N

RAI
S
FAR
HUA SUBJECT: Opthalmology DATE: 07 03 08
JOS
TOPIC: EYELIDS AND LACRIMAL APPARATUS
LECTURER: Dra. Valdez
CO
MAR
ISAY TRANSGROUP: Pipoy’S Dream Academy ScHolars
DY
CAN
NG LACRIMAL APPARATUS Epiphora
KRI
EISA I. Secretory System excessive tearing may be due to the ff:
E
ANN • produces tears • Hypersecretion of tears:
H
• responsible for formation of precorneal -emotional
KYT
film
ON -local irritants in the eye and nose
AAR • mucin – deep mucoid
HE • tears – watery (middle) • Interference and outflow of tears through
ALP
• superficial oily secretion the drainage canal
II. Excretory System
LA
KAR
Drainage interferences may be due to:
• provides normal passage for the
G
PEN
KC conduction of tears from cul de sac to • Displacement of lower punctum
ADI inferior meatus • Destruction of lower punctum, canaliculi,
N lacrimo-nasal duct
• Impairment of normal suction of sac
MAA
AM SECRETORY SYSTEM
A
MON Basic Secretors: *Obstruction of the upper punctum or canaliculus
F does not cause excessive tearing as long as the
BUF 1. Mucin Secretors - made up of conjunctival lower punctum and the rest of the excretory
DIE
goblet cell, crypts of Henle, gland of Manz mechanism are functioning
2. Lacrimal Secretors- gland of Krause, gland
GOL
A Dryness of tears:
EZR of Wolfring
KIX 3. Oily Secretors- Meibomian gland As an individual grows older, his glands
RIZ -glands of Zeiss and Moll (roots of undergo changes, causing alteration in quality
EY eyelashes) and quantity of respective secretion resulting in
ocular discomfort due to dryness (hyposecretion
LAIN
N Reflex Secretors: of tears)
XTIA
CES The main lacrimal gland located at the However, dryness does not occur even if
PS upper temporal portion of the orbit; involved in the lacrimal glands are removed as long as the
the true hypersecretion.
HOO
E basic secretors are normal; present during sleep.
Conjunctival secretory stimulation
VINC
Clinical conditions when dryness is (+)
activates the reflex system whenever the basic
E
ESS
DEN secretors become inadequate in both eyes. • Xeropthalmia – vitamin A deficiency,
LLE bitot’s spot; dryness of conjunctiva
EXCRETORY SYSTEM:
• Cornea affected – photophobia
CECI

•
JAM
TLE Lacrimal passage consist of: Sjogren Syndrome – deficit lacrimal
Y secretion
PIPO • Lacrimal punctum - Dry mouth, polyarthritis
H • Canaliculi
RIC
• Lacrimal Sac - Chronic conjunctivitis with punctuate
HEIN
• Lacrimal Sac corneal erosion with filament attached to
T erosion
BAR
Tears:
• Steven-Johnson’s syndrome- severe
RYL
SHE
LH • Sl. Alkali purulent conjunctivitis
RAP • H2O – 98.2% -Conjunctival ulceration with necrosis –
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blindness
• Solid – 0.8%
TINA

•
AIN
ALL Enzyme – lysozyme which is antimicrobial -With secondary infection and scarring of
TTE conjunctiva, cul de sac
YVE
ARY
M
 SUBJECT: Opthalmology DATE: 07 03 08
TOPIC: EYELIDS AND LACRIMAL APPARATUS
LECTURER: Dra. Valdez
TRANSGROUP: Pipoy’S Dream Academy ScHolars

-May be completely obliterated Tx:

-Eyelids may be bound to cornea • frequent massage or probing of lacrimal sac

-Associated with erythema multiforme In Adults

Chronic

• May be caused by Strep. Pneumococcus

• May be hereditary; common to females
• No evidence that it is due to intranasal
Inflammatory Conditions disease or obstruction of lacrimal duct
• Lining of the sac is thickened or enlarged
Dacryo-adenitis

Acute or subacute infection of the Acute

lacrimal gland due to org ___ suppuration
• may arise from a chronic dacryocystitis
Usually a complication of mumps,
• If extended beyond the limit of the sac –
measles, influenza
abscess
Uveo-parotitis • Swelling over the side of the inner canthus
with pain; if it ruptures, spontaneous fistula
Bilateral enlargement of lacrimal gland Tx:
with chronic inflammatory lesion of uveal tract;
with swelling of parotid gland and sometimes • Warm compress
facial palsy • Antibiotics

