DT - Palpebrae & App.lacrimal

8/18/2019 DT - Palpebrae & App.lacrimal

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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



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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



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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



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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



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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

DT - Palpebrae & App.lacrimal

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