Disorders Of Eyelids

Question 1

Eyelid anatomy

Answer 1

Skin
Muscle - orbicularis oculi - Levator palpebra superioris
Tarsal plate & glands
Palpebral conjunctiva

Question 2

Function of eyelid

Answer 2

Direct protection of eye
Production of glandular secretions
Distribution of tear film

Question 3

Congenital abnormalities of eyelids

Answer 3

Anklyoblepharon
Ophthalmia neonatorum
Eyelid agenesis
Eyelid dermoid
Macroblepharon
Lagophthalmos

Question 4

Ankyloblepharon

Answer 4

Normal occurrence of palpebral fissures being sealed at birth and opening between 10-15 days of age
Eyelids that open prematurely can be exposured for KCS and ulcerations

Question 5

Pathologic ankyloblepharon

Answer 5

Delayed of complete failure of eyelid opening
Infection may develop - ophthalmia neonatorum

Question 6

Ophthalmia neonatorum

Answer 6

Infections due to failure of eyelid opening
Staph in dogs
Chlamydia in cats

Question 7

Eyelid agenesis

Answer 7

Complete or partial underdevelopment of eyelid
common in cats
Friction between haired skin & cornea can lead to keratitis
- mild cases can be treated w lubrication /cryotherapy
- severe cases might require a reconstructive blepharoplasty - creating a new eyelid

Question 8

Eyelid dermoid

Answer 8

Ectopic island of skin at the eyelid margin
Common in frenchies, shih tzu, GS, dachshund
Must surgically remove or scrape off

Question 9

Macroblepharon

Answer 9

Overly large palpebral fissure - common in Brachycephalic
Contributes to KCS, Proptosis, lagophthalmos
Can cause Pigmentary keratitis

Question 10

Lagophthalmos

Answer 10

Inability to close eyelids completely
Congenital in Brachycephalic breeds
Acquired/secondary condition with facial nerve paralysis, exophthalmia, buphthalmia
Can cause keratitis

Question 11

Structural abnormalities

Answer 11

Distichiasis - hairs from meibomian glands
Trichiasis - normal cilia/ hair grows facing towards cornea
Ectopic cilia - cilia emerging through palpebral conjunctiva

Question 12

Distichiasis

Answer 12

Can cause epiphora, tear staining, blepharospasm & keratitis
Thin hair - ocular lubrication
Stiff hair - cryotherapy (most common)

Question 13

Trichiasis

Answer 13

Congenital form can cause entropion, eyelid agenesis & dermoid
Acquired form can cause cicatricial - eyelid lacerations & surgeries

Question 14

Ectopic cilia

Answer 14

Common in young dogs - Distichiasis is a predisposing factor for development
Upper eyelid is most common location
Intense blepharospasm, epiphora, corneal ulcerations - can be used as hints for diagnosis based on location
Genetics - retrievers, Pekingese, spaniel, bulldog

Question 15

Entropion

Answer 15

Inversion of eyelid margin - causing haired skin to contact conjunctiva and corneal surface
Can lead to blepharospasm, epiphora, corneal pigmentation & ulceration

Question 16

Classifications of entropion

Answer 16

Primary- congenital or developmental
Secondary - cicatricial or spastic - hard squinting

Question 17

Breeds / locations for entropion

Answer 17

Common in large breeds (Great Danes) or Brachycephalic
Large breeds - commonly develop lateral inversion
Brachycephalic - commonly develop medial inversion

Question 18

Treatment for entropion

Answer 18

Temporary tacking sutures - common in puppies or younger animals or high anesthesia risk patients or patients w spastic (secondary) entropion
Permanent surgical correction - Hotz-Celsus +/- wedge resection is the most common treatment

Question 19

Ectropion

Answer 19

Eversion of eyelid margin - over exposure of the conjunctiva and corneal surfaces
–Typically accompanied by macroblepharon

Question 20

Classification for ectropion

Answer 20

Conformational - Hounds, Setters, Spaniels, St. Bernard, Bulldogs, Boxers
Transient fatigue - hunting dog breeds (after exercise)
Secondary - cicatricial (over-correction of entropion)

Question 21

Eyelid lacerations

Answer 21

Partial vs. full-thickness
• Marginal vs. nonmarginal
• Usually require surgical correction
– Two-layer closure
– Careful apposition of margin (Figure 8 or mattress suture)

Question 22

Blepharitis

Answer 22

Inflammation of the eyelids - can lead to blepharospasm, hyperemia, edema, epiphora, +/- ulceration

Question 23

Causes for blepharitis

Answer 23

Bacterial, mycotic (uncommon), parasitic (Demodex, Sarcoptes, Cuterebra), protozoal (leishmania), allergic and immune- mediated

Question 24

Treating blepharitis

Answer 24

ID underlying cause & treat appropriately, protect w antibiotics / e collar / steroids

Question 25

Another name for puppy strangles

Answer 25

Bacterial blepharitis in puppies

Question 26

Most common bacteria for adult blepharitis

Answer 26

Staph and strep bacteria with development of uveitis

Question 27

Chalazion

Answer 27

“Sty” Impacted meibomian gland - firm/non painful
Treat w warm packing & topical antibiotics

Question 28

Eyelid neoplasia in dogs

Answer 28

Meibomian gland Adenomas & Epitheliomas
– Most common, Pink lobulated masses
• Melanomas - benign usually
– Can arise as single or multiple pigmented masses
– Less aggressive than other locations
• Papillomas - common in small or old dogs

Question 29

Eyelid neoplasia in cats

Answer 29

Cats - should always be considered MALIGNANT
– Squamous Cell Carcinoma (most common)**
– Mast cell tumors, hemangiomas and other connective tissue type tumors

Question 30

Eyelid neoplasia in horses

Answer 30

– Squamous Cell Carcinoma - high recurrence rate**
– Sarcoid - recurrence is common* metastasis is rare
– Melanoma - locally ivasive

Question 31

Eyelid neoplasia treatment

Answer 31

Surgical resection +/- adjunctive therapy
–Surgical technique will depend on the size and location of the tumor
• If involving <1/3 of the eyelid
– Wedge resection or “house incision”
• If involving >1/3 of the eyelid
Reconstructive blepharoplasty

Question 32

Retained spectacle

Answer 32

Reptiles**
Spectacle - fused eyelids - normally shed with skin
So a retained spectacle doesn’t shed with the skin
Treatment is ^ humidity and lubrication