Tx: Inflammatory sequela and noninflammatory

conditions
• Warm compress over the affected area
• antibiotics Eversion of the lower punctum
• Incision of abscess
Normally the lower punctum is directed
Diseases of the Lacrimal Passages- Inflammatory backwards, towards the eyeball. If everted it
conditions comes forward and away from the marginal strip
of tear fluid-epiphora
Fungal Infection of the Canaliculus
Eversion may be due to the ff:
caused by Actinomycosis affecting the
upper canaliculus • Senile laxity of eyelids
• Chronic blepharitis or ectropion
Tx: Tx:

• Dilatation of canalicuclus • electrocautery of lower conjunctival

• Evacuate purulent discharge fornices behind and below the punctum

Dacrocystitis Occlusion of punctum:

Inflammation of lacrimal sac; due to stasis • Congenital

of tears in sac • Inflammatory- result of sac formation
• Foreign body
In infants
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Division of lower canaliculus

• incomplete canalization of lower lacrimal duct
due to presence of membrane
 SUBJECT: Opthalmology DATE: 07 03 08
TOPIC: EYELIDS AND LACRIMAL APPARATUS
LECTURER: Dra. Valdez
TRANSGROUP: Pipoy’S Dream Academy ScHolars

As a result of trauma, adequate or proper

locepation of the lip of the punctum should be Inflammatory conditions
carefully done.
Blepharitis – inflammation of the lid margins

Types:
EYELIDS Squamous
Functions: •Characterized by redness, greasy scaling
skin,fine flakes
• To protect the globe from external injury
• Secondary to sebborheic dermatitis of
and excessive light
scalp and eyebrows
• Distributes tears uniformly over anterior
• Aggravated by smoke, chemicals, fumes,
surface of the eye
etc.
• Serves as curtain
Tx: control of sebborheic dermatitis- application
of eye ointment
Layers (from the external):
Ulcerative
• Skin
• Subcutaneous tissue • Eyelid maybe red or inflamed
• Muscles • Presence of yellowish crust found on the
• Tarsus lid margin which may adhere to the lashes
• Conjunctiva – ulcerate
Madarosis – loss of eyelashes due to distortion of
Skin is composed of loose areolar tussue, hair follicles
thus, any traumainflicted on it will bring about
ecchymosis or excessive swelling. Tylosis – in long-standing cases the lid margin
hypertrophies; thickening- drooping of eyelids 
Lid margin sleepy appearance

• grayline -3 rows of eyelashes; Opening of Tx:

meibomian glands; Superior and inferior
punctum located medially • Towards cause of eyelid infection
• Warm moist compress
Anteriorly • Tarsal massage
• Synthetic antibiotics
• Skin
• Orbicularis oculi Hordeolum or stye – an acute infection of
• Hair follicle associated glands of lids; circumscribed, red,
Grayline swollen, tendermass along the lid margins

Posteriorly -If away for the lid margin –Meibomian gland

• Tarsal plate -If at the lid margin – glands of Zeiss and Moll
• Conjunctiva
Tx: warm compress 2-3x a day
• Tarsus
Chalazion – chronic granulomatous inflammation
Tarsus of Meibomian gland which is painless and
appears as a small hard tumor
• important because it gives tone to the lid
• extends from the lacrimal punctum nasally Tx: incision and drainage
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to the lateral canthus temporally

• contains parallel row of sebaceous glands Conact dermatitis – local inflammation affecting
which are the meibomian glands skin and lids resulting from allergy to cosmetics
 SUBJECT: Opthalmology DATE: 07 03 08
TOPIC: EYELIDS AND LACRIMAL APPARATUS
LECTURER: Dra. Valdez
TRANSGROUP: Pipoy’S Dream Academy ScHolars

Itchiness and drying of the skin Tx:

Tx: • epilation
• elicholysis
• anti-histamines
• eliminate cause Entropion – result from scarring of conjuntiva and
• cold compress lid margin, inflammatory injuries and lid surgery

Herpes Zoster Opthalmicus – unilateral, vesicular Ectropion – outward eversion of lid margin; may
eruptions along the distribution of 1 & 2 division result from burns, lid injury, skin infection
of trigeminal nerve
Symblepharon-adhesion of part of palpebral
- Lids swollen, vesicular eruptions leaving conjunctiva to bulbar conjunctiva
heavy scars; Cornea may be affected
- Results from alkali burn, chronic
Tx: inflammation like trachoma and SJD.

