Eyelid deformities by Rutuja Mane bsc nursing

Eyelid deformities

1. Eyelid deformities By Rutuja Mane
4 th sem bsc nursing GTCN , Solapur Roll no. 27

2. INTRODUCTION EYELIDS: Two movable folds with eyelashes. ◆ Layers present are skin, aerolar tissue; muscles- orbicularis oculi, levator palpebrae superioris & Muller's muscle; thin sheet of dense connective tissue, tarsal plate; thin lining of palpebrae conjunctiva.

3. EYELID INFECTIONS, TUMORS AND DEFORMITIES DEFINITION = 1 An eyelid infection is any abnormal condition that effect eyelid. 2. Infection of an oil gland on the surface of the upper and lower parts of eyelids

4. CLASSIFICATION OF EYELIDS INFECTIONS CONGENITAL ANOMALIESB. EDEMA INFLAMMATIONS ANOMALIES & POSITION OF EYELIDS TUMORS

5. A. CONGENITAL ANOMALIES Able-pharon: Macrostomia syndrome Extremely rare, the lid is not developed autosomal recessive genetic disorder. ii. Micropharon: Rare, lids are abnormally small

6. iii. Cryptopharon: Rare anomaly in which a fold of skin passes from the eyebrow over the malformed eye to the cheek. iv. Ptosis: Common, drooping of eyelid

7. V . Epicanthus: A vertical fold of skin on either side of the noise sometime covering the inner canthus.(the outer or inner corner of the eye) vi. Distichiasis: an additional row of lashers occupies the position of meibomian glands .abnormal growth of lashers.

8. vii. Coloboma: condition where normal tissue in or around the eye is missing from birth.

9. B. EDEMA A swelling eyelid occurs when there is inflammation or excess fluid (edema) in the connective tissue surrounding the eye. Common due to looseness of tissues Inflammatory edema Passive edema

10. Inflammatory Edema: Found in conjunctivitis, tarsitis, (inflammation of gland and lasher) dacryocystitis, (inflammation of lacrimal sac ) orbital cellulitis, (inflammation of eye tissue) drug allergy (atropine).

11. Passive edema: common feature of cavernous sinus thrombosis (formation of blood clot with in the cavernous sinus a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart,

12. Inflammation It includes 1. Blepharitis 2. Hordeolum (stye) 3. Chalazion (tarsal or meimobian cyst) 4. internal Hordeolum

13. BLEPHARITIS * Is an inflammation of the eye lids in which they become red, irritated and itching dandruff like scales from on the eyelashes.

14. Squamous Blepharitis Ulcerative Blepharitis 1. Squamous Blepharitis*: it is due to abnormal metabolism (abnormal chemical in body) & seborrhea usually associated with the dandruff of the scalp. Numerous white coloured small scales accumulate among the eyelashes.

15. ULCERATIVE BLEPHARITIS it is an ineffective condition. The yellow crusts glue (sticky) the lashes together. On removing the crust there are small ulcers seen around the bases of lashes. Symptoms : itching, redness, soreness, lacrimation and photophobia.

16. Treatment Local: - removal of scales, crusts & diseased lashes is done by bathing lid margin with 3% of NaHCO3 (sodium bicarbonate) lotion.- antibiotics & ointment are applied. General : Improvement of general health & personal hygiene.- Dandruff of the scalp is to be adequately treated.

17. 2. Hordeolum (Stye ) Hordeolum (Stye): is a localized infection or Inflammation of the eye lid margin involving hair follicles of eyelid or meibomian gland (supply of meibomian, an oily substance) Etiology: Associated with staphylococci infection, Common in young adults & debilitated persons(very week person). Symptoms: Acute Pain & tenderness over inflamed Zeis's gland Signs: Localized Pain, redness & edema near the lid margin

18. Treatment: Hot fomentation, (to apply a warm compressor eye )Evacuation of pus, antibiotic eye drop =tobramycin= it is killing or slow the growth of certain type of bacteria. ointment & broad spectrum antibiotics is useful. Analgesics & anti-inflammatory drugs control pain & inflammation.

