Eyelids

Dr.Abdurahman
 Anatomy and Physiology
• The eyelids are vital to the maintenance of ocular
surface integrity.
Functions:
-Act to protect the anterior surface of the globe
from local injury. 
- Sweeping mechanism to remove debris from the
cornea ( blink reflex).
- Production and drainage of the tear film
- Facial expression
 Anatomy and Physiology
• The lids comprise a layered structure of skin,
orbicularis oculi, tarsal plate, and conjunctiva.
• The interpalpebral fissure is usually 30 mm
wide and 10 mm high
• The eye lashes are slightly more numerous in
the upper (100) than lower(50).
• Lid retractors: levator palpebrae superioris
(LPS) andMuller’s muscle.
 Chalazion
• A chalazion (meibomian
cyst):a chronic, sterile,
granulomatous inflammatory
lesion caused by retained
sebaceous secretion leaking
from the meibomian gland
• Presentation:at any age with
a gradually enlarging painless
nodule.
• Treatment: sugical or steroid
injection.
 External hordeolum (Stye)
• Acute staphylococcal abscess
of a lash follicle.
• More common in children
and young adults.
• Signs: A tender swelling in
the lid margin pointing
anteriorly through the skin.
• Treatment: hot compresses ,
epilation of the associated
lash, and topical antibiotic
drops/ointment.
 Trichiasis (1)
-Lashes arise from their normal position but are
posteriorly directed.
- may occur in isolation or as a result of scarring of
the lid margin secondary to chronic blepharitis and
herpes zoster ophthalmicus.
- Presents with ocular irritation worsened by blinking.
- Complications: Corneal ulceration and pannus
formation.
- Treatment options include Epilation with forceps,
Electrolysis, Argon laser ablation or surgery.
Trichiasis (2)
 Blepharitis (1)
• Blepharitis is inflamation of lid margin
• Anterior lid margin disease: seborrheic or staph
blepharites
• Posterior lid margin disease: Meibomianitis
• Symptoms: burning, itching, redness, tearing.
• Signs: crusting, lid thickening, oil globules, poating
of Meibomian glands
• Treatment: include lid hygiene, Topical antibiotics
and or oral systemic antibiotics.
Blepharitis (2)
 Ptosis
• Ptosis is an abnormally
low position of the
upper lid which may be
congenital or acquired.
• Eatiology: Neurogenic,
Myogenic, Aponeurotic
or mechanical.
Oculomotor nerve palsy
 Herpes zoster ophthalmicus
• Common, unilateral infection caused by
varicella-zoster virus
• Primary infection is chicken pox
• Presents with pain in the distribution of the
first division of the trigeminal nerve
 Signs A maculopapular rash on the forehead
• Progression through vesicles and pustules to
crusting.
• Periorbital oedema may spread to the other
side, giving the erroneous impression that the
condition is bilateral.
-Ocular complications include corneal ulcer,
uveitis,
 Herpes zoster ophthalmicus
 Treatment:
-oral acyclovir and topical
acyclovir
-warm compressess
- Analgesia
 Orbital Celluitis(1)
• Definition:inflammation
of eye tissues behind
the orbital septum.
• Bacterial orbital
cellulitis is a life-
threatening infection
• occur at any age but is
more common in
children
 Orbital Celullitis(2)
• The most common causative organisms are S.
pneumoniae, S. aureus, S. pyogenes and H. influenzae.
• Presentation is with the rapid onset of severe malaise,
fever, pain and visual impairment.
• Signs: Unilateral tender warm and red periorbital and
lid oedema, proptosis, painful ophthalmoplegia and
optic nerve dysfunction.
• Complications:Exposure keratopathy, optic nerve
atrophy, endophthalmitis, Meningitis, cavernous sinus
thrombosis, brain abcess and subperiosteal abscess .
 Orbital Cellulitis(3)
• Management:
- Hospital Admission
- Antibiotic therapy
.investigations: white cell count, blood culture,
and CT scan.