• no specific treatment; topical steroids - Limited movement of the eyeball

• anti-viral
Tx:

Lid vaccinia – may result from accidental transfer

of virus from an inoculation site (arm or leg) to
the lids
- Lesion may start as a vesicle pustule
becomes umbilicated  crusting  scar
formation
Tx:
• no specific treatment; warm compress
• topical antibiotic
• IDU eye out conjunctival sac prophylaxis
against corneal involvement
Verruca – viral wart may involve the skin and
intermarginal space of the lids; may result to a
chronic conjunctivitis and keratitis
- Infection may be transmitted directly or
indirectly (barbers, handshaking, etc.)
Tx: excision
Inflammatory sequela
Trichiasis – misdirected eyelashes towards
cornea, found in entropion, membranous
conjunctivits, injury of the lid margin
• removal of adhesion and scarring and
replacement of mucosa graft
Ankyloblepharon – fusion of the upper and lower
lid due to infection
Non-inflammatory conditions
Developmental anomalies
Ablepharon – absence of lids
Coloboma – break in continuity of lid margin
Epicanthus – presence of V-fold of skin from inner
eyebrow to the root of the nose, one looks like
oriental
Blepharophimosis- reduced length and width of
palpebral fissure
Blepharoptosis –abnormal drooping of upper lid
due to (-) or weakness of levator palpebrae
muscle or lesion of CN3
Marcus Gunn Jaw Winking Phenomenon – the
affected eyelid elevated when one open his
mouth or when chewing or lateral movement of
jaw brought to normal

- Characterized by lacrimation, foreign Neurogenic Anomalies

body sensation, pain and discomfort
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Myokimia – the most of the lid due to eyestrain,

- If cornea is affected – visual disturbance tension, weak body resistance
 SUBJECT: Opthalmology
TOPIC: EYELIDS AND LACRIMAL APPARATUS
LECTURER: Dra. Valdez
TRANSGROUP: Pipoy’S Dream Academy ScHolars
Blepharoclonus – exaggerated extraction of
orbital parts (orbicularis oculi muscle) with
marked reflex blinking
Lagophthalmos – inability of the lid to close; CN
VII paralysisproptosis, enlarged globe, lid
retraction
Blepharospasm – forcible spasm of eyelid;
bilateral due to marked contraction of orbicularis
oculi muscle of possible corneal lesion
Blepharoptosis – drooping of the upper lid, can’t
be lifted
- Secondary to paresis of oculomotor
nerve- due to tumors, severe head injuries
- Affection of cervical sympathetic (muller
muscle)
Horner’s Syndrome –ptosis, anhydrosis, miosis
Abnormal drooping – lid edema, inflammation,
hypertrophies, tumor mass of the upper lid
Aquired ptosis or Blepharoptosis
The upper lid may droop, it can’t be lifted.
The acquired type may affect one or both eyes,
and can be partial or complete
Acquired type can be due to the ff:
• Paralytic – affection of oculomotor nerve
• Myotonic – affection of the levator muscle
• Mechanical – due to weight of the lid
*Paralysis or paresis of Occulomotor nerve may
be due to:
• Intracranial aneurysm
• Tumors
• Head injuries
Affection of cervical sympathetic may affect
muller muscle muscle; Horner’s syndrome (ptosis,
Anhydrosis, Miosis)
Abnormal Drooping may be due to:
• Lid edema
• Inflammation
• Hypertrophies
• Tumors or masses in the upper lid
DATE: 07 03 08
Except for visual interference, in severe
causes, ptosis is symptomless. The cornea is
partly covered.
On upward gaze, there is lid lag and wrinkled
in the forehead
In paralytic ptosis, there is need for a
backward tilt to gain better vision
Therapy is directed to cause
Baggy lids – localized swelling of lower lid
resulting from dehiscence in orbital septum –
prolapse of orbital fat.
Systemic causes: Hyperthyroidism, nerphrosis,
angioneurotic edema
Blepharochalasis – in ages, lids looses its
elasticity, large fold of skin hanging over lid
margin
Malignant Tumors
Basal Cell CA
• Most common tumor of the eyelids
• Males, affects lower lid at inner canthus
• Spared by direct extension, highly
invasive, but do not metastasize
• Dx: biopsy
• Tx: radiation tx and reconstructive surgery
Squamous Cell CA
• Male; upper lid
• Starts as warty growth with a keratotic
covering, gradually eroding until ulcer
develops
• As it changes, it appeards as a shallow
crusted ulcer with a granular red base
• Spreads through lymphatic system
Meibomian Gland CA
• Appears as a yellowish white tumor on
tarsal plate of lid
• May be associated with chalazion;
metastatic
• Therefore recurrent chalazion should be
biopsied
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Benign Tumors
 SUBJECT: Opthalmology DATE: 07 03 08
TOPIC: EYELIDS AND LACRIMAL APPARATUS
LECTURER: Dra. Valdez
TRANSGROUP: Pipoy’S Dream Academy ScHolars

Cutaneous horn – small, benign, cylindrical

protruding growth of epithelial cells affecting lid
margin

Melium – small pinhead size, yellowish white

elevation due to sebaceous gland retention. Tx:
excision

Xanthelasma – skin deposition of lipid material

seen in upper and lower lids. Tx: excision,
diathermy

Hemangioma – blood tumors, mostly congenital

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