Eyelid deformities

By Ms. Rutuja Mane

4th sem bsc nursing
GTCN , Solapur
Roll no. 27
INTRODUCTION

EYELIDS: Two movable folds with

eyelashes.
◆ Layers present are skin, aerolar
tissue; muscles- orbicularis oculi,
levator palpebrae superioris &
Muller's muscle; thin sheet of dense
connective tissue, tarsal plate; thin
lining of palpebrae conjunctiva.
EYELID INFECTIONS, TUMORS
AND DEFORMITIES

DEFINITION = 1 . An eyelid
infection is any abnormal
condition that effect eyelid.
2. Infection of an oil gland on
the surface of the upper and
lower parts of eyelids
CLASSIFICATION OF EYELIDS
INFECTIONS

a. CONGENITAL ANOMALIESB.
b. EDEMA
c. INFLAMMATIONS
d. ANOMALIES & POSITION OF
EYELIDS
e. TUMORS
A. CONGENITAL ANOMALIES

Able-pharon: Macrostomia
syndrome Extremely rare, the lid is
not developed autosomal recessive
genetic disorder.
ii. Micropharon: Rare, lids are
abnormally small
iii. Cryptopharon: Rare
anomaly in which a fold of skin
passes from the eyebrow over
the malformed eye to the
cheek.
iv. Ptosis: Common,
drooping of eyelid
V . Epicanthus: A vertical
fold of skin on either side of the
noise sometime covering the
inner canthus.(the outer or inner
corner of the eye)
vi. Distichiasis: an additional
row of lashers occupies the
position of meibomian
glands .abnormal growth of
lashers.
vii. Coloboma: condition
where normal tissue in or
around the eye is missing
from birth.
B. EDEMA

A swelling eyelid occurs when there is inflammation or excess fluid

(edema) in the connective tissue surrounding the eye.
Common due to looseness of tissues

Inflammato Passive
ry edema edema
Inflammatory Edema:
Found in conjunctivitis,
tarsitis, (inflammation of gland and
lasher)
dacryocystitis, (inflammation of
lacrimal sac )
orbital cellulitis, (inflammation of eye
tissue)
drug allergy (atropine).
Passive edema:
common feature of cavernous sinus
thrombosis (formation of blood clot with in
the cavernous sinus a cavity at the base
of the brain which drains deoxygenated
blood from the brain back to the heart,
Inflammation

• It includes
1. Blepharitis
2. Hordeolum (stye)
3. Chalazion (tarsal or meimobian cyst)
4. internal Hordeolum
 BLEPHARITIS

* Is an inflammation of the eye

lids in which they become red,
irritated and itching dandruff
like scales from on the
eyelashes.
• Squamous Blepharitis
• Ulcerative Blepharitis

1. Squamous Blepharitis*:
it is due to abnormal metabolism (abnormal chemical in body) &
seborrhea usually associated with the dandruff of the scalp.
Numerous white coloured small scales accumulate among the
eyelashes.
ULCERATIVE BLEPHARITIS

