Droopy Lids Lynn E. Lawrence, CMSgt(ret) USAF CPOT, ABOC, COA

Objectives Anatomy of the Eye Lid Different Types of Droopy Lids Causes of Droopy Lids Why Does this Impact Vision? When Is To Seek Surgical Intervention? Testing

Lipid Secretion: Meibomian Glands (WC Posey, Diseases of the Eye, 1902) Transillumination of meibomian glands (Transillumination image from Dry Eye and Ocular Surface Disorders, 2004) What eye is this? How does the lipid layer aid in contact lens wear?

Anatomy

What function does the pupil have?

Natural Folds

Muscles of the Eye Lid

Muscles Riolan’s muscle Levator Muscle Muller Orbicularis Oculi

The Eyelid 7 Layers of the eyelids 1. Skin-thinnest layer 2. Subcutaneous connective tissue 3. Striated Muscle 4. Sub-muscular connective tissue 5. Tarsal plate or fibrous layer 6. Smooth muscle 7. Conjunctiva (Bulbar/Palpebral) How are Hordoleum and Chalazions treated?

Pump Action – Lids Lateral/medial Muscles Disease – Punctum – Canniculli Lacrimal Sac Nasolacrimal Duct Facial Nerve Palsy (7 th CN) Lacrimal Pump

Eyebrows and Eyelashes Eyebrows – Thickened ridge of skin with short hairs – Diverts perspiration Eyelashes – Also protects – Sebaceous glands at base of each lash are called Glands of Zeis which produce a lubricating fluid Fluid can harden and clog the gland, producing a stye or painless chalazion. If painful and infected it is called an external hordeolum Cataracts (myotonia) are caused by?

Functions of the Eye Lid Protection – From debris – light Pump – moisturize the globe by spreading tears across the eye Pushes excess tears and bacteria from the surface Provides oil for the tear film

What Are Droopy Lids Droopy lids occur when the function of the eye no longer meets it’s normal required function or position This can be unilateral or bilateral

Causes of Droopy Lids Over 425 cause of droopy eyelids Aging Muscular Neurological Congenital Acquired – Disease – Trauma

Marcus Gunn Marcus Gunn phenomenon (a.k.a. Marcus Gunn Jaw- Winking [1][2] or Trigemino- oculomotor Synkineses) is an autosomal-dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid. This condition is characterized as a synkinesis: when two or more muscles that are independently innervated have either simultaneous or coordinated movements [1][2] autosomal-dominantincomplete penetrancesynkinesis Yamada K, Hunter DG, Andrews C, Engle EC (September 2005). "A novel KIF21A mutation in a patient with congenital fibrosis of the extraocular muscles and Marcus Gunn jaw-winking phenomenon"A novel KIF21A mutation in a patient with congenital fibrosis of the extraocular muscles and Marcus Gunn jaw-winking phenomenon Rachel Schoffner, ESG, Memphis, TN

Facial Nerves

7 th Cranial Nerve – Facial Nerve Bells Palsy

Cranial Nerves

Ptosis Ptosis /ˈtoʊsɪs/ (from Greek Ptosis or πτῶσις, to "fall") is a drooping or falling of the upper or lower eyelid. The drooping may be worse after being awake longer, when the individual's muscles are tired/ˈtoʊsɪs/ Greekeyelid

Dermatochalasis Dermatochalasis is a medical condition, defined as an excess of skin in the upper or lower eyelid, also known as "baggy eyes." [1] It may be either an acquired or a congenital condition. It is generally treated with blepharoplasty. skineyelid [1] blepharoplasty

Punctum Tear coverage Exposure issues Diagnosis assistance Eyelids are the pump for tears

Common Lid Conditions

Other Diseases

Terms Associated With Droopy lids Lagophthalmos Dermatochalasis Blepharoptosis Eyelid Crease Medial/Canthal webbing Inflammation/edema/infil tration Herniated orbital fat pads Prolapsed lacrimal gland Eyelid laxity

Why Does this Impact Vision? Interferes with the passage of light to the retina Decreases acuity Limits peripheral field of vision Changes posture Causes fatigue Impacts self-esteem Changes lifestyle

Seeking Surgical Intervention Why? Lifestyle change Job performance Insurance coverage Cosmetic

Before and After Surgery

Testing Insurance vs Cosmetic Visual field testing – HVF – Goldmann perimeter

Review Anatomy of the Eye Lid Different Types of Droopy Lids Causes of Droopy Lids Why Does this Impact Vision? When Is To Seek Surgical Intervention? Testing

David M. Mills, MD31 References Yanoff, M, Duker, JS. Ophthalmology. Mosby, St. Louis pp

David M. Mills, MD32 Recommended Texts

Thank you