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Lid and lacrimal disorders
Abdulrahman Al-Muammar, MD, FRCSC King Saud University
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Disorders of Lashes Trichiasis Distichiasis
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Disorders of Lashes
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Treatment options for trichiasis
Epilation Electrolysis Cryotherapy Argon laser Surgery
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Disorders of lashes Madarosis Poliosis Lid margin inflammation Tumor
Cryotherapy, radiotherapy or burns Alopecia Syphilis Leprosy SLE Poliosis VKH Sympathetic ophthalmia
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Entropion
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Entropion Entropion, or inversion of the lid margin, may be congenital or acquired The acquired variety can be the result of: Ageing changes (involutional) Cicatricial changes affecting the posterior lamella of the eyelid (cicatricial) Spastic
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Entropion
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Entropion
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Entropion Treatment Lubrication Taping the lid Epilation
Horizontal lid tightening Tarsal fracture procedure
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Ectropion
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Ectropion Ectropion, or eversion of the lid margin, may be congenital or acquired The acquired forms are the result of Ageing changes (involutional) Lumps (mechanical) Scarring of the anterior lamella of the lid (cicatricial) Burn Infection/ inflammation Trauma Weakness of the orbicularis muscle (paralytic)
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Ectropion
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Ectropion Treatment Lubrication
Horizontal lid shortening or tightening Punctal inversion
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Ptosis MARGIN-REFLEX DISTANCE INTERPALPEBRAL DISTANCE
LID CREASE POSTION
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Ptosis
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Ptosis
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Ptosis
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Ptosis Pseudoptosis Orbital volume deficiency Exophthalmos
Excess lid skin Hypotropia
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Ptosis Acquired or Congenital Neurogenic Myogenic Mechanical Traumatic
3rd nerve palsy 3rd nerve misdirection Horner syndrome Marcus Gunn jaw-winking syndrome Myogenic Myasthenia gravis Myotonic dystrophy Ocular myopathies Levator dystrophy Aponeurotic (levator dehiscence) Mechanical Traumatic
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Ptosis Treatment Ptosis crutch Taping of the lid Surgical
Levator advancement Muller’s muscle resection Frontalis suspension
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Eyelids inflammation Blepharitis Treatment Anterior Posterior
Staphylococcal Seborrhoeic Meibomianitis Treatment Lid hygiene Tears Antibiotics Warm compresses
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Eyelids inflammation Allergy Acute allergic blepharoconjuctivitis
Allergic dermatoblepharitis
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Eyelids inflammation Chalazion
Focal inflammation of the eye lids which result from obstruction of the meibomian glands Chronic lipogranulomatous inflammatory changes Treatment Warm compresses Local antibiotic Excision
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Eyelids inflammation Hordeolum
Acute infection involving the meibomian glands (internal) or the glands of Moll or Zeis (external) Overtime may evolve into chalazion Treatment Warm compresses Topical antibiotic
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Benign eyelid lesions Cysts Cyst of Moll Cyst of Zeiss Sebaceous cyst
Hidrocystoma
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Benign eyelid lesions Tumors Viral wart( papilloma) Actinic keratosis
Seborrheic keratosis Keratocanthoma Nevi Junctional Compound Dermal Capillary hemangioma Xanthelasma Pyogenic granuloma
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Benign eyelid lesions
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Malignant eyelid tumors
Basal cell carcinoma Squamous cell carcinoma Meibomian gland carcinoma Melanoma Kaposi sarcoma Merkel cell carcinoma
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Basal cell carcinoma Most common malignancy(90%) of the eyelid
Usually located on the lower lid and medial canthus Pearly nodules which ulcerate and have telangiectasias Treatment Surgical excision Cryotherapy Radiation therapy
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Basal cell carcinoma Most common malignancy(90%) of the eyelid
Usually located on the lower lid and medial canthus Pearly nodules which ulcerate and have telangiectasias Treatment Surgical excision Cryotherapy Radiation therapy Orbital exenteration for deep invasive lesions
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Squamous cell carcinoma
Less common than BCC May arise de-novo or from pre-existing actinic keratosis May metastasize
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Orbital cellulitis Preseptal cellulitis Orbital cellulitis
Infection anterior to orbital septum Orbital cellulitis 90% secondary to sinusitis Trauma Insect bite Endogenous bacteremia
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Orbital cellulitis Organisms Treatment Staphylococcus aureus
Streptococcus Hemophilus influenza Treatment admission Orbital CT I.V antibiotics (3rd generation cephalosporin and clindamycin) Drainage of orbital abscess
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Orbital disorders Children Adults Orbital cellulitis Pseudotumor
Dermoid cyst Capillary hemangioma Lymphangioma Rhabdomyosarcoma metastasis Adults Thyroid orbitopathy Cavernous hemangioma Lymphangioma Pseudotumor Lymphoma Meningioma Lacrimal gland tumor Dermoid cyst metastasis
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Thyroid orbitopathy Graves’ disease
Most common cause of exophthalmos in adult Onset: years Clinical picture: Unilateral or bilateral exophthalmos Eyelid retraction Lid lag Diplopia Periorbital edema Chemosis Optic neuropathy 90% HYPER, 1% HYPO, 6%EUTHYROID
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Thyroid orbitopathy
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Thyroid orbitopathy Complication: Treatment Diplopia Redness
Corneal exposure Optic neuropathy Treatment Lubrication Tape eyelids at night Steroid Radiation Surgery Decompression Muscle surgery Optic nerve fenestration
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Anatomy and physiology of the lacrimal system
Secretory apparatus Lacrimal gland Lacrimal ducts empty into superior cul-de-sac Afferent pathway: V nerve Efferent pathway: VII nerve (reflex tear) Accessory lacrimal glands of Krause and Wolfring (basic tear) Tear film Inner layer: mucin Middle layer: aqueous Outer layer: meibomian
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Anatomy and physiology of the lacrimal system
Lacrimal excretory apparatus Puncta Canaliculi Lacrimal sac Nasolacrimal duct Inferior meatus VALVE OF HASNER
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Anatomy and physiology of the lacrimal system
Lacrimal evaluation Dye disappearance test Primary and secondary dye test Lacrimal irrigation Tear break up time Schirmer test
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Lacrimal disorders Congenital nasolacrimal duct obstruction
Membranous block at the valve of hasner 2-4% of full term new baby Usually resolve spontaneously within 4 to 6 weeks Treatment Topical antibiotics Massage Probing: 6 to 12 months
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Lacrimal disorders Dacryocystocele
Combination of nasolacrimal duct obstruction and amniotic fluid or mucus trapped in the sac Treatment Antibiotics Massage probing
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Lacrimal disorders Punctal stenosis Canaliculitis
Dilation Snip procedure Canaliculitis Irrigation with antibiotics Oral antibiotics Canalicular obstruction Dacryoliths Dacryocystitis Dacryocystorhinostomy
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Lacrimal disorders Lacrimal sac tumors Lacrimal gland tumors
Squamous cell papilloma Transitional cell papilloma Squamous cell carcinoma Transitional cell carcinoma Adenocarcinoma Lacrimal gland tumors 70% of lacrimal gland masses are non-epithelial masses: Idiopathic inflammation Sarcoidosis, TB Lymphoid tumors 30% are epithelial Cyst Adenoid cystic carcinoma Pleomorphic adenoma(benign and malignant mixed tumor)
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