PALPEBRA (dr herman nur SpM)

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Peran

Protect the anterior surface of the globe from local injury.

Regulation of light reaching the eye; Regulation in tear film maintenance, by distributing the protective and optically important tear film over the cornea during blinking;

Regulation in tear flow, by their 3/10/13 pumping action on the conjunctival

ANATOMY PALPEBRA

lid anatomy are

the skin and subcutaneous tissue; the orbicularis oculi muscle the submuscular areolar tissue the fibrous layer, consisting of the tarsi and the orbital septum the lid retractors of the upper and lower eyelids; the retroseptal fat pads and the conjunctiva.

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ANATOMY PALPEBRA

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Lid Abnormalities

Telecanthus Epicanthus Coloboma Distichiasis Trichiasis

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Telecanthus

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ANATOMY PALPEBRA

Anteriorly, the lashes number approximately 100 in the upper lid and 50 in the lower Posteriorly, 20 to 25 meibomian glands mark the area where the margin blends into the palpebral conjunctiva at the mucocutaneous border . Between the two sits the gray line, a superficial reflection of the muscle of Riolan 3/10/13

Lid Abnormalities

Telecanthus Epicanthus Coloboma Distichiasis Trichiasis

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Telecanthus
A: Epicanthus B: Epicanthus inversus C: Epicanthus

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Telecanthus

Surgical correction of telecanthus necessitates resuspension of the medial canthal tendon, often requiring transnasal wiring

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Lid Abnormalities

Lid Coloboma

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Management coloboma

Small colobomas may be excised directly, with reconstruction of the affected lid through standard techniques Larger colobomas require earlier intervention with more extensive reconstructive efforts to prevent corneal complications.
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Distichiasis

Distichiasis

disorder in which extra lashes grow from the openings of metaplastic meibomian glands. The position of the lid margin is normal.

Electrolysis used to ablate distichiatic lashes

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Distichiasis

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Trichiasis

Trichiasis. Unlike entropion, the lid margin position is anatomically stable, but the lashes are misdirected

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Lid Malpositions

Entropion Ectropion Ptosis

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Entropion

is inversion of an eyelid is caused by

age-related tissue relaxation postinfectious or posttraumatic changes, or blepharospasm.

Eyelashes rub against the eyeball and may lead to corneal ulceration 3/10/13

Symptoms Entropion

can include foreign body sensation tearing, and red eye

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Treatment Entropion

Definitive treatment is surgery.

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Ectropion

Eversion of the lower eyelid is caused by age-related tissue relaxation, cranial nerve VII palsy, and posttraumatic or postsurgical changes

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Symptoms Ectropion

Symptoms are tearing (due to poor drainage of tears through the nasolacrimal system, which may no longer contact the eyeball) and symptoms of dry eyes (possibly due to inadequate blinking)

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Treatment Ectropion

Symptomatic treatment can include tear supplements and At night, ocular lubricants; Definitive treatment is surgery.

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Ectropion

Symptoms are tearing (due to poor drainage of tears through the nasolacrimal system, which may no longer contact the eyeball) and symptoms of dry eyes

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Lid Malpositions

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Ptosis

Km atas tidak bisa diangkat

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ptosis

The degree of ptosis

generally corresponds inversely to the degree of levator function; mild ptosis is generally associated with good levator function, and severe ptosis is indicative of poor levator function.

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Management ptosis

The evaluation

Congenital or acquired ptosis is directed to identifying the cause Neurologic and myogenic causes must be eliminated before surgical correction

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Management ptosis

Minimal ptosis can be corrected by internal (e.g., conjunctival mullerectomy, tarsal-conjunctival mullerectomy) or external (e.g., external levator resection) approaches Moderate ptosis often requires levator aponeurotic reconstruction but severe ptosis usually demands frontalis fixation

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Dermatochalasis

Dermatochalasis is a common aging change characterized by excess skin of the lids.

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Blepharochalasis

Blepharochalasis is characterized by recurrent bouts of bilateral angioneurotic edema, which secondarily distends the overlying skin tissues.

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Blepharitis

Blepharitis is a nonspecific inflammation of the eyelids, generally involving the lid margin and typically arising secondary to staphylococcal colonization. Seborrhea, acne rosacea, and Demodex folliculorum infection are additional etiologic agents.
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Symptoms Blepharitis

The classic findings include

Redness of the lid margin, Collarette formation, Scurf accumulation, Irregularity of the lid margin,

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Blepharitis

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Chalazion

Chalazion occurs if the meibomian gland duct is obstructed, with subsequent extrusion of the lipid into the adjacent soft tissues, stimulating lipogranulomatous inflammation and fibrosis The lesion is localized to the tarsus and often is tender initially but resolves to become nontender
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Chalazion

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Management Chalazion

Incision and drainage of the lesion produces a characteristic yellow gelatinous material (lipogranuloma) surrounded by dense fibrous tissue

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Hordeolum

Hordeolum is an acute infection of any gland of the lid, e.g., meibomian, Zeis, or Moll Styes are painful, tender masses that arise abruptly and that may incite a surrounding cellulitis.

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Hordeolum

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Management Hordeolum

Incision and drainage produces a purulent discharge.

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Thank You

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