Transcript Disorders of the lid margin and malposition of the lids

Disorders of
malposition of the
lids
Ayesha S Abdullah
11.09.2012
Learning objectives
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By the end of the lecture the students would be
able to:
Define the various disorders of malposition of the
lids
Classify ectropion, entropion & ptosis & correlate
their clinical presentation with the underlying
structural and functional disorder
Identify the complications of ectropion, entropion
& ptosis
Outline the management of ectropion, entropion &
ptosis
Disorders of malposition of the lids
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Ectropion
Entropion
Ptosis
Lagophthalmos
What are the factors responsible for the
normal positioning of the eyelids ?
What are the factors responsible for the
normal positioning of the eyelids ?
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Tarsal plate
Orbicularis oculi
Lid retractors
Medical and lateral canthal tendons
Clinical presentation
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Symptoms
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Watering
Itching and burning
Physical appearance specific to the disorder
Signs
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Malposition of the lid margin
Red eyes
Keratinized conjunctiva
Corneal signs; punctate staining
Snap test for lid laxity
Ectropion
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Definition
Outward rolling of the lid margin is called
ectropion
Types
Congenital
Acquired
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Involutional
Cicatrical
Paralytic
Mechanical
INVOL.
CICATRICAL
PARALYTIC
MECHANICAL
Ectropion
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Complications
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Conjunctival
Corneal
Ectropion
Management
 Medical
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Lubricants; artificial tears and lubricating
ointments
A protective eye shield worn at night to prevent
drying
Temporary taping of the lid
Surgical
Entropion
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Definition
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Inward rolling of the eyelid margin
What is inward turning of the eyelashes called?
Types
Congenital
Acquired
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Involutional
Cicatrical
Spastic
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Complications
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Conjunctival
Corneal
Management
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Medical
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Lubricants; artificial tears and lubricating ointment
Surgical
Ptosis
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Definition
Drooping of the upper eyelid
Types:
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Congenital
Acquired
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Neurogenic
Myogenic
Aponeurorotic
Mechanical
No MAM
Ptosis
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Clinical evaluation
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Amount of ptosis
Function of Levator Palpebrae Superioris
Bell’s phenomenon
• Distance between upper lid
margin and light reflex (MRD)
• Mild ptosis (2 mm of droop)
• Moderate ptosis (3 mm)
• Severe ptosis (4 mm or more)
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Reflects levator function
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Normal (15 mm or more)
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Good (12 mm or more)
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Fair (5-11 mm)
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Poor (4 mm or less)
Vertical fissure height
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Distance between upper and lower lid margins
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Normal upper lid margin rests about 2 mm below upper limbus
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Normal lower lid margin rests 1 mm above lower limbus
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Amount of unilateral ptosis is determined by comparison
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Complications
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Amblyopia in children
Treatment
Surgical
Congenital Ptosis
JAW WINKING
Photo Quiz
Summary