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Class1 Eyelids

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4 views61 pages

Class1 Eyelids

Uploaded by

rishavknath3
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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To understand pathogenesis of eyelid

malformation, a brief review of


embryogenesis is helpful
5 stages- development

Eyelids folds:6-8 wks

Eyelid fusion:8 wks-5mts

Specialized st. dev.:8 wks-7mts

Eyelid seperation:5-7
mts

Maturation:7mts-birth
Inflammatory disorders
⚫ Stye / hordeolum externum :
⚫
⚫ Acute purulent staphylococcal infection of the
gland of zeis.

⚫ Predisposing factors :
⚫ Local bad hygiene , chronic blepharitis , DM ,
refractive error and malnutrition .

⚫ Clinical features :
⚫ Severe pain.
⚫ A pus point develops at the root of the cilium
⚫ Treatment :
⚫ Hot
fomentation
⚫ Local
antibiotics
⚫ Epilation
⚫ Internal hordeolum :

⚫ It is a suppurative inflammation of the


meibomian gland associated with blockage of
the duct.

Etiology :

⚫ primary staphylococcal infection of the


meibomian gland
⚫ secondary infection in a chalazion (infected
chalazion).
⚫ Pain is more intense
⚫ Point of maximum tenderness is away
from the lid margin
⚫ A yellowish swelling m/b seen on everting
the tarsal conjunctiva .

⚫ Treatment :
⚫ Same as stye
⚫ When pus forms s/b slit open by a vertical
incision .
⚫ Chalazion :

⚫ A chalazion is a chronic, sterile,


granulomatous inflammatory lesion
caused by retained sebaceous secretion
leaking from the meibomian or other
sebaceous glands into adjacent stroma.
⚫ Gradually enlarging painless nodule.
⚫ May induce astigmatism and cause blurred
vision.

⚫ Signs
⚫ A nodule within the tarsal plate
⚫ Eversion of the lid may show an associated
polypoidal granuloma if the lesion has
ruptured through the tarsal conjunctiva
⚫ A ‘marginal’ chalazion is similar except that it
involves a gland of Zeis and is therefore located
not in the tarsal plate but on the anterior lid
margin.
⚫ Treatment :
⚫ Early cases : hot fomentation / lid
massage
⚫ Steroid injection
⚫I & C
⚫ Blepharitis :
⚫ Inflammation of the eyelid margin and
associated eyelash follicle s, apocrine and
meibomian glands .

⚫ Broad categories :

Anterior blepharitis : affecting the anterior


lid margin Posterior blepharitis : MGD
⚫ Anterior blepharitis :
⚫ Includes staphylococcal , seborrheic and mixed
staphylococcal and seborrheic blepharitis .

⚫ Anterior blepharitis affects the area surrounding the


bases of the
eyelashes and may be staphylococcal or seborrhoeic.

⚫ The former is thought to be the result of an


abnormal cell mediated response to components of
the cell wall of S. aureus.

⚫ Seborrhoeic blepharitis is often associated with


generalized
⚫ Symptoms :
⚫ • Burning, grittiness, mild photophobia, and
crusting and redness of the lid margins with
remissions and exacerbations are
characteristic.
⚫ 2 Signs
⚫ Staphylococcal blepharitis
⚫ • Hard scales and crusting mainly located around the
bases of the
lashes - collarettes
⚫
⚫ • Long-standing cases may develop scarring and notching
(tylosis) of
the lid margin , madarosis, trichiasis and poliosis.

⚫ • Associated tear film instability and dry eye syndrome


are common.

⚫ • The scalesblepharitis
Seborrhoeic are soft and located anywhere on the lid
⚫ lashe
• margin
Hyperaemic
and and greasy anterior lid margins with
sticking together of
s.
lashes
⚫ Treatment
⚫ Lid hygiene
⚫ Topical and systemic
antibiotics
⚫ Weak steroids
⚫ Tear substitutes .
⚫ Posterior blepharitis :

⚫ Caused by meibomian gland dysfunction and


alterations in meibomian gland secretions.
⚫ Bacterial lipases may result in the formation of
free fatty
acids.
⚫ This increases the melting point of the meibum
preventing its expression from the glands,
contributing to ocular surface irritation and
possibly enabling growth of S. aureus.
⚫ Loss of the tear film phospholipids that act as
surfactants results in increased tear
evaporation and osmolarity, and an unstable
tear film.
⚫ Symptoms are similar to anterior blepharitis.

⚫ Signs
⚫ Capping of meibomian gland orifices with oil
globules
⚫ Pouting, recession, or plugging of the
meibomian gland
orifices
⚫ Hyperaemia and telangiectasis of the posterior
lid margin.
⚫ Pressure on the lid margin results in
expression of meibomian fluid that may be
turbid or toothpaste-like
⚫ Treatment
⚫ Lid hygiene
⚫ Systemic tetracyclines
⚫ Topical antibiotics /steroids /
lubricants
⚫ Herpes zoster ophthalmicus :
⚫ HZO is a common, unilateral infection
caused by varicella-zoster virus.
⚫ It typically affects the elderly but may
occur at an earlier age.
⚫ It tends to be more severe in
immunocompromised individuals
⚫ Presentation :
⚫ Pain in the distribution of the first
division of the trigeminal nerve.