it is an ineffective condition.
The yellow crusts glue (sticky) the lashes together.
On removing the crust there are small ulcers seen around the bases
of lashes.
Symptoms: itching, redness, soreness, lacrimation and
photophobia.
2. Hordeolum Hordeolum (Stye):is a localized
(Stye ) infection or Inflammation of the eye lid
margin involving hair follicles of eyelid or
meibomian gland (supply of meibomian,
an oily substance)
Etiology: Associated with
staphylococci infection, Common in
young adults & debilitated persons(very
week person).
Symptoms: Acute Pain & tenderness
over inflamed Zeis's gland
Signs:
Localized Pain, redness & edema near
the lid margin
Chalazion 3. Chalazion: It is chronic
granulomatous inflammation (produce
response to infection, inflammation,) or the
presence of a foreign substance. of
meibomian gland.
Etiology: due to chronic irritation due to
organism of low virulence (The ability of
bacteria to cause disease) where the
glandular tissue is replaced by granulation
tissue containing giant cells.
Occur in crops, more common in adults.
Symptoms: No pain unless secondary
infected
Signs:
Small non tender hard swelling slightly away from and swelling lid
margin, swelling is red or purple, can be grey in later stages, yellow when
secondary infected with pyogenic organisms.
Treatment:
Inj. Triameinolone directly into the Chalazion cause complete
resolution.
It prevents the release of substances in the body that cause inflammation.
 4. Internal Hordeolum : It is an
Internal Hordeolum acute Supportive inflammation
(formation of pus )of meibomian gland
• Etiology: Occurs due to secondary
infection (occurs during or after
treatment for another infection.) of
Chalazion.
• Symptoms: More violent than stye
because the gland is larger &
embedded deeply in the dense
fibrous tissue.
• Sign
yellow spot (pus) seen in shining
through the conjunctiva on averting
(remaining )the lid
D. ANOMALIES & POSITION OF
EYELID
It includes
1.Trichiasis
2. Entropion
3.Ectropion
4. Symblepharon
5. Ankyloblepharon
6. Lagopthalamus
Trichiasis • 1. TRICHIASIS:
abnormally positioned eyelashes Few
lashes or whole lid margin involved.
• Etiology: Recurrent stye, Ulcerative
Blepharitis, Tight bandaging, Scars of lid
following burn, injury or operation.
• Symptoms a Foreign body sensation of
photophobia due to corneal involvement)
Irritation, pain & lacrimation
• Treatment
Trichiasis treatment involves removing
the eyelash, follicle or both, or redirecting
eyelash growth.
Entropion
2. ENTROPION:
Conditions in which the lid margin rolls inward
Etiology
a) Spastic Entropion: Due to the spasm of
orbicularis oculi muscle as may occur after tight
bandaging after operation of following irritative corneal
condition
b) Cicatricial Entropion:, ulcerative Blepharitis, burns,
operations, diphtheritic membranous conjunctivitis.
Sign & symptoms: Same as for Trichiasis
Treatment
A. Spastic :-
• Basic cause of blepharospasm is treated
• If due to prolonged & tight bandaging, discontinue it
Antibiotics
• Antinflammatory corticosteroids
3. ECTROPION:
It is a condition in which lid margin
rolls outward
Symptom: Most common epiphora
excessive watering of the eyes
Signs : Conjunctiva become dry in
appearance Chronic conjunctivitis & corneal
ulcers.
TREATMENT
Use of lubricating ointment or mild steroid
several day and weeks to ectropion repair
corneal epithelium,,,
4. SYMBLEPHARON :
It is a condition of the adhesion between
lids and the globe.
Etiology: due to burns, ulcers, diphtheria,
operation
Symptoms
Lagopthalamus: inability to close lids properly
2 Diplopia: double vision
treatment
• Lysis and removal of sub conjunctival scar
tissue
5. ANKYLOBLEPHARON
It is a condition of the adhesion of the
margins of two eyelids. A may be partial or
complete
Etiology Congenital or acquired due to
chemical burn i.e. acid, alkali.
Treatment-Separation of lid margins
along with mucus membrane or conjunctival
grafting is recommended
Lagopthalamus
Lagopthalamus is defined as the inability to
close the eyelids completely.
Blinking covers the eye with a thin layer of tear
fluid Etiology
• Loss of function of the facial nerve inhibits
eyelid closure as well as the blinking reflex
• Congenital deformity of lids, ectropion,
proptosis (abnormal protrusion or displacement
of an eye, paralysis, absence of reflex, blinking
in extremely ill patient’s
Treatment
1. Application of antibiotic eye ointment &
bandage during sleep is recommended.
2. 2 Levofloxacin
. PTOSIS
It is a condition in which there is drooping of the upper
lid below normal position.
Etiology
1. Congenital Ptosis: Occurs in 80% cases,
due to maldevelopment of levator muscle; congenital
weakness of superior rectus muscle.
2 Acquired Ptosis:
a). Neurogenic: partial/complete paralysis of 3rd nerve
b) Mechanical: Due to increased weight of upper lid as
a result of edema, hypertrophy or tumor formation.
c) Myogenic: Due to trauma of levator muscle,
muscular dystrophy ( increasing weakening or
breakdown of muscle) & myasthenia gravis.
( neuromuscular disease weakness of skeleton
muscle)
Symptoms: Visual disturbance visible drooping of the
upper eyelid
 E. TUMORS
1. Benign Tumors
2. Nevus Hemangioma
3. Papilloma
4. Xanthelasma (jenthelasma)
5. Neurofibroma
2. Malignant Tumors
6. Squamous cell carcinoma
7. Basal cell carcinoma
Nevus(mole on the skin red
patches)

* A choroidal nevus is a flat,

benign pigmented area that
appears in the back of the
eye
Heman-gioma

Hemangioma is a non-cancerous
(benign) tumor caused by
abnormal growth of blood
vessels. cavernous hemangioma
occurs in the deeper layers of
the skin or around the eye.
PAPILLOMA

a benign tumor derived from

epithelium. Papillomas may arise
from skin, mucous membranes, or
glandular ducts
Xanthelasma (jenthelasma)
are yellowish plaques that occur most
commonly near the inner canthus of
the eyelid, more often on the upper lid
than the lower lid. Xanthelasma
NEUROFIBROMA

It is a generalized disease that

may involve the lid & cause
mechanical ptosis. It is
associated with unilateral infant
glaucoma. Small, multiple
tumors are distributed along the
hypertrophied nerves.
Malignant Tumors

1. Squamous cell carcinoma-

2. Basal cell carcinoma
Squamous cell carcinoma
• Seen at the edge of the lid (transition
Zone where the epithelium changes. It
starts as a nodule that ulcerate.
• The preauricular lymph nodes are
enlarged.
• It spreads slowly the surrounding
structures and are painless.
• Metastasis (spread of cancer cells to new
area of the body) common,
Basal cell carcinoma

• It is most common seen in lower lid

near the inner canthus.
• It is locally malignant.
• Epithelial growth spreads under the
skin in all direction.
Bibliography

1) MJ Kumari adult health nursing II , medical surgical nursing

Jaypee brothers
first edition 2023
page number 40
2) Javed Ansari medical surgical nursing publisher Pee Vee
Second Edition Barbie page number 236