1 OCULAR ADNEXA

OCULAR ANNEXAS CONJUNCTIVA CONJUNCTIVA EYELID EYELID LACRIMAL SISTEM LACRIMAL SISTEM ORBIT ORBIT 2

3 THE EYELIDS 1.Congenital abnormalities of eyelids 2.Abnormalities of eyelids shape and position 3.Inflamation of eyelids 4.Tumors of eyelids

4. 4Blepharoptosis – dropping of the upper lid 4Blepharoptosis – dropping of the upper lid

6Epicanthus – a vertical skin fold occurring in the medial canthus that conceals the medial angle and the caruncle. 6Epicanthus – a vertical skin fold occurring in the medial canthus that conceals the medial angle and the caruncle. 5

6 Abnormalities of shape and position 1.Entropion 2.Ectropion 3.Blepharoptosis

Entropion eyelid margin is turned inward so that the lashes irritate the eye which causes corneal epithelial defects, conjunctival injection and tearing, sometimes leading to secondary infection of the cornea or conjunctiva eyelid margin is turned inward so that the lashes irritate the eye which causes corneal epithelial defects, conjunctival injection and tearing, sometimes leading to secondary infection of the cornea or conjunctiva 7

Ectropion eyelid margin is turned away from the eye so that the conjunctiva is exposed eyelid margin is turned away from the eye so that the conjunctiva is exposed atonic atonic cicatricial cicatricial spastic spastic allergic allergic 8

9 Blepharoptosis condition in which the upper eyelid drops and the palpebral fissure is narrowed condition in which the upper eyelid drops and the palpebral fissure is narrowed Surgical correction of blepharoptosis: Surgical correction of blepharoptosis: resection of the conjunctiva, tarsus, Muller muscle corrects up to 3 mm of blepharoptosis; resection of the conjunctiva, tarsus, Muller muscle corrects up to 3 mm of blepharoptosis; resection of levator palpebrae muscle is recommended in moderate blepharoptosis; resection of levator palpebrae muscle is recommended in moderate blepharoptosis; when the levator palpebrae muscle function is absent the upper eyelid is suspended to the frontalis muscle by means of fascia lata or synthetic material. when the levator palpebrae muscle function is absent the upper eyelid is suspended to the frontalis muscle by means of fascia lata or synthetic material.

10 Inflamation of eyelids 1.Blepharitis 2.Meibomitis 3.Hordeolum 4.Chalasion 5.Dermatitis

11 Blepharitis cronic inflamation of the eyelid margin cronic inflamation of the eyelid margin Treatment: Treatment: lid hygiene lid hygiene warm compresses warm compresses antibiotics antibiotics corticosteroids corticosteroids

Meibomitis passive retention of secretion by meibomian glands passive retention of secretion by meibomian glands Treatment: eyelid margin massage with moist washcloth Treatment: eyelid margin massage with moist washcloth 12

13 Hordeolum acute supurative inflammation of the follicle of an eyelash or the associated gland of Zeiss (sebaceous) or Mall (sweat) acute supurative inflammation of the follicle of an eyelash or the associated gland of Zeiss (sebaceous) or Mall (sweat)

Chalasion chronic inflammatory lipogranuloma of a meibomian gland chronic inflammatory lipogranuloma of a meibomian gland Clinical Clinical gradual painless swelling of the gland gradual painless swelling of the gland increase of size chalasion may cause pressure on the globe and astigmatism increase of size chalasion may cause pressure on the globe and astigmatism sometimes it may become secondary infected. sometimes it may become secondary infected. 14

15Dermatitis large variety of microbial organisms can infect the skin of eyelid large variety of microbial organisms can infect the skin of eyelid Impetigo Impetigo Erysipelas Erysipelas Anthrax Anthrax malignant pustule malignant pustule tuberculosis,leprosy, tuberculosis,leprosy, herpes zoster, herpes zoster, veruca vulgaris, veruca vulgaris, molluscum contagiosum molluscum contagiosum

Tumors of eyelids Benign tumors Benign tumors 1.papilloma 2.cutaneous horn 3.seborrehoeic keratosis 4.keratoachantoma 5.hemangioma 6.melanotic nevi Malign tumors Malign tumors 1.basal cell carcinoma 2.squamous cell carcinoma 3.melanoma 16

LECTURER DR. RUSU VALERIU17 papilloma irregular, frond-like projection of the skin with a central vascular pedicle irregular, frond-like projection of the skin with a central vascular pedicle Treatment: is usually esthetic and only sometimes symptomatic and consists in excision of the tumor Treatment: is usually esthetic and only sometimes symptomatic and consists in excision of the tumor

LECTURER DR. RUSU VALERIU18 cutaneous horn firm projecting keratinized mass firm projecting keratinized mass

19 seborrehoeic keratosis extremely common in the elderly and appears as a slow-growing, discrete, greasy, brown, round or oval lesion with friable verrucose surface extremely common in the elderly and appears as a slow-growing, discrete, greasy, brown, round or oval lesion with friable verrucose surface

20 keratoachantoma Typically starts as an erithematous papule Typically starts as an erithematous papule grows and raises in a pinkish, indurate nodule grows and raises in a pinkish, indurate nodule keratin-filled crater keratin-filled crater undergoes spontaneous regression undergoes spontaneous regression

21 hemangioma Treatment Treatment local injection with corticoids local injection with corticoids arterial ligature of the main sources arterial ligature of the main sources excision excision

22 basal cell carcinoma most common malignant tumor of the eyelid most common malignant tumor of the eyelid from the lower eyelid or medial canthus from the lower eyelid or medial canthus slow growing slow growing locally invasive locally invasive very late metastasize very late metastasize

23 squamous cell carcinoma the grown rate and the metastasize are faster the grown rate and the metastasize are faster

24 Sebaceous Cell Carcinoma.