1. Lid and lacrimal disorders
Abdulrahman Al-Muammar, MD, FRCSC
King Saud University

2. Disorders of Lashes
Trichiasis
Distichiasis

3. Disorders of Lashes

4. Treatment options for trichiasis
Epilation
Electrolysis
Cryotherapy
Argon laser
Surgery

5. Disorders of lashes Madarosis Poliosis Lid margin inflammation Tumor
Cryotherapy, radiotherapy or burns
Alopecia
Syphilis
Leprosy
SLE
Poliosis
VKH
Sympathetic ophthalmia

6. Entropion

7. 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

8. Entropion

9. Entropion

10. Entropion Treatment Lubrication Taping the lid Epilation
Horizontal lid tightening
Tarsal fracture procedure

11. Ectropion

12. 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)

13. Ectropion

14. Ectropion Treatment Lubrication
Horizontal lid shortening or tightening
Punctal inversion

15. Ptosis MARGIN-REFLEX DISTANCE INTERPALPEBRAL DISTANCE
LID CREASE POSTION

16. Ptosis

17. Ptosis

18. Ptosis

19. Ptosis Pseudoptosis Orbital volume deficiency Exophthalmos
Excess lid skin
Hypotropia

20. 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

21. Ptosis Treatment Ptosis crutch Taping of the lid Surgical
Levator advancement
Muller’s muscle resection
Frontalis suspension

22. Eyelids inflammation Blepharitis Treatment Anterior Posterior
Staphylococcal
Seborrhoeic
Meibomianitis
Treatment
Lid hygiene
Tears
Antibiotics
Warm compresses

23. Eyelids inflammation Allergy Acute allergic blepharoconjuctivitis
Allergic dermatoblepharitis

24. 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

25. 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

26. Benign eyelid lesions Cysts Cyst of Moll Cyst of Zeiss Sebaceous cyst
Hidrocystoma

27. Benign eyelid lesions Tumors Viral wart( papilloma) Actinic keratosis
Seborrheic keratosis
Keratocanthoma
Nevi
Junctional
Compound
Dermal
Capillary hemangioma
Xanthelasma
Pyogenic granuloma

28. Benign eyelid lesions

29. Malignant eyelid tumors
Basal cell carcinoma
Squamous cell carcinoma
Meibomian gland carcinoma
Melanoma
Kaposi sarcoma
Merkel cell carcinoma

30. 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

31. 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

32. Squamous cell carcinoma
Less common than BCC
May arise de-novo or from pre-existing actinic keratosis
May metastasize

33. Orbital cellulitis Preseptal cellulitis Orbital cellulitis
Infection anterior to orbital septum
Orbital cellulitis
90% secondary to sinusitis
Trauma
Insect bite
Endogenous bacteremia

34. 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

35. 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

36. 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

37. Thyroid orbitopathy

38. 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

39. 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

40. Anatomy and physiology of the lacrimal system
Lacrimal excretory apparatus
Puncta
Canaliculi
Lacrimal sac
Nasolacrimal duct
Inferior meatus
VALVE OF HASNER

41. 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

42. 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

43. Lacrimal disorders Dacryocystocele
Combination of nasolacrimal duct obstruction and amniotic fluid or mucus trapped in the sac
Treatment
Antibiotics
Massage
probing

44. Lacrimal disorders Punctal stenosis Canaliculitis
Dilation
Snip procedure
Canaliculitis
Irrigation with antibiotics
Oral antibiotics
Canalicular obstruction
Dacryoliths
Dacryocystitis
Dacryocystorhinostomy

45. 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)

46. Thank you