Anomalies of position of lashes and Lid margin
Trichiasis
- Inward misdirection of cilia thus rubbing against eyeball
- Causes : trachoma, ulcerative blepharitis, conjunctivitis, styes
- Like Foreign body(irritation,pain,lacrimation),photophobia
- Signs of other diseases + reveals misdirected cilia
- Recurrent corneal abrasion/opacities/vascularisation/ulcer
- Epilation, electrolysis of follicle, surgical redirection of lid
Entropion
- Inward turning of lid margin; congenital ,cicatrical (common) involves upper lid (contraction of palpebral conjunctiva) due to trachoma, conjunctivitis, chemical burns etc.
Spastic → with chronic irritative corneal conditions
Senile → common in elderly , lower eyelid
Mechanical( globe structure changes e.g. enophthalmos, enucleation operation , phthisis bulbi)
- similar to Trichiasis (foreign body sensation)+ lid margin inturned
- plastic reconstruction or treatment of cause
Ectropion
- outward rolling /turning of lid margin (big conjunctiva involved)
- Senile (most common &lower due to loss of tone) ,cicatrical (skin scarring),paralysis of 7th nerve , mechanical due to pushing out (tumour) or pulling inflammation of conjunctiva
- Epiphora due to chronic conjunctivitis as it is constantly exposed thus → irritation, discomfort photophobia
- Outrolled lid margin & may cause dryness ,corneal ulceration & thickening of conjunctiva+ epiphora→ dermatitis/eczema
- Treatment : conjuctivaplasty , lid shortening+ underlying cause treatment + skin surgery changing the tension
SYMBLEPHARON
Adherence of the palpebral and bulbar conjunctiva
- healing of the surfaces onto each other commonly after thermal or chemical burns, membranous conjunctivitis, injuries, conjunctival ulcerations
- difficulty in lid movements,
- diplopia (due to restricted ocular motility), inability
- to close the lids (Lagophthalamos) dryness, thickening and
- keratinisation of conjunctiva due to prolonged exposure
- and corneal ulceration (exposure keratitis).
- Treated by separating raw conjunctiva after injury
LAGOPHTHALMOS
by inability to voluntarily close the eyelids
- cause: paralysis of orbicularis oculi muscle, cicatrical contraction of the lids, symblepharon, severe ectropion, Proptosis,
- Physiologically → (nocturnal Lagophthalamos)
- conjunctival and corneal xerosis &exposure keratitis
- Treated with tear drops & antibiotic before sleeping esp
BLEPHAROSPASM
- involuntary, sustained & forceful closure of the eyelids.
- Essential (spontaneous) idiopathic (45-65 years)
- Reflex blepharospasm→ reflex sensory stimulation through branches of fifth nerve
- Due to →Phlyctenular keratitis, interstitial keratitis, corneal foreign body, corneal ulcers and iridocyclitis.
- Also in excess light or hysteria
- Persistent epiphora may occur due
- Epiphora → eczema of the lower lid. Oedema of the lids
- Spastic entropion (in elderly people) and spastic ectropion
- Treated with Neuromuscular blockers plus denervation
Ptosis→ abnormal drooping of upper eyelid
Normally one-sixth of the cornea ; here more than 2mm
- a) Congenital : weakening of levator palpebrae superior
- b) Acquired