19. Chalazion 3. Chalazion: It is chronic granulomatous inflammation (produce response to infection, inflammation,) or the presence of a foreign substance. of meibomian gland. Etiology : due to chronic irritation due to organism of low virulence (The ability of bacteria to cause disease) where the glandular tissue is replaced by granulation tissue containing giant cells. Occur in crops, more common in adults. Symptoms : No pain unless secondary infected

20. Signs: Small non tender hard swelling slightly away from and swelling lid margin, swelling is red or purple, can be grey in later stages, yellow when secondary infected with pyogenic organisms. Treatment: Inj. Triameinolone directly into the Chalazion cause complete resolution. It prevents the release of substances in the body that cause inflammation.

21. Internal Hordeolum 4. Internal Hordeolum : It is an acute Supportive inflammation (formation of pus )of meibomian gland Etiology: Occurs due to secondary infection (occurs during or after treatment for another infection.) of Chalazion. Symptoms : More violent than stye because the gland is larger & embedded deeply in the dense fibrous tissue.

22. Sign : Yellow spot (pus) seen shining through the conjunctiva on averting (remaining) the lid TREATMENT Warm compresses and massages of the lesions for 10 minutes 4 times per day Tropical antibiotic ointment Amoxicillin Doxycycline Erythromycin

23. D. ANOMALIES & POSITION OF EYELID It includes 1.Trichiasis 2. Entropion 3.Ectropion 4. Symblepharon 5. Ankyloblepharon 6. Lagopthalamus 7. Ptosis.

24. Trichiasis 1. TRICHIASIS: abnormally positioned eyelashes Few lashes or whole lid margin involved. Etiology: Recurrent stye, Ulcerative Blepharitis, Tight bandaging, Scars of lid following burn, injury or operation. Symptoms a Foreign body sensation of photophobia due to corneal involvement) Irritation, pain & lacrimation Treatment Trichiasis treatment involves removing the eyelash, follicle or both, or redirecting eyelash growth.

25. Entropion 2. ENTROPION: Conditions in which the lid margin rolls inward Etiology a) Spastic Entropion: Due to the spasm of orbicularis oculi muscle as may occur after tight bandaging after operation of following irritative corneal condition b) Cicatricial Entropion :, ulcerative Blepharitis, burns, operations, diphtheritic membranous conjunctivitis. Sign & symptoms: Same as for Trichiasis Treatment A. Spastic :- Basic cause of blepharospasm is treated If due to prolonged & tight bandaging, discontinue it Antibiotics Antinflammatory corticosteroids Botulinum toxin-using eyelid spasms

26. 3. ECTROPION: It is a condition in which lid margin rolls outward Symptom: Most common epiphora excessive watering of the eyes Signs : Conjunctiva become dry in appearance Chronic conjunctivitis & corneal ulcers. TREATMENT Use of lubricating ointment or mild steroid several day and weeks to ectropion repair corneal epithelium,,,

27. 4. SYMBLEPHARON : It is a condition of the adhesion between lids and the globe. Etiology: due to burns, ulcers, diphtheria, operation Symptoms Lagopthalamus: inability to close lids properly 2 Diplopia: double vision treatment Lysis and removal of sub conjunctival scar tissue

28. 5. ANKYLOBLEPHARON It is a condition of the adhesion of the margins of two eyelids. A may be partial or complete Etiology Congenital or acquired due to chemical burn i.e. acid, alkali. Treatment- Separation of lid margins along with mucus membrane or conjunctival grafting is recommended

29. Lagopthalamus Lagopthalamus is defined as the inability to close the eyelids completely. Blinking covers the eye with a thin layer of tear fluid Etiology Loss of function of the facial nerve inhibits eyelid closure as well as the blinking reflex Congenital deformity of lids, ectropion, proptosis (abnormal protrusion or displacement of an eye, paralysis, absence of reflex, blinking in extremely ill patient’s Treatment Application of antibiotic eye ointment & bandage during sleep is recommended. 2 Levofloxacin

