Review of clinical anatomy & physiology of the eyelids & common infective and inflammatory

disorders of the eyelids

Dr. Ayesha S Abdullah10.09.2012

Learning objectives

By the end of this lecture the students would be able to:-

• Correlate the structure of the eyelids with their functions and clinical presentation in common infective and inflammatory disorders.

• Define stye, chalazion, trichiasis & blepharitis.• Differentiate between stye & chalazion on the

basis of clinical presentation and describe the treatment.

Important superficial anatomical landmarks

Lid margin

Upper lid creasePalpebral fissure height (max)

Palpebral fissure length (max)

Structure of the lids

The eyelid has five layers of different structures 1. Skin2. Subcutaneous tissue3. Muscular layer4. Tarsal plate5. Conjunctiva

Surgical anatomy

Anterior Lamina Skin Orbicularis muscle

Posterior Lamina Tarsal plate Conjunctiva

Anterior lamina Muscular layer

Orbital part

Preseptal part

Pretarsal part

Palp

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l Pa

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Posterior lamina

Orbital Septum

Structures at the lid margin

HW msqheartline@hotmail.com

• Nerve supply- sensory • Blood supply• Lymphatic drainage

Functions

• Protect the anterior surface of the globe • Aid in regulation of light reaching the eye• Tear film maintenance; distribution & flow• Lipid/ oily layer of the tear film

Disorders of eyelids

• Infective• Inflammatory• Neoplastic• Structural / disorders of malposition

Trichiasis

• In-turned eyelashes

Complications

Treatment

• Epilation - but recurrences within few weeks• Electrolysis - but frequently repeated

treatments• Cryotherapy - for many lashes• Laser ablation - for few scattered lashes• Surgical correction - for resistant, localized

crop• Ocular lubricants

Blepharitis

• “ inflammation of the lid margin”• Anterior Blepharitis– Affects base of eyelashes– Associated with staphylococcal infection or Seborrhea– Complicated by recurrent stye ,scarring of the lid margin and

loss of eyelashes• Posterior Blepharitis– Affects meibomian gland openings– Associated with meibomian gland dysfunction– Complicated by recurrent chalazia, tear film instability and

scarring of the lid margin

Anterior Blepharitis

Posterior Blepharitis

Management– Maintain lid hygiene• Apply warm compress • Gently massage posterior lid to express meibomian gland

contents• Scrub lashes and lid margins with dilute baby shampoo• Wipe lid margins with warm cloth after scrubbing

– Acute infectious flare-up (e.g. staphylococcal Blepharitis)• Antibiotic ophthalmic ointment

– Meibomian gland dysfunction• Ocular lubricants ( artificial tears/ tear substitutes) • Tetracycline / Doxycycline orally • Steriods for limited period

Stye

“ Acute staphylococcal infection (abscess) of a lash follicle”

• Common in children• Tender hot swelling at the lid margin• May spread to the entire lid causing prespetal

or at time orbital cellulitis

Treatment

• Hot compresses• Self-limiting; epilation of the infected lash

hastens resolution• If spread of infection is likely with gross

redness and swelling of the lid than topical and systemic antibiotics can be given along with analgesics/ NSAIDs

Chalazion

“Chronic granulomatous inflammation of the Meibomian glands secondary to blockage of the gland orifice”.

• Common in patients with posterior blepharitis• Non-tender swelling a little away from the lid

margin

Treatment

• Small – no treatment• Incision and curretage of the affected gland.

Summary

• Important anatomical landmarks• Trichiasis• Blepharitis• Stye• Chalazion