HALIMAH PAGARRA

DEPARTMENT OF OPHTHALOMOLGY
FACULTY OF MEDICINE
HASANUDDIN UNIVERSITY
2009

EYELID AND ADNEXAL DISEASE
EYELID
DISORDERS
CONGENITAL
ACQUIRED
Congenital anomalies
Blepharophimosis Syndrome
Euryblepharon
Ankyloblepharon
Epicanthus
Coloboma
Ectropion
Entropion
Distichiasis
Ptosis

Acquired Eyelid Disorders
- Chalasion
- Hordeoulum
- Eyelid Edema


Periocular malposition

-Entropion

-Ectropion

-Ptosis
CLASSIFICATION OF EYELID
DISORDERS

A. CONGENITAL ANOMALIES
- Associated with other eyelid, facial, or
systemic anomalies.
- Occur during the 2nd month of gestation
failure of fusion or an arrest of
development
- Eyelid
a. Anterior lamelar :
skin and Orbikularis muscle
b.Posterior Lamelar
Tarsal and conjunctiva
ANATOMY of the EYELIDS
7 Structural layers:
1. Skin & subcutaneous tissue
2. Muscle of protraction (Orbicularis Oculi)
3. Orbital septum
4. Orbital fat
5. Muscle of retraction (levator)
6. Tarsus
7. Conjunctiva
CONGENITAL
ANOMALIES

1. Blepharophimosis Syndrome
- blepharophimosis, epicanthus
inversus, telecanthus and ptosis.
- palpebra fissure are shortened
horizontally and vertically with
poor levator function and no eyelid fold.
- horizontal palpebra fissure length 25-30 mm is
reduced
18-22 mm in these patient




- .
CONGENITAL..
2. Congenital Ptosis of the Upper Eyelid
- Ptosis drooping or inferodisplacement of
the upper eyelid.
- Caused by maldevelopment of the levator
muscle is characterized
- by decreased levator function, eyelid lag,
and sometimes lagophthalmos.

CONGENITAL .
3. Congenital Ectropion
- Caused by a vertical insufficiency of
the anterior lamella of the eyelid.
- Characterized by eversion of the
eyelid margin, if severe may give rise to
chronic epiphora and exposure keratitis.


Congenital Entropion
inward rotation of the margins of the upper
and lower eyelids
is a frequent finding in Asian populations and
is usually asymptomatic
CONGENITAL..

4. Euryblepharon
- Enlargement of the lateral part of the palpebra
aperture with downward displacement of the
temporal half of the lower eyelid.
- Very wide palpebral fissure or a droopy lower
eyelid.

CONGENITAL.

5. Ankyloblepharon
- Partial or complete fusion of the eyelids by
webs of skin.
- A variant is ankyloblepharon filiforme
adnatum, in which the eyelid margins are
connected by fine strands.
CONGENITAL..
6. Epichantus
- is a medial canthal fold that may result from
immature midfacial bones or a fold of skin and
subcutaneous tissue.
- 4 types of epicanthus :
epicanthus tarsalis if the fold is most
prominent in the upper eyelid
epicanthus inversus if the fold is most
prominent in the lower eyelid
epicanthus palpebralis if the fold is equally
distributed in the upper and
lower eyelids
epicanthus supraciliaris if the fold arises
from the eyebrow region running
to the lacrimal sac
CONGENITAL..
7. Epiblepharon

- the lower eyelid pretarsal muscle and skin ride
above the lower eyelid margin to form a horizontal
fold of tissue that causes the cilia to assume a
vertical position.
CONGENITAL..
9. Congenital Distichiasis
- A partial or complete accessory row of
eyelashes growing
out of or slightly posterior to the meibomian
gland orifices.
- Occurs when embryonic pilosebaceous units
improperly
differentiate into hair follicles.

CONGENITAL..
10. Congenital Coloboma
- An embryologic cleft that is usually an isolated
anomaly
when it occurs in the medial upper eyelid.
- The eye of an infant with a congenital
coloboma should be
observed for exposure keratopathy,which
uncommon.


CONGENITAL.
11. Congenital Eyelid Lesions
a. Capillary hemangioma
- Usually appear over the first weeks or
months of life

b. Cryptophthalmos
- is a rare condition that presents with partial
or
complete absence of the eyebrow,
palpebra fissure,
eyeleshes and conjunctiva. May be
unilateral or
bilateral.
1. Chalazion
- a type of focal inflammation of the eyelids,
can result
from an obstruction of the meibomian
glands.
- usually first appears as a firm, tender,
erythematous
lump in the tarsal plate.
- painless





B. ACQUIRED EYELID DISORDERS

Chalazion
R/
- Management is generally hot
compresses and good eyelid hygiene.
- If do not resolve can be managed by
incision and
curretage.

