Lid Problems; significant and trivial Miss Carole Jones Oculoplastic Surgeon EEMU July 2010

Lid Problems; significant and trivial Lid Tumours Benign and malignant Lid Malposition Entropion Ectropion Ptosis EEMU July 2010

Lid Tumours EEMU July 2010

Epidermis Sebaceous glands Sweat glands Hair follicles Melanocytes Neural Vascular Lymphoid Mucous membrane EEMU July 2010

Cystic Lesions; Meibomian, Sebaceous EEMU July 2010

White dots; Milia, Molluscum EEMU July 2010

Hair Follicle; Pilomatrixoma of Malherbe EEMU July 2010

Naevi EEMU July 2010

Haemangioma EEMU July 2010

Benign Epidermal Lesions Seborrheic Keratosis Actinic Keratosis Keratoacanthoma EEMU July 2010

Malignant Epidermal Lesions BCC SCC Sebaceous Gland Carcinoma Merkel Call Tumour EEMU July 2010

Signs of Significance EEMU July 2010

Signs of Significance Colour Contour EEMU July 2010

Signs of Significance Distortion Destruction EEMU July 2010

Signs of Significance EEMU July 2010

If in doubt..biopsy EEMU July 2010

Tumour Biopsy Initial Punch Biopsy Incisional Biopsy if doubt

Lid Malposition Entropion Ectropion Ptosis

Lid Malposition Assess; Ectropion - syringe cornea lid laxity medial canthal tone cicatrisation Ectropion - syringe Entropion - everting sutures if symptomatic

Entropion Congenital Acquired; Involutional Cicatricial EEMU 2009 The layer with increased tension is evident on examination and allows classification of the type of lid malposition…In both congenital and involutional entropion overaction of the marginal orbicularis the cause of lid malposition EEMU 2009

Entropion Orbicularis override Lid laxity Buckling of tarsal plate Retractor dehiscence

Medical Treatment Entropion Ointments and Drops Taping Everting sutures Botox

Ectropion Cicatricial Paralytic Mechanical Involutional EEMU 2009 With increasing age attenuation of the canthal tendons and the lower lid retractors lead to lid laxity and the role of gravity in pulling a lax lid out of place is evident in ectropion. Any additional weight or cicatricial changes in the skin further promote the lid displacement. In facial palsy the lack of orbicularis tone results in the unopposed effect of gravity and a progressive and marked ectropion develops with distortion of the lid structures and loss of canalicular function. EEMU 2009

Ectropion Congenital EEMU 2009 With increasing age attenuation of the canthal tendons and the lower lid retractors lead to lid laxity and the role of gravity in pulling a lax lid out of place is evident in ectropion. Any additional weight or cicatricial changes in the skin further promote the lid displacement. In facial palsy the lack of orbicularis tone results in the unopposed effect of gravity and a progressive and marked ectropion develops with distortion of the lid structures and loss of canalicular function. EEMU 2009

Classification of Ptosis Neurogenic Myogenic Mechanical Aponeurotic Regional Study Day 2009 Frueh The Mechanical Classification of Ptosis. Ophthal 1980;87:1019-1021

Classification of Ptosis Neurogenic Non localised Ophthalmoplegic migraine Cyclic oculomotor palsy Localised Third nerve Sympathetic nerve Synkinesis Regional Study Day 2009

Classification of Ptosis Neurogenic Non localised Ophthalmoplegic migraine Cyclic oculomotor palsy Localised Third nerve Sympathetic nerve Synkinesis Regional Study Day 2009

Classification of Ptosis Myogenic: Congenital levator dystrophy Myaesthenia Myopathy Myotonic dystrophy Regional Study Day 2009

Classification of Ptosis Mechanical Regional Study Day 2009

Classification of Ptosis Aponeurotic Regional Study Day 2009 Frueh The Mechanical Classification of Ptosis. Ophthal 1980;87:1019-1021

Lid Problems; significant and trivial Lid Tumours Benign and malignant Lid Malposition Entropion Ectropion Ptosis EEMU July 2010

Lid Problems; significant and trivial Check for colour and contour Look for destruction or distortion Be suspicious of failure to heal If in doubt biopsy! EEMU July 2010

May all your lid problems be little ones! Thank you