30. . PTOSIS It is a condition in which there is drooping of the upper lid below normal position. Etiology 1. Congenital Ptosis: Occurs in 80% cases, due to maldevelopment of levator muscle; congenital weakness of superior rectus muscle. 2 Acquired Ptosis: a). Neurogenic: partial/complete paralysis of 3rd nerve b) Mechanical: Due to increased weight of upper lid as a result of edema, hypertrophy or tumor formation. c) Myogenic: Due to trauma of levator muscle, muscular dystrophy ( increasing weakening or breakdown of muscle) & myasthenia gravis.( neuromuscular disease weakness of skeleton muscle) Symptoms : Visual disturbance visible drooping of the upper eyelid

31. TREATMENT high doses of opioid drugs such as morphine, Morphine is a narcotic pain reliever used to treat moderate to severe pain. 0.05 mg/kg IM, IV, or subcutaneously every 4 to 8 hours oxycodone hydrochloride analgesic agents heroin, or hydrocodone can cause ptosis. Pregabalin (Lyrica), an anticonvulsant drug, has also been known to cause mild ptosis.

32. E. TUMORS Benign Tumors Nevus Hemangioma Papilloma Xanthelasma (jenthelasma) Neurofibroma 2. Malignant Tumors Squamous cell carcinoma Basal cell carcinoma

33. Nevus(mole on the skin red patches) * A choroidal nevus is a flat, benign pigmented area that appears in the back of the eye

34. Heman-gioma Hemangioma is a non-cancerous (benign) tumor caused by abnormal growth of blood vessels. cavernous hemangioma occurs in the deeper layers of the skin or around the eye.

35. PAPILLOMA a benign tumor derived from epithelium. Papillomas may arise from skin, mucous membranes, or glandular ducts

36. Xanthelasma (jenthelasma) are yellowish plaques that occur most commonly near the inner canthus of the eyelid, more often on the upper lid than the lower lid. Xanthelasma

37. NEUROFIBROMA It is a generalized disease that may involve the lid & cause mechanical ptosis. It is associated with unilateral infant glaucoma. Small, multiple tumors are distributed along the hypertrophied nerves.

38. Malignant Tumors Squamous cell carcinoma- Basal cell carcinoma

39. Squamous cell carcinoma Seen at the edge of the lid (transition zc W where the epithelium changes. It starts as a nodule that ulcerate. The preauricular lymph nodes are enlarged. It spreads slowly the surrounding structures and are painless. Metastasis (spread of cancer cells to new area of the body) common,

40. It is most common seen in lower lid near the inner canthus. It is locally malignant. Epithelial growth spreads under the skin in all direction. Basal cell carcinoma

41. ETIOLOGY Environmental toxins such as exposure to radiation Genetics Diet - deficiency of minerals and vitamins Stress excessive stress cause blocking mutation in the cells of their developing eyes Local trauma or injury- orbital trauma and bleeding Inflammation or infection

42. CLINICAL MANIFESTATION Bulging of one eye (protrusion) Complete and partial loss of sight Pain in or around the eye Blurred vision Change in the appearance of the eye Edema Redness Itching Burning

43. DIAGNOSIS Ultrasound scans * CT SCAN * MRI * They show the size, location, and shape of the tumors and also show the enlarged or affected lymph node around the eye.

44. MEDICAL MANAGEMENT 1.Identify the cause & eliminate the cause 2. Achieve and maintain control of symptoms 3. Avoid adverse effects of medication. 4. to give antibiotics and anti inflammatory drugs. 5. Maintain normal activity level, including exercise 6 , Prevention foreign particles enter in eye* Use of sunglasses* To keep the eye clan, wipe away the drainage from around the eye 'moisten and clan cotton ball or wash cloth with warm water, from inner to the outer part the eye.

45. Bibliography 1) MJ Kumari adult health nursing II , medical surgical nursing Jaypee brothers first edition 2023 page number 40 2) Javed Ansari medical surgical nursing publisher Pee Vee Second Edition Barbie page number 236