anomalies of eyemargin ophthalmology.pptx

Ophthal

1. ANOMALIES OF LID MARGIN Abiya Thomas 01

2. ENTROPION Entropion refers to inward rolling and rotation of the lid margin
toward globe.

Types:
1.Congenital entropion
2.Cicatricial entropion
3.Involutional entropion
4.Mechanical entropion
5.Spastic entropion

3. CLINICAL FEATURES Symptoms: occur due to rubbing of cilia against the cornea and conjuctiva include:
>Foreign body sensation
>Irritation
>Lacrimation
>Photophobia.

4. Signs Inturning of lid margins. On examination, lid margin is found inturned . Grading: Grade I = only the posterior lid border
Grade II = up to inter-marginal strip
Grade III = whole lid margin including the anterior border

5. 2.Signs of complications
•Recurrent corneal abrasions
•superficial corneal opacities.
•Corneal vascularization
• corneal ulceration

6. CONGENITAL ENTROPION Etiology:( lower lid than Upper lid )
• Lower eyelid :caused by improper development of the lower liretractors .
•Upper eyelid :secondary to microphthalmos .

7. TREATMENT •Resolve with time •HOTZ PROCEDURE excision of a strip of skin and muscle with plastic reconstruction of the Lid crease

8. CICATRICIAL ENTROPION Causes:Trachoma , membranous conjunctivitis,chemical burns, pemphigus and Stevens-Johnson syndrome.

9. TREATMENT Surgical procedures 1.Anterior lamellar resection Elliptical strip of skin and orbicularis muscle is resected 3 mm away from the lid margin. 2.Tarsal wedge resection Skin and muscle and wedge shaped tarsal plate removed

10. 3.Posterior lamellar Graft Deficient conjunctiva and the scarred and contracted tarsus are replaced by Posterior lamellar graft. Tarsus replaced by preserved sclera or ear cartilage or hard palate along with conjunctival or mucous membrane graft.

11. MECHANICAL ENTROPION Due to lack of support provided by the globe to the lids. occur in patients with phthisis bulbi , enophthalmos and after enucleation or evisceration operation. SPASTIC ENTROPION Spasm of orbicularis muscle •Irritative inflammation of lid margin, conjunctiva and cornea
•Ocular surface trauma
•Tight bandaging
•Degeneration of connective tissue, tarsal plate or orbicularis

12. TREATMENT Treatment of underlying cause
Supportive measures like lubricants and bandage contact lens (BCL)
Adhesive tape may be used to release the inward turning
Botulinum toxin injection into the orbicularis muscle may be useful in marked and persistent spasm.

13. SENILE ENTROPION 1.Horizontal laxity of lid = weakening of orbicularis muscle 2.Vertical lid instability= weakening of lower lid retractor 3.Overriding of pretarsal orbicularis=degeneration of palpebral conjunctivaal tissue 4.Laxity of orbital septum

14. TREATMENT 1.transverse suture and everting suture Transverse suture: full thickness of lids prevent over riding of muscles Everting suture : passed at lower level of fornix emerge out near lash line.

15. 2.JONES OPERATION Plication of lower lid retractors Lower lid Id retractors are exposed via horizontal skin incision at the
lower border of the tarsal plate, shortened and the sutures are
“used tocreate a barrier to prevent over-riding of the preseptal muscle

16. ECTROPION Out rolling or outward turning of the lid margin Etiological types
•Congenital ectropion •Cicatricial ectropion • Involutional ectropion •Mechanical ectropion •Paralytic ectropion

17. CLINICAL FEATURES SYMPTOMS Epiphora ( main symptom) Irritation Discomfort Mild photophobia

18. SIGNS 1.Lid Margin is outrolled Grade I =only punctum exerted Grade II =lid margin exerted, palpebral conjunctiva visible Grade III =Fornix visible

19. 2.Signs of complications Dryness and thickening of conjuctival and corneal ulceration(exposure keratitis) occur due to prolonged exposure.
Eczema and dermatitis of the lower lid skin.

