Eye lid diseas The eye lid is made

Eye lid diseas The eye lid is made up of 4 layersg 1 -skin - it is thin and characterized by absence of fat. 2 -muscle layer A-orbiclaris oculi consist of horizontal concentric fibres. It is supplied by the facial nerve. b-levator palpebral superioris. The end in an aponeurosis which is inserted.

1=To the skin of the upper lid 2=Upper border of the tarsus 3=conjuctiva at the fornx It is subblied by the 3 rd cranial nerve. c-Mullers muscle supplied by the sympathetic nerve. 3 -Tarsus =Consists of dense fibers tissue. Embidded in it are enormously developed sebaceous glands-the meibomian glands. 4 -Mucous layer =formed by the palpebral conjuctiva.

Glands of the eye lids 1 -Meibomian glands= They are embedded in the tarsus and are modified sebaceous glands. They secret an oily secretion. They open thrugh vertically arranged ducts into the lid margin. 2 -Glands of zies They are sebaceous glands developed as outgrowth of the hair follcles of the eye lashes. They are situated at the margin. 3 -Glands of moll These are modified sweat glands.

The lid margin 1 -Eye lashes-arranged in 2 -3 rows anteriorly. 2 -Opening of the ducts of the meibomian gland posteriorly. 3 -Glands of zies and moll.

DISEASES OF THE LIDS Oedema of lids-this is common and owing to lossencess of the tissue may be so great as to close the eye. Causes a-Inflammatory oedema 1=Inflammation of the lids –allergic dermatitis due to atropine, cosmetics, insect bite. 2 -Acute conguctivitis 3 -Acute dacryocystitis 4 -Acute iridocyclitis 5 -panophthalmaitis 6 -Obital cellulites] b-Passive oedema due to circulatory obstruction. 1 -Nephrotic syndrome 2 -cardiac failure 3 -Cavernous sinus thrombosis

INFLAMMATION OF THE LIDS 1 -Blepharitis It is a chronic inflammation of the margin of the lid. The lid margin becomes thickned and red. VARIETIES AND ETIOLOGY Squamous blepharitis There is encrustration of lid margin by white scales. It is of 2 types a-Oleosa – or seborrheic Often essintially metabolic associated frequently with seborrheic dermatitis of scalp. dandruff b-Sicca Chemicl irritants and cosmetics such as , acne rosacea , uncorrected refractive error particularly astigmatism.

-Ulcerativeblepharitis They is encrustation of the lid margin by yellow scales with underliing ulceration. The ulcers bleed on removing the scales. is an infective condition caused by staphylococci. 3 -Mixed blepharitis

-Angular blepharitis The inflammation of the lid margin is associated with angular conguctivitis-foamy discharge. It is caused by Morax-AXenfeld bacillius

Symptoms Itching. Soreness. Lacrimation, photophobia. Complications Occure especially in ulcerative blepharitis 1 -Chronic conguctivitis 2 -Marginal corneal ulcer 3 -stye 4 -Madarosis loss of lashes 5 - Tylosis There is hypertrophy of lid border. 6 -Trichiasis 7 -Entropin 8 -Ectrpion

Treatment Antibiotics such as chlormycetin, erythromycin, oxytetracycline ointment.

INFLAMMATION OF THE GLANDS OF THE LIDS Acute inflammation at the edge of the lid, caused by staphylococcal infection of the glands of zies, usually ending in suppuration. Symptoms and signs Red swelling appears in the lash line of the margin of the lid, pain, tendernessand oedemaof the lids, very soon a yellowish summit will be seen indicating suppuration. Treatment 1 -Hot fomentation to hasten suppuration, the pus should be evacuated by a horizontal incision. 2 -Antibiotics

2 -Hordeolum internum This is an acute suppurative inflammation of a miebomian gland due to staphylococcus. Symptoms and sings Symptoms are more violent than those of stye, very soon pus points on the palpebral conjuctiva. Treatment is the same as fore stye, the pus should be evacuated by a vertical incision.

