1. Disorders of the eyelids
Švehlíková G.
Department of Ophthalmology LF UPJS v Košiciach
Prednosta: prof. MUDr. Juhás T., DrSc.

2. Examination – inspection of tarsal conj., fornix, the bulbar conj.

3. The eyelid malposition
Ectropion
Entropion
Ptosis

4. Ectropion The eyelid is everted away from the globe
- Involutional – predisposing factors – laxity of the palpebral skin, laxity of eyelid, weaknes of the fascia and elongation of the medial and lateral cantal tendom

5. Involutional ectropion
Medial portion of the lower eyelid with lover punctum is everted
Epiphora
Dermatitis – iritation by frequent rubbing

6. Paralytic ectropion Facial nerve palsy Atony of the orbicularis muscle
Lagophthalmus
Complications . secondary conjunctivitis, exposure keratopathy

7. Mechanical ectropion
Fibroma in the lover eyelid

8. Cicatrical ectropion
Scarring or contraction of the skin

9. Surgical technique
The eyelid is shortened by an excision of full- thickness wedge

10. Entropion
- inward turning of the eyelid and contact of eyelashes with cornea and conjunctiva

11. Surgical correction of involutional entropion

12. Ptosis
1. neurogenic p. - acquired or cong. innervation defect ( third n. palsy, Horner sy.)
2. myogenic p ( myastenia gravis, myotonic dystrophy )
3. aponeurotic p ( involutional )
4. mechanical p.

13. Aponeurotic ptosis - age – weakness of the aponeurosis of the levator muscle

14. Myogenic ptosis – myastenia gravis – pac. activates the frontalis m
Myogenic ptosis – myastenia gravis – pac. activates the frontalis m., and backward position of the head

15. Eyelid allergic disorders

16. Contact dermatitis Sensitivity to topical medication Severe itching
Erytema
Edema of the eyelid skin
Changes are restricted to the area of contact between skin and the noxious agent
Th- steroid

17. Acute allergic oedema Insect bites, angiooedema, urticaria
Bilateral, painless oedema
Th - systemic antihistamines

18. Infections

19. HS blepharitis uncommon
bilat. upper and lower eyelids herpes simplex v. infection
small vesicles, rupture, crusts
occasionaly associated with conjunctivitis
th – acyclovir cream

20. Herpes zoster
Skin lesions follows the first division of the trigeminal nerve
An involvement of the nasociliary nerve indicates ocular involvement
Th – systemic and topical

21. The lid margin glands
Meibomian glands – modified sebaceous g., located in the tarsal plate – lipid layer
Glands of Zeis – modif. sebaceous g., associated with the lash follicles
Glands of Moll – modif. sweat g., ducts open either into lash follicle or onto the ant. Lid margin

22. Hordeolum Acute inflamation of the gland of Zeis or Moll
swelling, erytema, pain

23. Chalasion chronic granulomatous inflamation of Meibomian gland
painless, roundish lesion in the tarsal plate
treatment - incision

25. Eyelid tumors

26. Binign tumors
Cyst of Zeis
Xantelasmas

27. Papilloma
Hemangioma

28. Nevus
Surgical approach for resection

29. Malignant tumors
Nodular basal cell carcinoma
Squamous cell carcinoma

30. Malignant melanoma

31. conjunctiva

32. anatomy layers - epitelium, stroma
the mucin secretors ( Goblet cells, crypts of Henle, glands of Manz)
accessory lacrimal gl. of Krause and Wolfring

33. Inflammation

34. Conjunctivitis
Symptoms – lacrimation, irritation, burning, photophobia
Discharge-
watery- acute viral, acute allergic inf.
mucoid – vernal conj., keratoconj. Sicca
purulent – acute bact. inf.
mucopurulent – mild bact., chlamydial inf.

