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    Aditya Islami

    I 11112009

    PALPEBRA ANDAPPARATUS LACRIMALIS

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    Subjets

    - Eyelids-  Anatomy

    - Chalazion and Hordeolum

    - Blepharitis

    - Congenital Malformations- Entropion, and Ectropion

    - Tumours and Malignancies

    -  Apparatus Lacrimalis-  Anatomy and Physiology

    - Ostruction

    - !nflammation

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    A!at"my

    - Protection from e"ternalsustance

    - #ecretion$ To maintainoptimal condition of the eye

    - Epidermis

    - %eratin Layer 

    - &ranular Cell layer 

    - Pric'le Cell Layer 

    - Basal Cell Layer 

    - (ermis) Component$

    - #eaceous &lands

    - Meiomian &lands

    - &land of *eiss

    - &land of Molls

    - Eccrine s+eat glands- Piloseaceous glands

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    C#ala$i"!

    Chalazion -meiomiancyst. sterile chronicgranulomatousinflammatory lesion-lipogranuloma. of themeiomian

    caused y retained

    seaceous secretions /ecurrent chalazion 001

    iopsy -to e"clude

    malignancy.

    Bowling B. Kanski's Clinical Ophtalmology; ASystematic Approach, Eight Edition. !"#.Else$ier% Sydney, A&stralia

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    C#ala$i"!

    #ymptoms #uacute2chronic$

    gradually enlarging painless

    rounded nodule Acute$ sterile inflammation

    or acterial infection +ithlocalized cellulitis

    #igns A nodule +ithin the tarsal

    plate, sometimes +ith

    inflammation3 Bulging in in4ol4ed gland A lesion at the anterior lid

    margin

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    C#ala$i"!

    Treatment 5 Oral Antiiotics

     5 #teroid !n6ection

     5 #urgery

    Bowling B. Kanski's Clinical Ophtalmology; ASystematic Approach, Eight Edition. !"#.Else$ier% Sydney, A&stralia

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    %"&de"lum

    E"ternal hordeolum -stye. 001acute staphylococcal ascessof a lash follicle and itsassociated gland of *eis

    Presents as a red tenders+elling in the lid marginpointing anteriorly through thes'in3

    Multiple lesions may e present

    Treatment in4ol4es topical-occasionally oral. antiiotics,hot compresses and epilation ofthe associated lash3

    Bowling B. Kanski's Clinical Ophtalmology; ASystematic Approach, Eight Edition. !"#.Else$ier% Sydney, A&stralia

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    't#e& Eyelid Cyst

    a. Cyst of *eiss$ ostructedseaceous glandsassociated +ith theeyelash follicle

    . Cyst of Moll$ smallretention cyst of the lid

    margin apocrine glandsc. #eaceous Cyst$ loc'ed

    piloseaceous follicle andcontains seaceoussecretions

    d. Comedones$ plugs of'eratin and seum

    e. Milia

    f. Epidermal !nclusion Cyst$implantation of epidermisinto the dermis follo+ing

    trauma or surgery

    Bowling B. Kanski's Clinical Ophtalmology; ASystematic Approach, Eight Edition. !"#.Else$ier% Sydney, A&stralia

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    Ble(#a&itis

    !nflammation in Eyelid-Anterior2Posterior.

    Sym(t"m(s ) Si*!s+

    Burning, mild photophoia, andcrusting and redness of the lidmargins +ith remissions ande"acerations

    Treatment

    Lid hygiene can e carried out

    once or t+ice daily initially) Topical and Oral Antiiotics

    Topical #teroid Patient +ithacti4e inflammation

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    C"!*e!ital Disease i! Eyelids

    Colooma

    Epichantus

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    C"l"b"ma

    !ncomplete de4elopment ofeyelids 001 failure of migrationof lid ectoderm to fuse the lidfolds

    T+o %inds$ 5 7pper lid Colooma

     5 Lo+er lid Colooma

    Treatment$ Primary closure,s'in grats, or rotation flaps

    Bowling B. Kanski's Clinical Ophtalmology; ASystematic Approach, Eight Edition. !"#.

    Else$ier% Sydney, A&stralia

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    E(i#a!ti ,"ld

    Epicanthic folds are ilateral4ertical folds of s'in that e"tendfrom the upper or lo+er lidsto+ards the medial canthi3 Theymay gi4e rise to a

    pseudoe"otropia

    Bowling B. Kanski's Clinical Ophtalmology; ASystematic Approach, Eight Edition. !"#.Else$ier% Sydney, A&stralia

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    Mal("siti"! "- Eyelids

    Entropion

    Ectoprion

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    Et&"(i"!