⚫ Signs
⚫ A maculopapular rash on the forehead
⚫ Progression through vesicles and
pustules to crusting.
⚫ Periorbital oedema may spread to the
other side (F, giving the erroneous
impression that the condition is bilateral.
⚫ Treatment :
⚫ Systemic and topical
antivirals
⚫ Steroid antibiotic creams
Basal cell
carcinoma
•General features

•BCC - malignant eyelid tumour - elderly patients.

•Risk factors : fair skin


•inability to tan
•chronic exposure to sunlight

•Site : lower eyelid, followed in relative frequency by the


•medial canthus, upper eyelid and lateral canthus.
•Slow-growing and locally invasive but non-metastasizing.
•Prone to invade the orbit and sinuses
•Greatest risk of recurrence- needs aggressive treatment.

•Histology
•Arises from basal layer of the epidermis - proliferate downwards
palisading at the periphery tumour
lobule
•Squamous differentiation - production of keratin - hyperkeratotic type of
BCC.
•Sebaceous and adenoid differentiation
•Clinical types

• Clues : ulceration, lack of tenderness, induration,


irregular borders and destruction of lid margin
•architecture.

• 1 Nodular BCC - shiny, firm, pearly nodule with


small dilated
blood vessels On its surface.

• 2 Noduloulcerative BCC (rodent ulcer)

- central ulceration,
- pearly raised rolled edges
- Dilated and irregular blood vessels
(telangiectasis)
3 Sclerosing BCC (morphoeic)
-infiltrates laterally beneath the epidermis as an
indurated plaque .
-simulate a localized area of chronic blepharitis
Squamous cell
carcinoma
•General features

• SCC is a much less common , more aggressive tumour - metastasis to


regional lymph
nodes - elderly individuals

• Careful surveillance of regional lymph nodes is therefore an important


aspect of initial management.

•Perineural spread to the intracranial cavity via the orbit.


•SCC accounts for 5–10% of eyelid malignancies
•arise de novo / pre-existing actinic keratosis / carcinoma in situ

• Immunocompromised patients such as those with AIDS or


following renal transplants are at increased risk.

Site - lower eyelid and the lid margin.

Risk Factors : fair complexion


history of chronic sun exposure.

The diagnosis of SCC may be difficult


because keratoacanthoma and
cutaneous horn
• Histology

• Arise from squamous cell layer of the epidermis.

• Atypical epithelial cells with prominent nuclei and


abundant eosinophilic cytoplasm within the dermis

• Well-differentiated tumours - keratin


‘pearls’ and intercellular bridges
(desmosomes).

•Clinical types

• 1 Nodular SCC - hyperkeratotic nodule


develop crusting erosions and fissures
2Ulcerating SCC - red base and sharply
defined, indurated and everted borders.
•
3 Cutaneous horn with underlying invasive
SCC
Sebaceous gland
carcinoma
•General features
•Very rare slowly-growing tumour - elderly
Females
• It usually arises from the meibomian glands,
glands of Zeis or from sebaceous glands in the
caruncle.
•Site - upper eyelid [ meibomian glands
numerous].

• The clinical diagnosis of SGC is frequently difficult


because, in its early stages, external signs of
malignancy may be subtle so that the tumour may
resemble a chalazion or blepharitis.

• A yellowish material within the tumour is highly


suggestive of SGC. There are difficulties in diagnosis
and delay in treatment
•Histology

• Lobules of cells with pale foamy vacuolated lipid-


containing cytoplasm and large hyperchromatic
nuclei

•Clinical types

• 1 Nodular SGC - discrete, hard nodule, most


commonly within the upper tarsal plate, that may exhibit
yellow discoloration due to the presence of lipid .
- may masquerade as a chalazion , unusual
consistency should undergo full-thickness resection
and histological examination.
2 Spreading SGC infiltrates into the dermis and causes
a diffuse thickening of the lid margin that may result in
loss of lashes and be mistaken for ‘chronic blepharitis’.
2 Pagetoid spread refers to extension of the tumour
within epithelium including the palpebral forniceal or
bulbar conjunctiva.
- mistaken diagnosis of an inflammatory condition.
Reconstructi
on
• Depends on the extent of tissue
removed & whether this is full- or
partial-thickness.
If one of the lamellae has been sacrificed
during excision of the tumour, it must be
reconstructed with similar tissue.
• 1Small defects involving less than one-
third of the eyelid closed directly -
surrounding tissue is sufficiently elastic -
approximation of the cut edges .
• If necessary, a lateral cantholysis - to
mobilize additional tissue - defect
• 2 Moderate size defects involving
up to half of the eyelid may require a
flap (e.g. Tenzel semicircular) for
closure
3 Large defects involving over
half of the
eyelid
• a Posterior lamellar reconstruction
- an upper lid free tarsal graft, buccal
mucous membrane or hard palate
graft.

b Anterior lamellar
reconstruction - skin advancement, a
local skin flap or a free skin graft (At
least one reconstructed lamella

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