35. Conjunctival appearance
Hyperplasia of lymphoid tissue within the stroma
Follicular reaction
Viral inf.
Chlamydial inf.
Hypersensitivity to topical medication

36. Allergic conjunctivitis Bacterial inf. Contact lens-related problems
Hyperplastic conj. epitelium
Papillary reaction
Chronic blepharitis
Allergic conjunctivitis
Bacterial inf.
Contact lens-related problems

37. Membranes – beta- haemolytic str., diphtheria
Pseudomembranes – severe adenoviral inf., gonococcal inf.
Oedema - chemosis

38. Bacterial conjunctivitis
Staph. epidermidis, Staph. aureus, Strep. pneumoniae, H. influenzae, Moraxella
presentation – acute redness, burning, discharge – mucopurulent,
on waking – the eyelids are stuck together
hyperemia – max. in the fornices
Th- ATB drops and ointment

39. Adenoviral keratoconjunctivitis
Pharyngoconjunctival fever – children – respiratory tract inf.
Epidemic keratoconj. – no system. sympt.
acute watering, redness, photophobia
follicular reaction, hyperemia, oedema
discharge – watery
lymph node swelling
risk of corneal involment
Th- symptomatic, resolution spontaneous within 2 weeks

40. Trachoma population with poor conditions of hygiene
Chlamydia Trachomatis
scarring of upper tarsal conj.
population with poor conditions of hygiene
chronic conj. inflam., keratitis, progressive conj. scarring.

41. entropion, trichiasis, blindness
Th – azitromycin + hygiene
end-stage trachoma
entropion, trichiasis, blindness

42. Allergic conjunctivitis

43. Allergic rhinoconjunctivitis
hypersensitivity reaction to specific airborne antigens
frequently associated nasal symptoms
seasonal – allergens are pollens
perennial – allergens – house-dust mites, animal dander – symptoms throughout the year

44. presentation – acute itchy watery eyes, sneezing, watery nasal discharge
oedema of the eyelids
milky appearance of conj.
Th – either a topical mast cells stabilizer (nedocromil )
or a topical antihistamine ( azelastin )

45. Vernal keratoconjunctivitis
uncommon, recurent, bilateral inflamation affecting children and young adults, more common in males, resolves around puberty, rarely persist beyond the age of 25y.
cell-mediated immune mechanisms play important role
¾ patients have associated atopy

46. Vernal keratoconjunctivitis
symptoms – ocular itching, lacrimation, photophobia, foreign body sensation, burning, mucus discharge
clinical types:
palpebral
limbal
mixed

47. Limbal VKC Palpebral VKC
Hyperemia, diffuse papillary hypertrophy
Limbal VKC
Mucoid nodules, composed predominantly of eosinophils

48. Th- mast cell stabilizers , topical steroids.
Punctate epitelopathy
Macroerosion

49. Atopic keratoconjunctivitis
rare
typically affects young patients with atopic dermatitis
characteristic skin changes + astma, urticaria, migraine, rhinitis
ocular symptoms similar to VKC

50. Keratoconjunctivitis sicca
tear film – layers :
a.- lipid – to retard evaporation
b.- aqueous – to supply atmospheric oxygen to the avascular corneal epith., antibacterila f., wash away debrits
c.- mucin – to convert the corneal epith. from a hydrophobic to a hydrophilic surface

51. Causes of a dry eye
atrophy and fibrosis of lacrimal tissue – Sjogren sy – prim. or sec. ( associated with rheumatoid arthritis, SLE, syst. sclerosis, psoriatic arthritis, juvenile chron. arthritis, polymyositis)
destruction of lacrimal tissue ( tumors, chron. inflamm.)
Meibomian gland dysfunction
blockage of the excretory ductules as a result of severe conj. scaring
Clinical features
Irritaion, a foreign body sensation, burning, transient blurring vision, tired or heavy feeling to the eyelids

52. Special tests
Break-up time test – assesse precorneal tear film stability
Schirmer test – mesuring the amount of secretion

53. Pterygium degenerative lesion conjunctiva grown over the limbus
unknown etiology
Th- surgical

54. Conjunctival naevus benign, usualy unilateral
signs of potential malignancy - -sudden increase in pigmentation or growth

55. Conjunctival melanoma
rare
solitary black or grey nodule which is fixed to episclera

56. Conjunctival papiloma

57. Squamous cell carcinoma
Conjunctival Kaposi sarcoma

58. Questions and discussion

59. Thank you for your attention !