Eyelid & Lacrimal

Disorders
A A Ayu Sukartini Djelantik

Bagian I.K.Mata FK Unud/RSUP

Sanglah
Denpasar

Core subject
Anatomy

of eyelid
& lacrimal
apparatus
Hordeolum
Chalazion
Anterior Blepharitis
Posterior
Blepharitis
Entropion

Ectropion
Epicanthus
Telecanthus
Blepharoptosis
Dacryoadenitis
Dacryocystitis
Tears

Anatomy of eyelids
Two

lamella: anterior & posterior

Thin fold of Skin, muscle, fibrous
tissue
Orbicularis muscle innervated by the
facial (VII) cranial nerve
Many gland in the eyelid

Anatomy of eyelid

Anatomy of eyelid glands

Hordeolum
Infection

of the gland of the eyelid

H. Internal :infection on meibomian
glands
swelling may point to the
conjunctival surface
H. External :infection of Zeiss or
Molls glands
swelling may point to the skin
E/: Staphylococcus aureus

Hordeolum

Hordeolum
Symp&sign:

pain, redness, swelling

Treatment:

- warm compresses 3-4x/day for 10-15

minutes
- AB topical & systemic
- Incision & drainage : H.I (vertical),
H.E (horizontal)

Chalazion
Chronic

granulomatous inflammation of a
meibomian gland
Symp&sign: painless localized swelling
during over period of weeks, absent of acute
inflammatory sign
If large can press the eyeball astigmatism
Th/:
- intra lesional steroid injection small
lesion
- Incision & curettage

Chalazion

Blepharitis
Anterior

& posterior blepharitis

Anterior Blep.is common chronic bilateral
inflammation of the lid margin
2 main type: staphylococcal & seborrheic
Type staph.due to: Staph.aureus,
Staph.epidermidid
Type seborr.doe to: Pityrosporum ovale,
>> ~ seborrhea of scalp, brown, & ear

Blepharitis
Symp&sign:

irritation, burning, itching of

lid margin, granulation in lashes, lashes
tend to fall out
Th/: AB, sulfonamide eo, scalp,eyebrow,lid
margin kept clean baby shampoo
Posterior blep.is inflammation of the
eyelids secondary to dysfunction of the
meibomian glands
Symp&sign:
meibomianitis,hordeola,chalazia
lid margin hyperemia & telengiectasia

Blepharitis
Th/:

doxycycline 100mg 2x1, or

erytromycin 250mg 3x1, artificial tear

Entropion
Turning

inward of the eyelid

E/: involutional (spastic,senile),
cicatricial, congenital
K/: Trichiasis is impingement of
eyelashes on cornea corneal
irritation/ulcer
Th/: Surgery to evert the eyelid

Entropion

Ectropion
Sagging

& eversion of lower eyelid

E/: relaxation of orbicularis muscle
aging process, N VII palsy
Symp&sign: tearing, irritation, exposure
keratitis
Th/: Surgical revision

Ectropion

Epicathus
Vertical

fold of skin over the medial

canthi
The skin fold is often large enough to
cover part of nasal sclera
pseudoesotropia
It is typical of Asian race
E/:vertical shortening of skin between
the chantus & nose
Th/: surgical correction

Epicanthus

Telecanthus
A

wide intercanthal distance traumatic

disinsertion or congenital craniofacial
dysgenesis
Normal distance: 30 mm in adult
Th/: Surgical correction

Blepharoptosis
The

condition in which one or both

eyelid assume an abnormally low
position
Normally upper lid rests 2 mm lower
limbus
E/: congenital, acquired, hereditary
Classification: myogenic, aponeurotic,
neurogenic, mechanical
Th/:surgical correction (resection levator
aponeurosis, Frontal sling)

Ptosis

Lacrimal drainage system

Tear drainage

Dacryocystitis acute
Acute

infection of lacrimal sac

It is most unilateral
E/: Staphy.aureus,Haemophilus
influenzae, Streptococcus pneumoniae,
Candida albicans
Symp&sign: tearing, discharge,
inflammation, pain, swelling, purulent
material can be express from sac
Th/: AB systemic & topical,

Dacryocystitis acute

Dacryocystitis chronic
Chronic

infection of lacrimal sac

E/: ~ acute
Symp&sign: tearing, discharge, less
inflammation sign, tenderness in tear
sac area
Exacerbation acute ~ acute sign
Th/: DCR (dacryocystorhinostomy)

Dacryoadenitis
Acute

inflammation of lacrimal gland

Most in child as comp.mumps,
measles or influenza
Symp&sign: pain,swelling,hyperemia
over temporal upper eyelid
Th/: AB systemic, surgical drain

Tears
Tears

form a thin layer that covers corneal

& conjunctiva epithelium
The function:
- make cornea a smooth optical surface
- to wet & protect delicate surface of
cornea & conj.epithelium
- to inhibit the growth of microorganism by
mechanical flushing & antibacterial action
- provide nutrient for cornea

Layers of the tear film

Layers of the tear film

Superficial

layer lipid meibomian gland

to retard evaporation
Middle aqueous lacrimal gland
contain salts & proteins
Deepmucinous goblet cell glycoprotein,
lipoprotein
Composition of tears: albumin, globulin,
lysozymes, IgA,IgG,IgE,K,Na,Cl,glucose,
urea.

Dry eye syndrome

Dryness

of the eye cause by

deficiency of tear film component.
Many form: keratoconjunctivitis
sicca, Sjogrens syndrome
Symp&sign: sandy sensation,
excessive mucus secretion, burning
sensation, photo sensitivity,redness,
pain, difficult to moving the lids.

Dry eye syndrome

Diagnostic

methods:
- Schirmer test
- Tear film Break-up Time
- Ocular ferning test
- Flourescein staining
- Rose bengal staining
- Tear lysozyme assay

Diagnostic
methods:

Dry eye syndrome

Th/:

Artificial tears, Ointment, topical

vit.A, punctal plugs to retain lacrimal
secretion, laser th.