Chapter 3 · Chapter 3 Skills 20-27 . Slides edited by Argyrios Tzamalis , MD, PhD, MA, FEBO . ......
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Transcript of Chapter 3 · Chapter 3 Skills 20-27 . Slides edited by Argyrios Tzamalis , MD, PhD, MA, FEBO . ......
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Eyelids
Orbit
Lacrimal duct
Chapter 3
Skills 20-27
Slides edited by Argyrios Tzamalis, MD, PhD, MA, FEBO
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TS 20 : Eyelid Functions
a) Mechanical protection of globe
b) Even tear dispersion on ocular surface
c) Lipid secretion - enrichment of tears
d) Lacrimal pump drains the tears
during blinking of eyelids
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Anterior lamella: i. Skin ii. Orbicularis m.
Posterior lamella: i. Tarsal plate ii. Conjunctiva
• Glands Moll, Zeiss, Meibomius
• Muscles a. Levator palpebrae superioris b. Müller c. Lower lid retractors (ligaments & fascias) d. Orbicularis
Eyelids : Anatomical Landmarks
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Motor supply of eyelids
• ΙΙΙ rd cranial nerve
Levator palpebrae m.
• Sympathetic supply
Μüller muscle
• VII nth cranial nerve
Orbicularis oculi m.
Opening Closure
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TS 21 : Lid position alterations
The student should be able to:
• Recognize Lagophthalmos, Ptosis, Entropion /ectropion and address their aetiology
• Describe possible sequelae of the above conditions on ocular surface and cornea
• Explain why severe unilateral ptosis necessitates surgical correction in children younger than 10y
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Lagophthalmos Incomplete closure
of eyelids
Ptosis Droopy upper lid
Ectropion Rolling out of the lid
Entropion • Rolling in of the lid
Malpositions of eyelids
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Congenital Ptosis
CAUTION !!!
• Needs surgical correction when interfering with vision in kids • High risk for
amblyopia
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• Myogenic • i.e. Myasthenia Gr.
• Neurogenic • i.e. III rd palsy
• Mechanical • i.e. tumors
• Aponeurotic
Ptosis : Causes
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The student should be able to…
• Describe the VZV-related
ophthalmic pathology and its management
• Explain pathophysiology of ocular involvement • Gasserian ganglion
TS 22 : Eyelid Skin
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The students should …
• Recognize stye and explain its
pathophysiology (inflammation
of the base of cilia)
• (Removal of involved eyelash)
• Diagnose chalazion and
differentiate it from stye
TS 23 : Eyelid glands
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Exophthalmometre measurements
Causes
Orbital inflammation
Orbital tumors
AV shunts
Thyroid Eye Disease
D/D of inflammatory dis.
CT/MRI
TS 24 : Orbit - Exophthalmus
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TS 25 : Thyroid Eye Disease
Pathogenesis: Autoimmune disease
T lymphocytes vs thyroid-presented antigens
Involved tissues: Orbital fat, extraocular
muscles, eyelids
Severity grading 1: mild lid oedema, conjunctival injection
2: + lid retraction
3: + ocular motility disturbances
4: + compressive optic neuropathy
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Thyroid Eye Disease
Clinical presentation
• Proptosis • Lid retraction (Dalrymple) • Upper lid lag (von Graefe) • Reduced blinking rate • Lid oedema • Conjunctival chemosis & oedema • Punctate keratopathy • Diplopia due to motility disturbances • Rise of intraocular pressure
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TS 25 : Orbital inflammations
D/D between pre-septal & orbital cellulitis
Preseptal cellulitis Marked lid oedema
Mechanical ptosis
Orbital cellulitis + restriction of ocular motility
+ globe proptosis
Serious condition! Requires Hospital admission
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Tear Functions
Nourishing and oxygenation of outer corneal layers (avascular tissue)
Maintain smoothness and homogenity of refractive corneal surface
Chemical and mechanical protection of ocular surface (enzymatic action , wash-out)
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Dry Eye - Epiphora
Dry Eye Syndrome:
• Quantitative (reduced aqueous
secretion) or/and qualitative (reduced
mucin or lipid composition) tears
deficiency
Watery Eye:
• Excess lacrimation (increased
production or/and reduced drainage)
Epiphora:
• Spill over of tears
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TS 27 : Tear Drainage
• Congenital nasolacrimal duct obstruction
Mucous discharge, epiphora
Massage, antibiotics until the age of 18 months
Nasolacrimal duct probing
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TS 27 : Dacryocystitis
Acute
• Rapid progress
• Marked oedema
• Sensitivity, pain
Antibiotics per os
Chronic
• Epiphora
• Mucopurulent discharge
• Unilateral conjunctivitis
Dacryocystorrhinostomy
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Electronic Referrals – 3rd Chapter
1. http://emedicine.medscape.com/article/834932-overview
2. http://www.revophth.com/content/d/plastic_pointers/c/38692/
3. http://emedicine.medscape.com/article/1212082-overview
4. http://www.aafp.org/afp/2002/1101/p1723.html
5. http://www.optometry.co.uk/uploads/articles/0e8005e0bc2e021ee066d330df17d893_skorin20020628.pdf
6. http://emedicine.medscape.com/article/1218575-overview
7. http://emedicine.medscape.com/article/1218444-overview
8. http://www.patient.co.uk/doctor/orbital-and-preseptal-cellulitis
9. http://eyewiki.aao.org/Nasolacrimal_Duct_Obstruction,_Congenital
10. http://emedicine.medscape.com/article/1210688-overview