    !n4olutional2Age relatedEctropion

    Cicatrical Ectropion

    Paralytic Ectropion28acial 9er4ePalsy

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    I!."luti"!al/A*eRelated Et&"(i"!

    !n4olutional -age0related.ectropion affects the lo+er lid ofelderly patients3 !t causesepiphora -tear o4erflo+. and

    may e"acerate ocular surfacedisease3

    !n long0standing cases thetarsal con6uncti4a may ecomechronically inflammed,

    thic'ened and 'eratinized

    Treatment$ /epair lid la"ity-surgery.

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    Ciat&ial Et&"(i"!

    Caused y scarring orcontracture of the s'in andunderlying tissues 001 pulls theeyelid a+ay from the gloe3

    (epending on the cause, othlids may e in4ol4ed and thedefect may e local -e3g3trauma. or general -e3g3 urns,dermatitis, ichthyosis.3

    Mild localized cases are treatedy e"cision of the offendingscar tissue comined +ith aprocedure that lengthens4ertical s'in defiiency

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    Pa&alyiti/,aial Ne&.e Palsy Et&"(i"!

    Caused y ipsilateral facialner4e palsy and is associated+ith retraction of the upper andlo+er lids and ro+ ptosis) the

    latter may mimic narro+ing ofthe palpera aperture3

    Complications 001 e"posure'eratopathy due tolagophthalmos and +atering

    caused y malposition of theinferior lacrimal punctum, failureof the lacrimal pumpmechanism and increase incorneal e"posure3

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    E!t&"(i"!

    !n4oluntional Entropion

    Cicatrical Entropion

    The constant ruing of the

    lashes on the cornea in long0standing entropion-pseudotrichiasis. may causeirritation, corneal punctateepithelial erosions and, inse4ere cases, pannus formationand ulceration

    Treatment$ Temporaryprotection -luricants, soft

    andage contact lenses.3#urgery

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    T&i#iasis

    Trichiasis is misdirection of eyelasheson the cornea and may e due toentropion, epilepharon, or simplymisdirected gro+th3 !t causes cornealirritation and encourages ulceration3

    Chronic inflammatory lid diseasessuch as lepharitis may causescarring of the lash follicles andsuse:uent misdirected gro+th3

    (istichiasis is a condition manifested

    y accessory eyelashes, oftengro+ing from the orifices of themeiomian glands3

    Treatment$ E(ilati"!

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    Tum"u& a!d Mali*!a!ies

    Benign 5 9e4us

     5 ;anthelasma

     5 Hemangioma Maligna

     5 Basal Cell Carcinoma

     5 #:uamous Cell Carcinoma

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    Ne.us

    Congenital  Ac:uired

    7niformly ro+n macule orpla:ue

    Can e located inepidermal2dermal 6unction,compound, or intradermal

    Treatment -E"cision. isindicated for cosmetics or forconcern aout malignancy

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    a!t#elasma

    8re:uently ilateral condition typicallyaffecting middle0aged and elderlyindi4iduals

     Associated +ith hyperlipidemia

    ;anthelasma are yello+ishsucutaneous pla:ues, usually in the

    medial aspects of the eyelids,commonly ilateral and are multiple

    Treatment

     5 #imple e"cision is commonlyperformed +here ade:uate e"cess

    s'in is present3 5 Microdissection3 the fatty deposits

    dissected from o4erlying s'inunder a surgical microscope usingmicroscissors

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    Ca(illa&y %ema!*i"ma

    Capillary haemangioma

     one ofthe most common tumours ofinfancy) !t presents shortly afterirth as a unilateral, raised rightred lesion, usually in the upper lid

    appears purplish3 Ptosis is

    fre:uent3 The lesion lanches onpressure and may s+ell on crying3

    There may e orital e"tension

    Occasionally the lesion mayin4ol4e the s'in of the face

     Associated +ith multiplecutaneous lesions and 4isceralhaemangiomas considersystemic assessment inappropriate cases

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    Basal Cell Ca&i!"ma

    Typically affects older age groups3 /is' factors are fair s'in, inaility

    to tan and chronic e"posure tosunlight3

    !t most fre:uently arises from thelo+er eyelid, follo+ed in relati4e

    fre:uency y the medial canthus,upper eyelid and lateral canthus3

    The tumour is slo+ly gro+ing andlocally in4asi4e ut non0metastasizing3

    Tumours located near the medialcanthus are more prone to in4adethe orit and sinuses morediffiult to manage

