Disorders Of Eyelids Flashcards
Eyelid anatomy
Skin
Muscle - orbicularis oculi - Levator palpebra superioris
Tarsal plate & glands
Palpebral conjunctiva
Function of eyelid
Direct protection of eye
Production of glandular secretions
Distribution of tear film
Congenital abnormalities of eyelids
Anklyoblepharon
Ophthalmia neonatorum
Eyelid agenesis
Eyelid dermoid
Macroblepharon
Lagophthalmos
Ankyloblepharon
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
Pathologic ankyloblepharon
Delayed of complete failure of eyelid opening
Infection may develop - ophthalmia neonatorum
Ophthalmia neonatorum
Infections due to failure of eyelid opening
Staph in dogs
Chlamydia in cats
Eyelid agenesis
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
Eyelid dermoid
Ectopic island of skin at the eyelid margin
Common in frenchies, shih tzu, GS, dachshund
Must surgically remove or scrape off
Macroblepharon
Overly large palpebral fissure - common in Brachycephalic
Contributes to KCS, Proptosis, lagophthalmos
Can cause Pigmentary keratitis
Lagophthalmos
Inability to close eyelids completely
Congenital in Brachycephalic breeds
Acquired/secondary condition with facial nerve paralysis, exophthalmia, buphthalmia
Can cause keratitis
Structural abnormalities
Distichiasis - hairs from meibomian glands
Trichiasis - normal cilia/ hair grows facing towards cornea
Ectopic cilia - cilia emerging through palpebral conjunctiva
Distichiasis
Can cause epiphora, tear staining, blepharospasm & keratitis
Thin hair - ocular lubrication
Stiff hair - cryotherapy (most common)
Trichiasis
Congenital form can cause entropion, eyelid agenesis & dermoid
Acquired form can cause cicatricial - eyelid lacerations & surgeries
Ectopic cilia
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
Entropion
Inversion of eyelid margin - causing haired skin to contact conjunctiva and corneal surface
Can lead to blepharospasm, epiphora, corneal pigmentation & ulceration
Classifications of entropion
Primary- congenital or developmental
Secondary - cicatricial or spastic - hard squinting
Breeds / locations for entropion
Common in large breeds (Great Danes) or Brachycephalic
Large breeds - commonly develop lateral inversion
Brachycephalic - commonly develop medial inversion
Treatment for entropion
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
Ectropion
Eversion of eyelid margin - over exposure of the conjunctiva and corneal surfaces
Typically accompanied by macroblepharon
Classification for ectropion
Conformational - Hounds, Setters, Spaniels, St. Bernard, Bulldogs, Boxers
Transient fatigue - hunting dog breeds (after exercise)
Secondary - cicatricial (over-correction of entropion)
Eyelid lacerations
Partial vs. full-thickness
• Marginal vs. nonmarginal
• Usually require surgical correction
Two-layer closure
Careful apposition of margin (Figure 8 or mattress suture)
Blepharitis
Inflammation of the eyelids - can lead to blepharospasm, hyperemia, edema, epiphora, +/- ulceration
Causes for blepharitis
Bacterial, mycotic (uncommon), parasitic (Demodex, Sarcoptes, Cuterebra), protozoal (leishmania), allergic and immune- mediated
Treating blepharitis
ID underlying cause & treat appropriately, protect w antibiotics / e collar / steroids
Another name for puppy strangles
Bacterial blepharitis in puppies
Most common bacteria for adult blepharitis
Staph and strep bacteria with development of uveitis
Chalazion
“Sty” Impacted meibomian gland - firm/non painful
Treat w warm packing & topical antibiotics
Eyelid neoplasia in dogs
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
Eyelid neoplasia in cats
Cats - should always be considered MALIGNANT
Squamous Cell Carcinoma (most common)**
Mast cell tumors, hemangiomas and other connective tissue type tumors
Eyelid neoplasia in horses
Squamous Cell Carcinoma - high recurrence rate**
Sarcoid - recurrence is common* metastasis is rare
Melanoma - locally ivasive
Eyelid neoplasia treatment
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
Retained spectacle
Reptiles**
Spectacle - fused eyelids - normally shed with skin
So a retained spectacle doesn’t shed with the skin
Treatment is ^ humidity and lubrication
