Lid and lacrimal disorders

1. Lid and lacrimal disorders

2. Trichiasis Distichiasis Disorders of Lashes

3. Disorders of Lashes

4. Treatment options for trichiasis Epilation Electrolysis Cryotherapy Argon laser Surgery

5. Madarosis Lid margin inflammation Tumor Cryotherapy, radiotherapy or burns Alopecia Syphilis Leprosy SLE Poliosis VKH Sympathetic ophthalmia Disorders of lashes

6. Entropion

7. Entropion Entropion, or inversion of the lid margin, may be congenital or acquired The acquired variety can be the result of: Ageing changes (involutional) Cicatricial changes affecting the posterior lamella of the eyelid (cicatricial) Spastic

8. Entropion

9. Entropion

10. Entropion Treatment Lubrication Taping the lid Epilation Horizontal lid tightening Tarsal fracture procedure

11. Ectropion

12. Ectropion Ectropion, or eversion of the lid margin, may be congenital or acquired The acquired forms are the result of Ageing changes (involutional) Lumps (mechanical) Scarring of the anterior lamella of the lid (cicatricial) Burn Infection/ inflammation Trauma Weakness of the orbicularis muscle (paralytic)

13. Ectropion

14. Ectropion Treatment Lubrication Horizontal lid shortening or tightening Punctal inversion

15. Ptosis

16. Ptosis

17. Ptosis

18. Ptosis

19. Ptosis Pseudoptosis Orbital volume deficiency Exophthalmos Excess lid skin Hypotropia

20. Ptosis Acquired or Congenital Neurogenic 3rd nerve palsy 3rd nerve misdirection Horner syndrome Marcus Gunn jaw-winking syndrome Myogenic Myasthenia gravis Myotonic dystrophy Ocular myopathies Levator dystrophy Aponeurotic (levator dehiscence) Mechanical Traumatic

21. Ptosis Treatment Ptosis crutch Taping of the lid Surgical Levator advancement Muller�s muscle resection Frontalis suspension

22. Blepharitis Anterior Posterior Staphylococcal Seborrhoeic Meibomianitis Treatment Lid hygiene Tears Antibiotics Warm compresses Eyelids inflammation

23. Allergy Acute allergic blepharoconjuctivitis Allergic dermatoblepharitis Eyelids inflammation

24. Chalazion Focal inflammation of the eye lids which result from obstruction of the meibomian glands Chronic lipogranulomatous inflammatory changes Treatment Warm compresses Local antibiotic Excision Eyelids inflammation

25. Hordeolum Acute infection involving the meibomian glands (internal) or the glands of Moll or Zeis (external) Overtime may evolve into chalazion Treatment Warm compresses Topical antibiotic Eyelids inflammation

26. Cysts Cyst of Moll Cyst of Zeiss Sebaceous cyst Hidrocystoma Benign eyelid lesions

27. Tumors Viral wart( papilloma) Actinic keratosis Seborrheic keratosis Keratocanthoma Nevi Junctional Compound Dermal Capillary hemangioma Xanthelasma Pyogenic granuloma Benign eyelid lesions

28. Benign eyelid lesions

29. Basal cell carcinoma Squamous cell carcinoma Meibomian gland carcinoma Melanoma Kaposi sarcoma Merkel cell carcinoma Malignant eyelid tumors

30. Basal cell carcinoma Most common malignancy(90%) of the eyelid Usually located on the lower lid and medial canthus Pearly nodules which ulcerate and have telangiectasias Treatment Surgical excision Cryotherapy Radiation therapy

31. Basal cell carcinoma Most common malignancy(90%) of the eyelid Usually located on the lower lid and medial canthus Pearly nodules which ulcerate and have telangiectasias Treatment Surgical excision Cryotherapy Radiation therapy Orbital exenteration for deep invasive lesions

32. Squamous cell carcinoma Less common than BCC May arise de-novo or from pre-existing actinic keratosis May metastasize

33. Orbital cellulitis Preseptal cellulitis Infection anterior to orbital septum Orbital cellulitis 90% secondary to sinusitis Trauma Insect bite Endogenous bacteremia

34. Orbital cellulitis Organisms Staphylococcus aureus Streptococcus Hemophilus influenza Treatment admission Orbital CT I.V antibiotics (3rd generation cephalosporin and clindamycin) Drainage of orbital abscess

35. Orbital disorders Children Orbital cellulitis Pseudotumor Dermoid cyst Capillary hemangioma Lymphangioma Rhabdomyosarcoma metastasis Adults Thyroid orbitopathy Cavernous hemangioma Lymphangioma Pseudotumor Lymphoma Meningioma Lacrimal gland tumor Dermoid cyst metastasis

36. Thyroid orbitopathyGraves� disease Most common cause of exophthalmos in adult Onset: 20-45 years Clinical picture: Unilateral or bilateral exophthalmos Eyelid retraction Lid lag Diplopia Periorbital edema Chemosis Optic neuropathy 90% HYPER, 1% HYPO, 6%EUTHYROID

37. Thyroid orbitopathy

38. Thyroid orbitopathy Complication: Diplopia Redness Corneal exposure Optic neuropathy Treatment Lubrication Tape eyelids at night Steroid Radiation Surgery Decompression Muscle surgery Optic nerve fenestration

39. Anatomy and physiology of the lacrimal system Secretory apparatus Lacrimal gland Lacrimal ducts empty into superior cul-de-sac Afferent pathway: V nerve Efferent pathway: VII nerve (reflex tear) Accessory lacrimal glands of Krause and Wolfring (basic tear) Tear film Inner layer: mucin Middle layer: aqueous Outer layer: meibomian

40. Anatomy and physiology of the lacrimal system Lacrimal excretory apparatus Puncta Canaliculi Lacrimal sac Nasolacrimal duct Inferior meatus VALVE OF HASNER

41. Anatomy and physiology of the lacrimal system Lacrimal evaluation Dye disappearance test Primary and secondary dye test Lacrimal irrigation Tear break up time Schirmer test

42. Lacrimal disorders Congenital nasolacrimal duct obstruction Membranous block at the valve of hasner 2-4% of full term new baby Usually resolve spontaneously within 4 to 6 weeks Treatment Topical antibiotics Massage Probing: 6 to 12 months

43. Lacrimal disorders Dacryocystocele Combination of nasolacrimal duct obstruction and amniotic fluid or mucus trapped in the sac Treatment Antibiotics Massage probing

44. Lacrimal disorders Punctal stenosis Dilation Snip procedure Canaliculitis Irrigation with antibiotics Oral antibiotics Canalicular obstruction Dacryoliths Dacryocystitis

45. Lacrimal disorders Lacrimal sac tumors Squamous cell papilloma Transitional cell papilloma Squamous cell carcinoma Transitional cell carcinoma Adenocarcinoma Lacrimal gland tumors 70% of lacrimal gland masses are non-epithelial masses: Idiopathic inflammation Sarcoidosis, TB Lymphoid tumors 30% are epithelial Cyst Adenoid cystic carcinoma Pleomorphic adenoma(benign and malignant mixed tumor)