Droopy Lids Lynn E Lawrence CMSgtret USAF CPOT

Droopy Lids Lynn E. Lawrence, CMSgt(ret) USAF CPOT, ABOC, COA

Objectives • • • Anatomy of the Eye Lid Different Types of Droopy Lids Causes of Droopy Lids Why Does this Impact Vision? When Is To Seek Surgical Intervention? Testing

Lipid Secretion: Meibomian Glands What eye is this? (WC Posey, Diseases of the Eye, 1902) Transillumination of meibomian glands How does the lipid layer aid in contact lens wear? (Transillumination image from Dry Eye and Ocular Surface Disorders, 2

Anatomy

Anatomy What function does the pupil have?

Natural Folds

Muscles of the Eye Lid

Muscles • • Riolan’s muscle Levator Muscle Muller Orbicularis Oculi

The Eyelid • 7 Layers of the eyelids 1. Skin-thinnest layer 2. Subcutaneous connective tissue 3. Striated Muscle 4. Sub-muscular connective tissue 5. Tarsal plate or fibrous layer 6. Smooth muscle 7. Conjunctiva (Bulbar/Palpebral) How are Hordoleum and Chalazions treated?

Lacrimal Pump • Pump Action – Lids • Lateral/medial • Muscles • Disease – Punctum – Canniculli • Lacrimal Sac • Nasolacrimal Duct • Facial Nerve Palsy (7 th CN)

Eyebrows and Eyelashes • Eyebrows – Thickened ridge of skin with short hairs – Diverts perspiration • Eyelashes – Also protects – Sebaceous glands at base of each lash are called Glands of Zeis which produce a lubricating fluid • Fluid can harden and clog the gland, producing a stye or painless chalazion. If painful and infected it is called an external hordeolum Cataracts (myotonia) are caused by?

Functions of the Eye Lid • Protection – From debris – light • Pump – moisturize the globe by spreading tears across the eye • Pushes excess tears and bacteria from the surface • Provides oil for the tear film

What Are Droopy Lids • Droopy lids occur when the function of the eye no longer meets it’s normal required function or position • This can be unilateral or bilateral

Causes of Droopy Lids Over 425 cause of droopy eyelids • Aging • Muscular • Neurological • Congenital • Acquired – Disease – Trauma

Marcus Gunn Rachel Schoffner, ESG, Memphis, TN • Marcus Gunn phenomenon (a. k. a. Marcus Gunn Jaw. Winking[1][2] or Trigeminooculomotor Synkineses) is an autosomal-dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid. This condition is characterized as a synkinesis: when two or more muscles that are independently innervated have either simultaneous or coordinated movements Yamada K, Hunter DG, Andrews C, Engle EC (September 2005). "A novel KIF 21 A mutation in a patient with congenital fibrosis of the extraocular muscles and Marcus Gunn jaw-winking phenomenon

Facial Nerves

7 th Cranial Nerve – Facial Nerve Bells Palsy

Cranial Nerves

Ptosis • Ptosis /ˈtoʊsɪs/ (from Greek Ptosis or πτῶσις, to "fall") is a drooping or falling of the upper or lower eyelid. The drooping may be worse after being awake longer, when the individual's muscles are tired

Dermatochalasis • Dermatochalasis is a medical condition, defined as an excess of skin in the upper or lower eyelid, also known as "baggy eyes. "[1] It may be either an acquired or a congenital condition. It is generally treated with blepharoplasty.

Eyelids are the pump for tears • • Punctum Tear coverage Exposure issues Diagnosis assistance

Common Lid Conditions

Other Diseases

Terms Associated With Droopy lids Lagophthalmos Dermatochalasis Blepharoptosis Eyelid Crease Medial/Canthal webbing Inflammation/edema/infil tration • Herniated orbital fat pads • Prolapsed lacrimal gland • Eyelid laxity • • •

Why Does this Impact Vision? • Interferes with the passage of light to the retina • Decreases acuity • Limits peripheral field of vision • Changes posture • Causes fatigue • Impacts self-esteem • Changes lifestyle

Seeking Surgical Intervention • • • Why? Lifestyle change Job performance Insurance coverage Cosmetic

Before and After Surgery

Testing • Insurance vs Cosmetic • Visual field testing – HVF – Goldmann perimeter

Review • • • Anatomy of the Eye Lid Different Types of Droopy Lids Causes of Droopy Lids Why Does this Impact Vision? When Is To Seek Surgical Intervention? Testing

References • Yanoff, M, Duker, JS. Ophthalmology. Mosby, St. Louis. 1999. pp. 8. 1 -10. David M. Mills, MD 31

Recommended Texts David M. Mills, MD 32

Thank you martralyn@msn. com