eyelids Flashcards
name the structures of the eyelid anterior to posterior
Skin
- Orbicularis oculi
- Fibrous layer
- Levator palpebrae superioris muscle 5. Müller muscle
what is the skin adnexa
ie deep in the dermis and includes the eyelashes and many types of glands:
what type of glands are found in skin adnexa
- Eccrine glands: Sweat glands.
● Apocrine glands: Modified sweat glands (e.g. gland of Moll).
● Holocrine glands: Gland of Zeis, and meibomian glands. These glands
synthesize/secrete lipids and oily substances.
sensory supply of the eyelid
● Lateral upper eyelid: Lacrimal nerve (CNV1).
● Upper eyelid: Supraorbital and supratrochlear nerves (branches of frontal
nerve of CNV1).
● Medial canthal area: Infratrochlear nerve (branch of nasociliary nerve of
CNV1).
● Lower eyelid: Infraorbital nerve (CNV2).
role of the orbicularis oculi and the name of its components
nerve supply
A striated muscle arranged in concentric bands that functions in closing the eye. It has four parts: palpebral, orbital, lacrimal and ciliary parts. Nerve supply is via temporal and zygomatic branches of CNVII.
role of LPS
nerve supply
orgination
type of muscle
A striated muscle responsible for eyelid retraction that originates at the lesser wing of the sphenoid to insert into the tarsal plate. Nerve supply is via the superior division of CNIII.
role of the muller muscle
type of muscle
nerve supply
A smooth muscle innervated by the sympathetic nervous system which contributes to eyelid retraction. Originates from the aponeurosis of the levator to insert into the tarsal plate.
what are the different stimulus for blinking reflex
● Corneal stimulus: CNV1 (afferent), CNVII (efferent)
● Light stimulus: CNII (afferent), CNVII (efferent)
● Auditory stimulus: CNVIII (afferent), CNVII (efferent)
what is the bell’s phenomenon
upward and outward rotation of the globe on forced lid closure. This is particularly obvious in patients with CNVII palsy, as the lid remains open when patients are asked to close their eyes. This phenomenon is regarded as a defensive mechanism
what is a chalazion and pathology
sterile lipogranuloma that occurs due to obstruction of the meibomian glands and occasionally the gland of Zeis
presentation of a chalazion
it presents over several weeks as a painless round nodule in the eyelid. If infected, it may become red, swollen and painful.
what is associated with chalazion
blepharitis
acne rosacea
Mx of chalazion
conservative
medical
surgical
Management is mainly with hot compresses twice daily and use of oral
antibiotics if infected. Incision and curettage is also an option.
pathology of port wine stain
A congenital capillary malformation of the dermis
presentation of port wine
ass w what eye conditions
They present as pink/ purple well-demarcated patches that do not blanch on pressure and never cross the midline. Typically, they occur along the distribution of choroidal neovascularization (CNV)
overlying skin becomes hypertrophies and coarse
ass w ipsilateral glaucoma
episcleral haemangioma
iris heterochromia
diffuse choroidal haemangioma
what is associated with port wine stain
It may be associated with Sturge-Weber syndrome.
what is BCC
RFs
most common malignant eyelid tumour. They are slow growing and rarely metastasize.
fair skin
inability to tan
chronic exposure to sunlight
histopathology of BCC
Clusters of darkly staining basaloid cells with peripheral palisading arrangement of nuclei.
features of BCC
Centrally ulcerated pearly edged papules with associated telangiectasia
● Location (from most common to least common)
Eye: Lower lid > medial canthus > upper lid > lateral canthus Lips: Upper lip > lower lip
ulcerative is the most common type unlike nodular or sclerosing
non metastasizing
Mx of BCC the name
Mohs micrographic surgical excision (layered excision of the tumour to allow better total clearance).
features of SCC
Keratotic (e.g. scaly, crusty), ill-defined nodule that may ulcerate.
● Dome-shaped nodule with keratin-filled crater is typical in
keratoacanthoma.
