Eyelid oedema - A brief review

A brief overview of conditions presenting with eyelid edema in modern and ayurvedic view.

1. अविनयमपनय विष्णो....

2. E Y E L I D o E D E M A D r . ASWATHY KRISHNA. S Guided by, Dr. K. V. Subhadra Antherjanam Dr. Ashwini . B. N Dr. K. Sivabalaji

3. CONTENTS

4. A movable f old of skin and muscle that can be clos ed over the eyeball or opened at will. Each eye has an upper and a lower lid; al so known as a palpebra .

5. VARTMA नयनगोलकावरकं  निमेषोन्मेषाश्रयंपटलद्वयं वर्त्म उच्यते | ( Ma.Ni.59/76 ) द्वे वर्त्मपटले विद्याच्चत्वार्यन्यानि चाक्षिणि |  जायते तिमिरं येषु व्याधिः परमदारुणः  ||   ( Su.U.1/17)

6. FUNCTIONS • P rovide physical protection to the eye . • Prevent drying of the eyes. • Ensuring normal tear film and drainage. • Secrete the oily part of the tear film.

7. Applied anatomy Acts as shutters, protecting eyes from injuries and excessive light. Also helps in spreading tear film over cornea and conjunctiva. Helps in drainage of tears. Parts – 2 Orbital Tarsal

8. Ciliary part Lacrimal part Punctum

9. GLANDS OF EYELID 2. Meibomian glands 4. Gland of Zeiss 3. Gland of Moll 1. Glands of Wolfring 1. Gland of Krause Modified sebaceous and sweat glands Accessory lacrimal glands

10. EYELID DISORDERS

11. Eyelid swelling usually results from eyelid disorders but may result from disorders in and around the orbit or from systemic disorders that cause generalized oedema .

12. OEDEMATOUS CONDITIONS OF EYELID Common, because of the looseness of tissue 3 types Inflammatory oedema Passive oedema Solid oedema

13. INFLAMMATORY oedema Inflammation of lid – dermatitis, stye , chalazion , insect bites Conjunctiva – conjunctivitis Lacrimal sac – Dacryocystitis , lacrimal abscess Lacrimal gland – dacryoadenitis Eyeball – endophthalmitis , panophthalmitis Orbit – cellulitis, abscess PNS – maxillary sinusitis

14. Conjunctivitis Endophthalmitis Orbital cellulitis Maxillary sinusitis

15. SOLID oedema OF EYELID Chronic thickening of eyelids. Hard on palpation.

16. PASSIVE oedema OF LIDS Secondary oedema due to local or general causes Local – head injury, angioneurotic oedema General – renal failure, severe anaemia

17. ANGIO oedema OF EYE Swelling of the lower layer of skin and tissue just under the skin or mucous membranes. May occur in the face, tongue, larynx, abdomen, or arms and legs.

18. COMMON CONDITIONS WITH EYELID SWELLING Blepharitis Stye / External Hordeolum Chalazion Internal hordeolum Dacryoadenitis Dacryocystitis

19. BLEPHARITIS The inflammation of margin of eyelids and lacrimal gland. SIGNS AND SYMPTOMS -Crusting around the eyes. -Tearing. -Burning sensation -Itching -Foreign body sensation

20. CHALAZION Chronic non infective granulomatous inflammation of Meibomian Gland Painless , firm swelling away from lid margin Upper lid is more affected Associated congestion in Conjunctiva Mild heaviness of lids Mechanical ptosis

21. Acute suppurative inflammation of glands of Zeiss and glands of Moll Acute pain Lid swelling Mild watering from eyes STYE / EXTERNAL HORDEOLUM

22. DIFFERENTIAL DIAGNOSIS

23. INTERNAL HORDEOLUM Suppurative inflammation of Meibomian gland. PRIMARY – Staphylococcal infection SECONDARY – Infected chalazion Signs and symptoms same as Stye , but away from lid margin. Intensity of pain is more

24. Dacryoadenitis Inflammation of the lacrimal gland . Circumscribed mass in outer 1/3 rd of upper lid. Unilateral pain. Redness.

25. Dacryocystitis Inflammation of the lacrimal sac and duct . Pain, redness and swelling over the medial aspect of the lower eyelid . May be associated with watering and fever. Mucoid or purulent discharge is seen when pressure is applied over the lacrimal sac.