Chalazion This is achronic granulomatous enlargement of one of the meibomian glands Etiology, Pathology The meibomian duct becomes obstructed through proliferation of its epithelium and consequently the gland enlarges. The fatty secretion escapes into the surrounding tissue and exites a forign body reaction. Symptoms 1 -Cosmetic disfigurement-lid swelling 2 -conjuctival irritation Sings A circumscribed swelling which feel hard Treatment 1 -Antibiotics 2 -operation

Blepharospasm It is a condation in which there are involuntary and forcible eye lid closure 1 -Reflex sensory stimulation through branches of 5 th cranial nerve –commonest. a-phlyctenular keratoconjunctivitis b-foreign body on cornea c-Membranous and pseudomembranous conjunctivitis d-Acute iridocyclitis 2 -Excessive stimulation of retina a-Bright light on sensitive eye b-Dilated pupil c- Albinism 3 -Essential blepharospasm whithout any cause 4 -Hysteria

Disorder of lashes Trichiasis an inversion of a varying number of eye lashes so that they rub against the conjuctiva or cornea Etiology same as entropion, secondry to chronic blepharitis, Sings and symptoms The misdirectionlashes cause mechanical irritation and injury to cornea with ulceration- pain, lacrimation, photophobiablepharospasm, vascularisation and opacities of cornea Treatment 1 -Epilation 2 -Electrolysis EYE

Distichiasis Congenital and acquired -variabal number of lashes which originate from meibomian gland orifices. Madarosis Is a decrease in number or complete loss of lashes Causes 1 -local -chronic anterior lid margin diseas -infiltrating tumours -burns -radiotherapy or cryotherapy of lid tumours

Entropion: Is a rolling in of the margin of the lid and with the lashes. Etiology and varieties 1 -Cicatricial entropion due to cicatricial changes in the conjuctiva and distortion of the tarsal plate, most commonly affects the upper lid a-Old case of trachoma b-Blepharitis c-Burns d-Operation upon the lids Spastic Due to spasm of the palpebral portion of the orbicularis muscle, most commonly ophthalmos as in a-Atrophy or absence of eye ball b-Old persons c-After surgical operation d-Blepharosbasm. Symptoms and sings same as for trichiasis

Spastic Due to spasm of the palpebral portion of the orbicularis muscle, most commonly ophthalmos as in a-Atrophy or absence of eye ball b-Old persons c-After surgical operation d-Blepharosbasm. Symptoms and sings same as for trichiasis

Ectropion It is a rolling out of the margin of the lid. Etiolgy and varieties 1 -Cicatrical due to cicatrical changes in the skin of the lid 2 -Senile 3 -Paralytic -it occurs as a result of weakness of the orbicularis muscle due to facial nerve paralysis. Symptoms- Epiphora due to eversion of lacrimal puncta.

Complicationsa 1 -Xerosis of conjuctiva 2 -Chronic conjunctivitis and exposure keratitis. Is a cictricial attachment between the conjuctiva of the lid and the eye ball. Etiology 1 -Burns from lime, acids, and molten metal. 2 -Operations 3 -Trachoma, rarly diptheritic conjunc

SYMBLEPHARON Is a cicatrical attachment between the conjuctiva of the lid and the eye ball. It may affect both lids, but usually the lower, sometimes it includes part of the cornea Types 1 -Anterior =when extending bridge like from lid to globe, leaving a free portion of the conjunctiva corresponding to the fornix. 2=posterior When in involves only the fornix 3 -Total –when the lids are adherent to the globe throughout. ETIOLOGY 1 -injuries especially burns from lime, acide, and molten metal 2 -operation 3 -trachoma

Lagophthalmos This is the incomplete closure of the palpebral aperture when an attempt is made to shut the eyes. Causes Exophthalmos as in Graves disease , proptosis due to orbital tumour. 12 - Facial nerve paralysis 3 -Cicatrical ectropion of upper lid 4 -Symblepharon Complications 1 -Xerosis of conjuctiva. 2 -Chronic conjunctivitis and exposure keratitis

CONGENITAL ABNORMALITIES OD THE LIDS 1 -Distichiasis 2 -Coloboma OF the lid 3 -Ptosis - is adrooping of the upper lid. Etiology –Classification 1 -Congenital ptosis a- Whith normal superior rectus function b-Whith superior rectus weakness c-Marcus Gunn or jaw-winking ptosis 2 -Acquired ptosis a- Neurogenic due to lesion of 3 rd nerve nucleus b-Myogenic Myasthenia gravis c-Mechanical -due to increase weight of lid –tuomor d-Traumatic

TUMOURS OF THE EYE LID 1 -Benign tumours of the lids a- Papilloma b-Molluscum contagiosum`-is a small umbilicated, nodular swelling, generally multiple due to a large pox virus. c-Naevus d-Xanthelasma This is a raised yellow plaque e-Haemangioma Malignant tumours a- rodent ulcer or basal cell carcinoma b-Squamous cell carcinoma –It start as a small nodule which ulcerates. c-Meibomian gland carcinoma