DISORDERS OF THE EYE LIDS

Dr. Abdirizak yusuf olow

MBBS-Somali international university
Senior clerkship at the university of Nairobi(UoN)
Clinical internship at MBALE RR HOSPITAL-
uganda
objectives
 definition of eyelids
 Glands of the eyelids
 Inflammations and infections of the lid
 Blepharitis
 Bening Tumors
 Malignant tumors
 Management of common eyelid disorders
 INTRODUCTION
 EYELIDS: Two movable folds with eyelashes.
i. Layers present are skin, aerolar tissue; muscles-orbicularis
oculi, levator palpebrae superioris & Muller’s muscle; thin
sheet of dense connective tissue, tarsal plate; thin lining of
palpebrae conjunctiva.
 EYELID MARGIN

i. Covered with stratified squamous epithelium

ii. Anterior border is round, posterior is sharp & lies closely
in contact with the eyeball.
iii. Eyelashes originate anterior to the grey line and ducts of
meibomian are located posterior to the grey line.
 GLANDS OF EYELIDS
 Zeis’s Gland: Sebaceous gland situated on the margin of the eyelid
 Moll’s Gland : Sweat glands & lie on the margin of eyelid. 
 Meibomian Gland : Enormously developed sebaceous gland
embedded in tarsal plate, secretes oily secretion that lubricates the eye
 Palpebral Fissure: Space between the two lids when the eye is open
 Outer Canthus: Outer or lateral angle of palpebrae fissure
 Inner Canthus: Inner or medial angle of the palpebral fissure
 Blood supply: Opthalmic & lacrimal arteries & opthalmic vein
 Nerve supply: 7th , 3rd & 5th cranial nerve.
 EYELID INFECTIONS
 DEFINITION:
An eyelid infection is any infectious condition that
effect eyelids.
Infection of an oil gland on the surface of the upper and
lower parts of eyelids ,hair follicle or sweat gland.
INFLAMMATIONS AND INFECTION
 It includes
1. Blepharitis
2. Hordeolum (stye)
3. Chalazion (tarsal or meimobian cyst)
 BLEPHARITIS
 Is a common chronic bilateral inflammation of the
eye lid margins, in which they become red, irritated
and itching dandruff like scales form on the
eyelashes.
 BLEPHARITIS
 Squamous blepharitis
 Ulcerative blepharitis

1. Squamous blepharitis: it is due to abnormal metabolism &

seborrhea usually associated with the dandruff of the scalp.
Numerous white coloured small scales
accumulate among the eyelashes.
2. ULCERATIVE BLEPHARITIS: it is an infective
condition. The yellow crusts glue ( sticky) the lashes
together. On removing the crust there are small ulcers seen
around the bases of lashes.
 Symptoms: itching, redness, soreness, lacrimation and

photophobia.
 Treatment
 Local:
removal of scales , crusts & diseased lashes is done by
bathing lid margin with 3% of NaHCO3 ( sodium
bicarbonate ) lotion.
 antibiotics & ointment are applied.
 General : Improvement of general health & personal

hygiene.
• Dandruff of the scalp is to be adequately treated.
 Hordeolum / Stye
 is a localized infection or inflammation of the sebaceous
glands (meibomian gland) in the eye lid margin involving hair
follicles of eyelashes.
 Etiology: Associated with staphylococci infection, Common in
young adults & debilitated persons (very week person).
 Symptoms: Ac. Pain & tenderness over inflamed meibomian
gland.
 Signs: Localized Pain, redness & edema near the lid margin.
 Treatment: Hot fomentation, ( to apply a warm compress on
eye) Evacuation of pus,
 antibiotic eye drop = tobramycin
 & ointment & broad spectrum antibiotics is useful. Analgesics
& anti-inflammatory drugs control pain & inflammation.
Chalazion/ Meibomian cyst
 DEFINITION: is a cyst in the eyelid due to a blocked mei-bomian
gland in the eyelid.
 Etiology: due to chronic irritation due to organism of low virulence
(The ability of bacteria to cause disease) where the glandular tissue
is replaced by granulation tissue containing giant cells.
 more common in adults.
 Symptoms and Signs: They are typically in the middle of the
eyelid, red, and not painful.
 Treatment: Warm moist compress and topical antibiotic eye drops
or ointment (e.g., chloramphenicol or fusidic acid)
 Sx- removal of the lesion and Inject the lesion with corticosteroids
 TUMORS
1. Benign Tumors:
 Nevus
 Capillary Hemangioma
 Xanthelasma
 Neurofibroma