26. Orbital cellulitis Infection of the soft tissues within the orbit, posterior to the orbital septum, due to spread from local sinus disease. Red, swollen, tender eyelid; extraocular movements limited due to pain or oedema ; vision changes, diplopia; in children, fever and ill appearance. Preseptal cellulitis Infection of lid tissues around the orbit, often with local skin defect . Red, swollen, tender eyelid; full extraocular movements; no vision changes LOCAL INFECTIONS

27. Lid oedema Due to Superficial skin Pathologies Atopic dermatitis Capillary hemangioma Contact dermatitis

28. Lid oedema Due To Mass effect from the orbit Autoimmune orbital mass effect Cavernous sinus thrombosis Endophthalmitis Orbital neoplasm

29. GENERAL EVALUATION OF LID oedema Proper history taking Torch light examination Lid examination –eversion Slit lamp examination Examination of systemic causes. (Lab investigations) CT MRI

30. शोफ in वर्त्म

31. Oedematous conditionS in vartmagata roga Disease Vagbhata Susruta Treatment कुम्भीक कृष्णाः पित्तेन बह्व्योऽन्तर्वर्त्म कुम्भीकबीजवत् कुम्भीकबीजप्रतिमाः लेखन लगण ग्रन्थिः पाण्डुररुक्पाकः कण्डूमान् कठिनः कफात्| कोलमात्रः अपाकः कठिनः स्थूलो  ग्रन्थिर्वर्त्मभवोऽरुजः |  सकण्डूः पिच्छिलः कोलप्रमाणो भेदन

32. पोथकी पिटिकाः श्वेताः सर्षपभा घनाः कफात् शोफोपदेहरुक्कण्डू पिच्छिलाश्रुसमन्विताः रक्तसर्षपसन्निभाः   पिडकाश्च रुजावत्यः लेखन उत्सङ्गि रक्ता रक्तेन पिटिका अभ्यन्तरमुखी बाह्योत्सङ्गेऽधो वर्त्मनश्च या लेखन अञ्जननामिका मध्ये वा वर्त्मनोऽन्ते वा कण्डूषारुग्वती स्थिरा| मुद्गमात्राऽसृजा ताम्रा दाहतोदवती ताम्रा पिडका , मृद्वी मन्दरुजा सूक्ष्मा भेदन बिस वर्त्म बहिः शूनं यदन्तः सूक्ष्मखाचितम्| सस्रावमन्तरुदकं बिसाभं शूनं यद्वर्त्म बहुभिः  सूक्ष्मैश्छिद्रैः | बिसमन्तर्जल इव   भेदन

33. श्याव वर्त्म श्यावं रुक्क्लेदशोफवत् बाह्यतोऽन्तश्च श्यावं  शूनं सवेदनम् |  दाहकण्डूपरिक्लेदि श्लिष्ट वर्त्म श्लिष्टे कण्डूश्वयथुरागिणी लेखन कुकूणक शिशुरुच्छ्रनताम्राक्षो वीक्षणाक्षमः मृद्गाति नेत्रमतिकण्डुमथाक्षिकूटं नासाललाटमपि तेन शिशुः स नित्यम् || सूर्यप्रभां न सहते स्रवति प्रबद्धं, लेखन पक्ष्मोपरोध कण्टकैरिव तीक्ष्णाग्रैर्घृष्टं तैरक्षि शूयते पित्तोत्क्लिष्ट वर्त्म सदाहक्लेदनिस्तोदं , रक्ताभं स्पर्शनाक्षमम् लेखन

34. Other oedematous conditions of eyelid V.ABHISYANDA ऽल्पशोफता| शङ्खाक्षिभ्रूललाटस्य तोदस्फुरणभेदनम् ANYATOVATA यथां तीव्रामपैच्छिल्यरागशोफं विलोचनम् P.ABHISYANDA दाहो धूमायनं शोफः श्यावता वर्त्मनो बहिः K,ABHISYANDA जाड्यं शोफो महान् R.ABHISYANDA सपित्तस्यन्दलक्षणम्

35. MANAGEMENT OF NETRA SOPHA SEKAM ASCHOTANAM PINDI

36. BIDALAKAM JALAUKA AVACHARANAM AVAGUNDANAM

37. BEFORE AFTER

38. CONCLUSION The differential diagnosis of eyelid oedema is extensive but knowledge of the key features of several potential causes can assist physicians in diagnosing this condition. Systemic disorders such as myxoedema , renal diseases, and superior vena cava syndrome may manifest with peri -orbital oedema . So particular attention must be paid to visual clues, exposures and other historical factors in the work-up of patients with eyelid oedema .

39. REFERENCES Parson’s diseases of eye. Textbook of ophthalmology, A. K. Khurana . Ashtanga Hridayam Susrutha Samhitha Madhava Nidanam Sarngadhara Samhitha Differential diagnosis of swollen red eyelid, Art Papier & David. J. Tuttle