20% metastise to regional lymph nodes
Mx of SCC
Mohs surgery and radiotherapy
what is sebaceous gland carcinoma
is tumour arises from meibomian glands or, less commonly, glands of Zeis
UNLIKE BCC or SCC it arises more commonly on the upper eyelid
histopathology of sebaceous gland carcinoma
foamy vacuolated lipid-containing cytoplasm with hyperchromatic nuclei are seen
features of sebaceous gland carcinoma
They are more common in elderly females and appear as a yellow nodule in the upper eyelid which may be mistaken for a chalazion.
what is trichiasis
Misdirected growth of eyelash follicles, in which eyelashes grow towards the cornea or sclera
common causes of trichiasis
Herpes zoster ophthalmicus and blepharitis.
what is distichiasis
Refers to the formation of a posterior row of eyelashes.
causes of distichiasis
Mx
- congenital (AD inheritance) - thinner and shorter
after 5 years maybe
ass w lymphoedema of the legs
upper eyelide Mx - crytotherapy and lammelar eyelide divsion - acquired from chemical injury
- Stevens-Johnson syndrome
- ocular cicatricial pemphigoid.
epilation
eclectrolysis
cryotherapy
what is anterior blepharitis
inflammation of the skin around the base of the eyelashes and is
divided into
1. staphylococcal
or
2. seborrheic.
what is posterior belpharitis
Inflammation of the meibomian gland around the eyelid margins due to gland dysfunction. May be associated with ocular rosacea.
RFs of blepharitis
Dry eyes
● Seborrheic dermatitis
● Demodex folliculorum: Associated with ocular rosacea
● Long-term contact lens wear
symptoms of blepharitis
Bilateral and symmetric, dry, gritty, crusted and red eyes
signs of staphylococcus anterior blephariits
– Associated with atopic dermatitis
– Lid hyperaemia and swelling
– Hard scales and crusting of the bases of the lashes
– Tear film instability, dry eye syndrome and trichiasis may develop
signs of seborrhoeic anterior blepharitis
– Associated with seborrheic dermatitis
– Soft scales and oily lid margins
signs of posterior blepharitis
ass w
– Associated with acne rosacea
– Foamy and unstable tear film (due to abnormal meibomian gland
secretion, leading to excess lipid in tear film)
– Posterior lid margin hyperaemia and telangiectasia
Mx for blepharitis
● Eyelid hygiene is the most important management.
● Antibiotics (e.g. tetracyclines, due to their ability to inhibit fatty acid
oxidation and lipase production).
● Tea tree oil may be used for demodex infestation.
causes of ptosis
neurogenic (e.g. Horner syndrome, CNIII palsy)
myogenic (e.g. myasthenia gravis, myotonic dystrophy)
involutional (age-related)
congenital (due to failure of development of the levator muscle).
what is marcus gunn jaw-winking syndrome
congenital ptosis.
It presents as a ptotic lid that retracts when the ipsilateral pterygoid muscle is stimulated (e.g. chewing).
what is dermatochalasis
Excessive skin of the upper eyelid leading to sagging, classically described as lateral hooding. This condition occurs in the elderly.
what is blepharochalasis
This bilateral condition results from abnormal elastic eyelids causing recurrent episodes of painless oedema of the upper eyelids.
This leads to stretching and atrophy of the skin and subsequent skin folds and ptosis.
what is floppy eyelid syndrome
middle-aged obese men
with obstructive sleep apnoea.
sleep facedown to pillow
The upper eyelid is extremely lax, which may lead to
papillary conjunctivitis and keratopathy.
causes of lid retraction
● Graves ophthalmopathy ● Parinaud syndrome (Collier sign) ● Third nerve misdirection ● Marcus Gunn jaw-winking syndrome ● Progressive supranuclear palsy ● Down syndrome ● Congenital hydrocephalus (setting-sun appearance: bilateral downward deviation of the globes with upper lid retraction)
what is lid coloboma
Incomplete development of the eyelid due to the failure of lid fold fusion. It can occur in either the upper or lower eyelids.
what is goldenhar syndrome
A sporadic condition characterized by upper lid coloboma, microphthalmia, optic disc coloboma, maxillary and mandibular hypoplasia, and limbal dermoids (smooth yellow subconjunctival mass, typically at the inferotemporal limbus with hair protrusion). May be associated with Duane retraction syndrome.
lower eyelid coloboma
ass w
middle and outer thirds of the lower eyelid. Can be associated with Treacher Collins syndrome.
what is hordeolum (stye)
stye is an External hordeolum is an infection of the glands of Zeis or Moll.
Internal hordeolum is an infection of the meibomian gland.
features of a stye
cause
ass w
due to a staphylococcal infection and presents as a painful, erythematous swelling of the eyelid.
ass w staphylococcal blepharitis
Mx of a stye
hot compresses, topical antibiotics and eyelid hygiene.
signs of keratoanthoma
hyperkeratotic nodule
regressing a keratin filled crater may develop
causes and Mx
of impetigo
erysipselas
necrtosing fascitis
staph aureues
- erythromycin or flucox
strep pyogenes - oral abx
same - benzylpenicillin
examples of pseudoptosis
dermatochalasis, blepharochalasis, microphthalmus and phthisis bulbi (atrophic, non-functioning eye that occurs as a result of severe ocular disease).