2. Malignant Tumors
 Squamous cell carcinoma
 Basal cell carcinoma
 Bening tumors
 Nevus :
A nevus is a common, colored growth on or in the eyes.
Sometimes called a freckle of the eye
A nevus (a benign tumor) is commonly found on the skin of other
parts of the human body.
A nevus can also occur on the eyelid skin.
These tumors are usually pigmented and have thickness.
Patients typically notice a dark spot on their eyelid that is thickened.
Treatments:
Large eyelid nevi can be a cosmetic problem that can be repaired by
ophthalmic plastic surgery.
Capillary Hemangioma
 is a non-cancerous (benign) tumor caused by
abnormal growth of blood vessels.
 May be bright, superficial, strawberry- red

lesions or bluish or purplish deeper lesions.

 Milia- are small, white, slightly elevated cysts of the
eyelid that may occur in multiples.

 Xanthelasma: are yellowish plaques that occur most

commonly near the inner canthus of the eyelid, more
often on the upper lid than the lower lid.
Occurs as a result of lipid disorders.
 TREATMENT
 Rarely indicated when visual function is
affected.
 Corticosteroid injection to the haemangioma

lesion is effective.
 Surgical excision or electrocautery is

primarily performed for cosmetic reasons.

 Malignant Tumors
 Occurs more frequently among fair complexion
people who have a history of chronic exposure to the
sun.
a) Squamous cell carcinoma
b) Basal cell carcinoma- most common tumor of
eyelid
 Squamous cell carcinoma
 Occurs less frequently but considered as the
2nd most common malignant tumor.
 May resemble the BCC
 It spreads slowly and tends to ulcerate and

invade the surrounding structures.

 Metastasis common
 Basal cell carcinoma
 It is most common seen in lower lid near the
inner canthus.
 Appears as a painless nodule that may

ulcerate.
 The lesion spread to the surrounding tissues

and grows slowly.

 ETIOLOGY
 Environmental toxins such as exposure to
radiation
 Diet – deficiency of minerals and vitamins
 Stress- excessive stress cause mutation in

the cells of their developing eyes

 Local trauma or injury- orbital trauma and

bleeding
 Inflammation or infection
CLINICAL MANIFESTATION
 Bulging of one eye (protrusion)
 Complete and partial loss of sight
 Pain in or around the eye
 Blurred vision
 Change in the appearance of the eye
 Edema
 Redness
 Itching
 Burning
 DIAGNOSIS
 Ultrasound scans
 CT SCAN

 MRI
 They show the size , location ,and shape of the tumors and also show the

enlarged or affected lymph node around the eye.

 MEDICAL MAANAGEMENT

1.Identify the cause & eliminate the cause

2.Control of symptoms
3.Antibiotics and anti inflammatory drugs .
4.Maintain normal activity level ,including exercise .
6.Prevention foreign particles enter in eye
• Use of sunglasses
• To keep the eye clean ,wipe away the drainage from around the eye

‘moisten or wash with warm water, from inner to the outer part the eye.
 MANAGMENT
 Chemotherapy eye drops
 Mitomycin C –are used to treat different types of

growths on the surface of the eye

 fluorouracil- Is used treatment pre-cancerous and

cancerous cell growth

 Radiation therapy uses high energy x- rays to kill the

cancer cell.
 Surgical management Complete excision of

carcinoma followed by reconstruction with skin

grafting if the surgical excision is extensive.
ANOMALIES & POSITION OF EYELIDS
 It includes
1. Trichiasis