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    Basal Cell Ca&i!"ma

    Clinical features 5 9odular BCC is a shiny, fim,

    pearly nodule +ith smallo4erlying dilated lood4essels3 !nitially, gro+th is slo+and it may ta'e the tumour 3? cm

     5 9oduloulcerati4e BCC -rodentulcer. is centrally ulcerated+ith pearly raised rolled edgesand dilated and irregular lood4essels -telangiectasis. o4erits lateral margins

     5 8uther E"amination$Histopatology E"am

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    Suam"us Cell Ca&i!"ma

    #CC is a much less common, ut typically more aggressi4etumour than BCC +ith metastasis to regional lymph nodes in

    aout =>@ of cases3

    The tumour may also e"hiit perineural spread to the

    intracranial ca4ity 4ia the orit3

    The clinical types are 4ariale and there are nopathognomonic characteristics3 The tumour may e

    indistinguishale clinically from a BCC ut surface

    4ascularization is usually asent, gro+th is more rapid and

    hyper'eratosis is more common3

    9odular #CC is characterized y a hyper'eratotic nodule thatmay de4elop crusting, erosions and fisures

    7lcerating #CC has a red ase and sharply defied, indurated

    and e4erted orders, ut pearly margins and telangiectasia

    are not usually present

    8uther E"amination$ Histopatology E"am

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    Suam"us Cell Ca&i!"ma

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    La&imal D&ai!a*e System

     Anatomy Physiology

    Canaliculitis

    (acryoadenitis (acryocystitis

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    A!at"my ) P#ysi"l"*y

    T#e (u!ta are located at theposterior edge of the lid margin, atthe 6unction of the lash0earing

    T#e a!aliuli pass 4erticallyfrom the lid margin for aout =mm-ampullae.3 They then turn

    medially and run horizontally foraout mm to reach the lacrimalsac3

    T#e la&imal sa is 5

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    A!at"my ) P#ysi"l"*y

    Tears 8lo+$ Lacrimal &land 

    Con6uncti4a and Cornea Canaliculi Lacrimal #ac 9asolacrimal (uct 

    9asal Ca4ity

    Epiphora O4erflo+ oftears

    Caused y$ 5 Hypersecretion

     5 (efecti4e (rainage

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    Ca!aliulitis

    Canaliculitis is an uncommonchronic unilateral infection causedy Actinomyces israelii, Candidaalicans, or aspergillus species3

    !t affects the lo+er canaliculusmore often than the upper 

    causes a secondary purulentcon6uncti4itis that fre:uentlyescapes etiologic diagnosis37ntreated, it +ill result incanalicular stenosis3

    #ymptoms$ mildly red and irritatedeye +ith a slight discharge3 Thepunctum usually pouts, andmaterial can e e"pressed fromthe canaliculus3

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    Da&y"ade!itis

     Acute inflammation of the lacrimalgland is most often seen inchildren as a complication ofmumps, Epstein0Barr 4irus,measles, or influenza and inadults in association +ith

    gonorrhea Considerale pain, s+elling, and

    in6ection occur o4er the temporalaspect of the upper eyelid3

    !f acterial infection is present,systemic antiiotics are gi4en3 !t israrely necessary to surgicallydrain the infection

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    Da&y"ystitis

    !nfection of the lacrimal sacis usually secondary toostruction of thenasolacrimal duct3 !t may eacute or chronic and is most

    commonly staphylococcal orstreptococcal3

    = %inds$

     5 Acute 5 Chronic

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    Aute Da&y"ystitis

    Present +ith the suacuteonset of pain in the medialcanthal area, associated+ith epiphora3 A 4ery tender,tense red s+elling de4elops

    at the medial canthus,commonly progressing toascess formation

    Treatment$ 5 arm Compress Oral

     Antiiotics

     5 !ncision and drainage may econsidered if pus e"ists

     5 (acryocystorhinostomy

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    C#&"!i Da&y"ystitis

    Present +ith chronicepiphora, +hich may eassociated +ith a chronic orrecurrent unilateralcon6uncti4itis3 A mucocoele

    is usually e4ident as apainless s+elling at the innercanthus ut if an o4iouss+elling is asent pressureo4er the sac commonly still

    results in mucopurulentcanalicular reflu"

    Treatment$ 5 dacryocystorhinostomy

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    T#a!3 4"u