20. 1.CONGENITAL ECTROPION Ankyloblepharon , ptosis, epicanthus inverses, Down syndrome and blepharophimosis syndrome.
occur in both the upper and lower lids and is due to congenital shortage of the skin. TREATMENT Mild =no treatment Moderate/severe = horizontal lid tightening and full thickness skin graft

21. Horizontal skin tightening Full thickness pentagonal excision

22. 2.INVOLUTIONAL ECTROPION Horizontal lid laxity Medial canthal tendon laxity Lateral canthal tendon laxity Dehisence of lower lid retractors

23. TREATMENT 1. Medial conjunctivoplasty Spindle-shaped piece of conjunctiva and subconthectival tissue from below the punctal area

24. 2.horizontal lid shortening 3. Byron Smith’s modified Kuhnt-Szymanowski operation a base up pentagonal full thickness excision from the lateral third of
the eyelid is combined with triangular excision of the skin from the area just lateral to lateral canthus to elevate lid

25. 3.PARALYTIC ECTROPION Bell’s palsy, head injury, infections of the middle ear and operations on parotid gland. TREATMENT Resolve within 6 months bells palsy Temporary measures include:
Topical lubricants
Taping temporal side of eyelid
Suture tarsorrhaphy

26. Permanent measures include:
Horizontal lid tightening with or without middle lamellar
buttress such as ear cartilage
Palpebral sling operation, in which a fascia lata sling is passed in the subcutaneous layer all around the lid margin

27. 4.CICATRICIAL ECTROPION Thermal burns, chemical burns, lacerating injuries skin ulcers, scarring skin tumours and medication allergies.

28. TREATMENT 1.V-Y operation, ( mild degree ectropion )
V-shaped incision is given, skin is undermined and sutured in a Y-shaped pattern.

29. 2.Z-plasty ( Elschnig’s operation)[mild to moderate degree of ectropion .] 3. Excision of scar tissue and full thickness skin grafting (severe cases) Skin graft may be taken from upper lid, behind the ear, or inner side of upper arm.

30. 5.MECHANICAL ECTROPION Tumours, proptosis , marked chemosis of conjunctiva

31. SYMBLEPHARON Lids become adherent with the eyeball as a result of adhesions between the palpebral and bulbar conjunctiva. Common causes:
•Thermal burns,
•Chemical burns
•Membranous conjunctivitis •Injuries,
•Conjunctival ulcerations
•Ocular pemphigus
•Stevens-Johnson syndrome.

32. CLINICAL FEATURES Ocular movements become restricted,
Diplopia Lagophthalmos , i.e. Inability to close the lids may occur due to adhesions.
Cosmetic disfigurement

33. TYPES 1.Anterior symblepharon - adhesions present only in the anterior part
2.Posterior symblepharon –adhesions presethin the fornices 3.Total symblepharon - adhesions involving whole of lid

34. COMPLICATIONS Due to prolonged exposure there can occur:
•Dryness
•Thickening
•Keratinisation of conjunctiva
•Corneal ulceration (exposure keratitis).

35. TREATMENT 1. Prophylaxis. During the stage of raw surfaces, the adhesions may be prevented by:
■Sweeping a glass rod coated with lubricant around the fornices several times a day ■Therapeutic soft contact lens of large size
2. Curative treatment consists of symblepharectomy Raw area covered by:
•Conjunctival or buccal mucosal grafts required in severe cases.
•Amniotic membrane transplantation (AMT)

36. ANKYLOBLEPHARON refers to the adhesions between margins of the upper and
lower lids.
Etiology:
•Congenital anomaly
•Acquired adhesions =after healing of chemical burns, thermal
burns, ulcers and traumatic wounds of the lid margins. Clinically ankyloblepharon may be complete or incomplete

37. TREATMENT Lids should be separated by excision of adhesions between the lid margins and kept apart during healing process. When adhesions extend to the angles, epithelial grafts given to prevent recurrences.

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