2. Entropion

3. Ectropion

4. Symblepharon

5. Ankyloblepharon

6. Able-pharon

7. Micropharon

8. Epicanthus

9. Distichiasis:

10. Lago-pthalamus,

11. Ptosis
 1. TRICHIASIS
 abnormally positioned eyelashes Few lashes
or whole lid margin involved.
 Etiology: Recurrent stye, Ulcerative

blepharitis, Tight bandaging, Scars of lid

following burn, injury or operation.
 Symptoms:

a) Foreign body sensation of photophobia due

to corneal involvement
b) Irritation, pain & lacrimation
 Treatment: Trichiasis treatment involves

removing the eyelash or redirecting eyelash

growth.
 2. ENTROPION
 Conditions in which the lid margin rolls inwards.
 Etiology :

a) Spastic entropion: Due to the spasm of orbicularis

oculi muscle as may occur after tight bandaging after
operation of following irritative corneal condition
b) Cicatricial entropion :, ulcerative blepharitis, burns,
operations, diphtheritic membranous conjunctivitis.
Sign & symptoms : Same as for trichiasis
 Treatment:

A. Spastic - Basic cause of blepharospasm is treated - If

due to prolonged & tight bandaging, discontinue it.
Antibiotics: Anti inflammatory - corticosteroids
 3. ECTROPION
 It is a condition in which lid margin rolls outwards
Symptom : Most common excessive watering of the
eyes Signs:
i) Conjunctiva become dry in appearance
ii) Chronic conjunctivitis & corneal ulcers.
 TREATMENT: Use of lubricating ointment or mild

steroid several day and weeks to ectropion repair

corneal epithelium
 4. SYMBLEPHARON
 It is a condition of the adhesions between lids and the
globe. Etiology : burns, ulcers, diphtheria, operation
Symptoms:
1. Lagopthalamus: inability to close lids properly
2. Diplopia : double vision Treatment: Lysis and removal
of subconjunctival scar tissue
 5. ANKYLOBLEPHARON: It is a condition of the

adhesion of the margins of two eyelids.Adhesion may

be partial or complete,
 Etiology - Congenital or acquired due to chemical burn

i.e. acid, alkali.

 Treatment - Separation of lid margins along with mucus

membrane or conjunctival grafting is recommended

 6. Able-pharon
 Macrostomia syndrome Extremely rare, the lid is not
developed autosomal recessive genetic disorder .
7. Micropharon: Rare, lids are abormally small
8. Epicanthus : A vertical fold of skin on either side
of the nose sometime covering the inner canthus.
9. Distichiasis: an additional row of lashers occupies
the position of meibomian glands. abnormal growth of
lashers.
 10. LAGOPTHALAMOS
 It is a condition of incomplete closure of palpebral aperture
 Lagophthalmos is defined as the inability to close the eyelids
completely. Blinking covers the eye with a thin layer of tear fluid,
 Etiology;
a) Loss of function of the facial nerve inhibits eyelid closure as well as
the blinking reflex .
b) Congenital deformity of lids, ectropion ,proptosis (abnormal
protrusion or displacement of an eye , paralysis , absence of reflex,
blinking in extremely ill patient’s
 Treatment
1. Application of antibiotic eye ointment & bandage during sleep is
recommended.
2. Levofloxacin
 10. PTOSIS
 It is a condition in which there is drooping of the upper lid below
its normal position .
 Etiology

1. Congenital Ptosis: Occurs in 80 % cases, due to maldevelopment

of levator muscle; congenital weakness of superior rectus muscle.
2. Acquired Ptosis :
a) Neurogenic : partial/ complete paralysis of 3rd nerve
b) Mechanical : Due to increased weight of upper lid as a result of
edema, hypertrophy or tumor formation.
c) Myogenic : Due to trauma of levator muscle, muscular dystrophy
(increasing weakening or breakdown of muscle) & myasthenia
gravis. (neuromuscular disease weakness of skeleton muscle)
 Symptoms : Visual disturbance visible drooping of the upper eyelid
 TREATMENT
 high doses of opioid drugs such as morphine,
Morphine is a narcotic pain reliever used to
treat moderate to severe pain. ... 0.05 mg/kg
IM, IV, or subcutaneously every 4 to 8 hours
 oxycodone hydrochloride analgesic agents
 heroin, or hydrocodone can cause ptosis.
 Pregabalin (Lyrica), an anticonvulsant drug,

has also been known to cause mild ptosis.