1. بسم الله الرحمن الرحيم

2. The eyelids
The eyelids are the moving folds of skin that cover the outer portion of the eyeball. Which protect the eye from injury and excessive light, and prevent excessive dryness of the cornea and conjunctiva
Macroscopic anatomy :-
1. The palpebral fissure
2.The canthi

4. Microscopic Anatomy The eyelid is formed of 6 layers :- 1. Skin
2. Subcutaneous areolar layer
3. Muscular layer
4. Sub muscular layer
5. Tarsus
6. Palpebral conjunctiva

6. The lid margin
It is about 2mm broad it had external and internal portion divided by gray line. it is divided into 2 portions :-
a. Lacrimal portion: in which content lacrimal papillae
b. Ciliary portion: in which eyelashes are present

7. The muscles of the lid 1. Orbicularis oculi muscle :-
a. Orbital portiona.
b.Palpebral portion
c. Horner’s muscle
2. Lavator palpebrae superioris muscle
3. Muller’s muscle

8. The gland of the lid
Meibomian gland
Zeis gland
Moll’s gland

9. Blood supply of the eyelid
Arteries
1. Superior and inferior medial palpebral arteries from the ophthalmic artery
2. Superior and inferior lateral palpebral arteries from the lacrimal artery
the above two anastomose to form two tarsal arcades in the upper lid and one tarsal arcade in lower lid
3. Branches from superficial temporal and facial arteries

10. Veins:-
Pre tarsal and post-tarsal plexus draining into the ophthalmic vein.
Lymphatic drainage of eyelids
Medial 1/3 drains to the sub maxillary lymph nodes
Lateral 2/3 drain to the pre auricular and parotid lymph nodes

11. Nerve supply of eyelids
Sensory : ophthalmic division of the trigeminal nerve(V1) through the supra orbital, supra trochlear, infra trochlear and lacrimal branches.
maxillary(V2) through the infraorbital branch..
2. Motor : 3rd ,7th and sympathetic fibers supply the levator ,orbicularis and Muller’s muscle respectively.

12. Diseases of the lids Congenital anomalies of the lids
Inflammation of the lids
Deformities of the lid margin and palpebral aperture
Tumours of the lids

13. Congenital Anomalies of Eyelids
Ablepharon: extremely rare congenital defect
Microblepharon
Cryptophthalmos: in which a fold of skin pass continuously from the eyebrow over the eye to the cheek
Ptosis

14. 5. Epicanthus: frequently bilateral and often associated with ptosis
6. Distichiasis: extra posterior row of cilia is present
7. Coloboma of the lid: a notch is usually situated at the junction of the middle third and the medial third
8. Entropion and Ectropion

17. Lid Edema Traumatic edema Inflammatory edema Non inflammatory edema
a. Allergic angioneurotic edema
b. Passive systemic edema

19. Inflammations Of The Lid
A- Inflammations of the lid itself (lid abscess)
B- Inflammations of the lid margin (blepharitis)
C- Inflammations of the glands of the lid (external hordeolum, internal hordeolum and chalazion)

20. A- LID ABSCESS It is a localized suppurative inflammation of the lid
Clinical picture: A painful, red, hot and tender swelling within the lid.
Treatment:
Systemic and local antibiotics
Surgical drainage by a transverse incision
(better cosmetically). Vertical incisions should be avoided as they may lead to shortening on fibrosis

22. B- BLEPHARITIS
Blepharitis usually presents as a chronic blepharoconjunctivitis and it is the most common external eye disorder in clinical practice
Types:
Anterior blepharitis.
Posterior blepharitis.

23. 1. Anterior Blepharitis A- staphylococcal blepharitis
- hard scales and crusting around the base of lashes.
- mild papillary conjunctivitis.
- scarring and notching of lid margin, madarosis, trichiasis and poliosis.
- marginal keratitis.
- tear film instability and dry eye.

24. B- Seborrhoeic Blepharitis
Hyperaemic and greasy anterior lid with sticking together of lashes.
The scale are soft and located anywhere on the lid margin and lashes.

26. Treatment
Lifelong treatment may be necessary and that a permanent cure is unlikely:
1- Lid hygiene.
2- Antibiotics:
a- topical: like sodium fusidic acid, bacitracin or chloramphenicol
b- oral: like azithromycin 500 mg for three days.
3- Weak topical steroid.
4- Tear substitute.

27. Posterior Blepharitis
Is caused by meibomian gland dysfunction and alteration in meibomian gland secretion.
- Excessive and abnormal meibomian gland secretion
- Plugging of the meibomian gland orifices.
Expression of meibomian fluid by pressure.
Tear film is oily.
Papillary conjunctivitis and inferior corneal punctate epithelial erosions.

28. Treatment Inform the patient that cure is unlikely 1- Lid hygiene.
2- Systemic tetracycline.
a- Oxytetracycline 250 mg b.d. for week.
b- Doxycycline 100 mg b.d. for one week and then daily for 6-12 wk.
c- Minocycline
d- Erythromycin
3- Topical therapy (AB, steroid and tear substitute).

29. Inflamation of eyelids glands 1.Stye: (Hordeolum externum)
Acute suppurative inflammation of Zeis gland and the lash follicle, forming a small abscess
Treatment: application of antibiotic ointment and removal of the affected cilium

31. 2. Hordeolum internum
Acute suppurative inflammation of the meibomian gland caused by staphylococcus aureus. It may be primary or it may occur on top of a chronic inflammation of the meibomian gland (chalazion)
Treatment: surgical drainage

33. Chalazion (cyst)
It is chronic non-specific inflammatory granuloma of a meibomian gland.

34. Deformities of the lid margin and palpebral aperture
Trichiasis
Entropion
Ectropion
Symblepharon
Ankyloblepharon
Blepharophimosis
Lagophthalmos
Ptosis

35. TRICHIASIS Misdirection of eye lashes. Etiology
Congenital trichiasis: often in all 4 lids.
It is called distichiasis. In this condition, an extra row of lashes is present behind the gray line in the place of the ducts of the meibomian glands.

37. 2. Acquired trichiasis: may be caused by the following:
Trachoma is the commonest cause due to fibrosis distorting the hair follicles
Ulcerative blepharitis
Burns

38. Entropion Definition:
Entropion is the rolling inwards of the eyelid. The whole row of the lashes will be rubbing against the cornea and finally there will be a deformity of the tarsus.

40. Types: Cicatricial (fibrotic) entropion Spastic entropion
Involutional (senile) entropion
Congenital entropion

41. ECTROPION Definition:
Ectropion is rolling outwards of the eyelid from the globe. It usually affects the lower lid as it stands against gravity.

43. Types:
Involutional (senile) ectropion
Cicatricial (fibrotic) ectropion
Paralytic ectropion
Mechanical ectropion
Congenital ectropion

44. Symblepharon
A condition where adhesion develops between the lid and the eyeball. Due
Membranous conjunctivitis
Chemical burns ulcers
Operation

46. Ankyloblepharon
Is the adhesion of the margins of the uper and lower lid either due
Congenital
Acquired condition due to burn

47. Blepharophimosis Is the narrowing of the palpebral aperture
Often congenital