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Lid Problems; significant and trivial
Miss Carole Jones Oculoplastic Surgeon EEMU July 2010
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Lid Problems; significant and trivial
Lid Tumours Benign and malignant Lid Malposition Entropion Ectropion Ptosis EEMU July 2010
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Lid Tumours EEMU July 2010
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Epidermis Sebaceous glands Sweat glands Hair follicles Melanocytes
Neural Vascular Lymphoid Mucous membrane EEMU July 2010
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Cystic Lesions; Meibomian, Sebaceous
EEMU July 2010
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White dots; Milia, Molluscum
EEMU July 2010
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Hair Follicle; Pilomatrixoma of Malherbe
EEMU July 2010
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Naevi EEMU July 2010
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Haemangioma EEMU July 2010
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Benign Epidermal Lesions
Seborrheic Keratosis Actinic Keratosis Keratoacanthoma EEMU July 2010
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Malignant Epidermal Lesions
BCC SCC Sebaceous Gland Carcinoma Merkel Call Tumour EEMU July 2010
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Signs of Significance EEMU July 2010
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Signs of Significance Colour Contour EEMU July 2010
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Signs of Significance Distortion Destruction EEMU July 2010
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Signs of Significance EEMU July 2010
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If in doubt..biopsy EEMU July 2010
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Tumour Biopsy Initial Punch Biopsy Incisional Biopsy if doubt
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Lid Malposition Entropion Ectropion Ptosis
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Lid Malposition Assess; Ectropion - syringe
cornea lid laxity medial canthal tone cicatrisation Ectropion - syringe Entropion - everting sutures if symptomatic
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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
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Entropion Orbicularis override Lid laxity Buckling of tarsal plate
Retractor dehiscence
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Medical Treatment Entropion
Ointments and Drops Taping Everting sutures Botox
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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
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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
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Classification of Ptosis
Neurogenic Myogenic Mechanical Aponeurotic Regional Study Day 2009 Frueh The Mechanical Classification of Ptosis. Ophthal 1980;87:
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Classification of Ptosis
Neurogenic Non localised Ophthalmoplegic migraine Cyclic oculomotor palsy Localised Third nerve Sympathetic nerve Synkinesis Regional Study Day 2009
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Classification of Ptosis
Neurogenic Non localised Ophthalmoplegic migraine Cyclic oculomotor palsy Localised Third nerve Sympathetic nerve Synkinesis Regional Study Day 2009
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Classification of Ptosis
Myogenic: Congenital levator dystrophy Myaesthenia Myopathy Myotonic dystrophy Regional Study Day 2009
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Classification of Ptosis
Mechanical Regional Study Day 2009
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Classification of Ptosis
Aponeurotic Regional Study Day 2009 Frueh The Mechanical Classification of Ptosis. Ophthal 1980;87:
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Lid Problems; significant and trivial
Lid Tumours Benign and malignant Lid Malposition Entropion Ectropion Ptosis EEMU July 2010
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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
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May all your lid problems be little ones!
Thank you
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