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

2. 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

3. 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?

4. Anatomy

5. What function does the pupil have?

6. Natural Folds

7. Muscles of the Eye Lid

8. Muscles Riolan’s muscle Levator Muscle Muller Orbicularis Oculi

9. 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?

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

11. 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?

12. 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

13. 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

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

15. 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

16. Facial Nerves

17. 7 th Cranial Nerve – Facial Nerve Bells Palsy

18. Cranial Nerves

19. 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

20. 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

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

22. Common Lid Conditions

23. Other Diseases

24. 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

25. 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

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

27. Before and After Surgery

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

30. 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

31. David M. Mills, MD31 References Yanoff, M, Duker, JS. Ophthalmology. Mosby, St. Louis. 1999. pp. 8.1-10.

32. David M. Mills, MD32 Recommended Texts

33. Thank you martralyn@msn.com