. Hordeolum
- An acute infection (usually
staphylococcal) can involve the
sebaceous secretions in the glands of
zeis,molle and wall palpebra(external
hordeolum or stye) or the meibomian glands
(internal ordeolum).

External Hordeoum Internal Hordeolum
2. Hordeolum
- Spontaneous resolutions often occurs.
- Hot compresses and topical
antibiotic ointment is usually curative.
- May progress to true superficial
cellulitis, or even abscesses of the
eyelid.
3. Eyelid Edema
- Caused by local conditions such as
cardiovascular disease,
renal disease, certain collagen vascular
diseases, or graves
disease.
- Cerebrospinal fluid leakage in to the orbit or
eyelids
following trauma may mimic eyelid edema.

4. Floppy Eyelid Syndrom
- Characterized by chronic papillary
conjunctivities,
easily everted, flaccid upper eyelids and
non spesific
irritative symptoms.
R/ : Initial conservative treatment with viscous
lubrication and patching or an eyelid shield is
helpful.


PERIOCULAR MALPOSITION
- ECTROPION
- ENTROPION
- PTOSIS
Ectropion
Definition: Ectropion refers to the condition in
which the margin of the eyelid is turned away
from the eyeball. This condition almost exclusively
affects the lower eyelid.

The following forms are differentiated according to
their origin :
Congenital ectropion.
Senile ectropion.
Paralytic ectropion.
Cicatricial ectropion.
Mechanical
Types of ectropion
Involutional
Cicatricial
Paralytic
Mechanical
Preoperative assessment
Postition of maximal ectropion
Medial canthal tendon laxity
Lateral canthal tendon laxity
Horizontal lid laxity
Surgical procedures for involutional
ectropion
A, Medial spindle procedure:
outline of excision of
conjunctiva and retractors.
B, Lateral tarsal strip procedure:
anchoring of tarsal strip to
periosteum inside lateral orbital rim
Entropion
Definition: Entropion is characterized by
inward rotation of the eyelid margin.
The margin of the eyelid and eyelashes or even
the outer skin of the eyelid are in contact with the
globe instead of only the conjunctiva. The
following forms are differentiated according to
their origin
1. Congenital
2. Acute spastic
3. Involutional
4. Cicatricial
Involutional entropion
Affects lower lid because upper lid
has wider tarsus and is more
stable
If longstanding may result in corneal
ulceration
Treatment options for involutional entropion
Transverse everting
sutures (temporary)
Weis procedure
(permanent)
(for recurrences)
Jones procedure
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
Treatment options for cicatricial entropion
Corneal protection from lashes by epilation or contact lenses
Tarsal fracture procedure for mild cases
Mucous membrane grafts to replace contracted conjunctival
tissue for severe cases
PTOSIS
Blepharoptosis

Ptosis drooping/inferodisplacement of any
anatomic structure

BLEPHAROPTOSIS drooping/
inferodisplacement of the upper eyelid

Pseudoptosis apparent eyelid drooping
abnormally low: hypermetropia, enophthalmos,
microphthalmos, phthisis bulbi, superior sulcus
defect (ec trauma), contralateral upper eyelid
retraction, dermatochalasis
PTOSIS
Blepharoptosis

Ptosis drooping/inferodisplacement of any
anatomic structure

BLEPHAROPTOSIS
drooping/ inferodisplacement of the upper
eyelid

Pseudoptosis apparent eyelid drooping
abnormally low: hypermetropia, enophthalmos,
microphthalmos, phthisis bulbi, superior sulcus
defect (ec trauma), contralateral upper eyelid
retraction, dermatochalasis
Cause myogenic
aponeurotic
neurogenic
mechanical
traumatic
Acquired Ptosis
Mechanical Ptosis
Bilateral asymmetric congenital ptosis
Levator aponeurosis defect/aponeurotic ptosis
Physical Examination
4 clinical measurement:
vertical interpalpebral fissure height
margin-reflex distance
upper eyelid crease position
levator function (upper eyelid excursion)
Distance between upper and lower lid margins
Normal upper lid margin rests about 2 mm below upper limbus
Normal lower lid margin rests 1 mm above lower limbus
Amount of unilateral ptosis is determined by comparison
Vertical fissure height
Marginal reflex distance
Distance between upper lid
margin and light reflex (MRD)
Mild ptosis (2 mm of droop)
Moderate ptosis (3 mm)
Severe ptosis (4 mm or more)
Upper lid crease
Distance between lid margin and
lid crease in down-gaze
Normals - females 10 mm;
- males 8 mm
Absence in congenital ptosis
indicates poor levator function
High crease suggests an aponeurotic
defect
Distance between lash line and skin
fold in primary position of gaze
Pretarsal show
crease
fold
Upper lid excursion
Reflects levator function
Normal (15 mm or more)
Good (12 mm or more)
Fair (5-11 mm)
Poor (4 mm or less)
PTOSIS DATA SHEET

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