through skin May discharge through skin or conjunctiva
Molluscum contagiosum
Signs Complications
Xanthelasma
Common in elderly or those with hypercholesterolaemia Yellowish, subcutaneous plaques containing cholesterol and lipid Usually bilateral and located medially
Eyelid cysts
Cyst of Moll
Eccrine sweat gland hidrocystoma
Cyst of Zeis
Sebaceous cyst
Pedunculated
Sessile
Keratoses
Seborrhoeic Actinic
Common in elderly Discrete, greasy, brown lesion Friable verrucous surface Flat stuck-on appearance
Affects elderly, fair-skinned individuals Most common pre-malignant skin lesion Rare on eyelids Flat, scaly, hyperkeratotic lesion
Naevi
Appearance and classification determined by location within skin Tend to become more pigmented at puberty
Intradermal
Junctional
Compound
Elevated
Flat, well-circumscribed
Capillary haemangioma
Rare tumour which presents soon after birth May be associated with intraorbital extension Starts as small, red lesion, most frequently Grows quickly during first year on upper lid
Blanches with pressure and swells on crying Begins to involute spontaneously during second year
Periocular haemangioma
Treatment options
Steroid injection in most cases Surgical resection in selected cases
Associations
Ipsilateral glaucoma in 30% Sturge-Weber or Klippel-Trenaunay-Weber syndrome in 5%
Pyogenic granuloma
Cutaneous horn
Usually antedated by surgery or trauma Uncommon, horn-like lesion protruding Fast-growing pinkish, pedunculated or through skin sessile mass May be associated with underlying actinic keratosis or squamous cell carcinoma Bleeds easily
Lateral canthus - 5%
Less common but more aggressive than BCC May arise de novo or from actinic keratosis Predilection for lower lid
Nodular
Ulcerative
10% mortality
Nodular
Spreading
Diffuse thickening of lid Conjunctival invasion; may margin and loss of lashes mimic chronic conjunctivitis
Melanoma
Nodular Superficial spreading
Kaposi sarcoma
Vascular tumour occurring
in patients with AIDS Usually associated with advanced disease Very sensitive to radiotherapy Early Advanced
Involutional
Affects lower lid of elderly patients May cause chronic conjunctival inflammation and thickening
Preoperative assessment
Mild
Medial conjunctivoplasty
a b
Severe
Lazy-T procedure
Mild localized cases are treated by excision of scar tissue combined with Z-plasty
Mechanical ectropion
Mechanical lid eversion by tumour
Treatment
Removal of the cause, if possible Correction of significant horizontal lid laxity
Involutional entropion
Affects lower lid because upper lid has wider tarsus and is more stable
Overriding of preseptal over pretarsal orbicularis during lid closure Weakness of lower lid retractors
Cicatricial entropion
Severe scarring of palpebral conjunctiva which pulls lid margin towards globe May affect lower or upper eyelid Causes include cicatrizing conjunctivitis, trachoma and chemical burns
Congenital entropion
Very rare - not to be confused with epiblepharon Inturning of entire lower eyelid and lashes Absence of lower lid crease When skin is pulled down lid also pulls away from globe Does not resolve spontaneously
CLASSIFICATION OF PTOSIS
1. Neurogenic
Third nerve palsy Third nerve misdirection Horner syndrome Marcus Gunn jaw-winking syndrome Myasthenia gravis Myotonic dystrophy Ocular myopathies Simple congenital Blepharophimosis syndrome
2. Myogenic
3. Aponeurotic 4. Mechanical
Causes of pseudoptosis
Ipsilateral hypotropia
Poor (4 mm or less)
Opening of mouth
Blepharophimosis syndrome
Moderate to severe symmetrical ptosis Short horizontal palpebral aperture Telecanthus (lateral displacement of medial canthus) Epicanthus inversus (lower lid fold larger than upper) Lateral inferior ectropion Poorly developed nasal bridge and hypoplasia of superior orbital rims
Aponeurotic ptosis
Weakness of levator aponeurosis Causes - involutional, postoperative and blepharochalasis
Mild
Severe
Deep sulcus
Mechanical ptosis
Causes
Dermatochalasis
Large tumours
Lacrimal Apparatus
Pars Secretorius & excretorius
Eyelid Anatomy
Eyelid covered eye
Skin & subcutaneus tissue Muscle of protraction Orbital septum Orbital fat Muscle of retraction Tarsus
Conjunctiva