2/3/2018
Objectives
• Lid anatomy • Malfunctions of the Put A Lid On It eyelid “Eyelids” • Diseases of the eyelid • Impact upon vision Lynn E. Lawrence, CMSgt(ret), USAF, – Spectacles CPOT, ABOC, COA, OSC – Contact lenses • Surgeries associated with the eyelid
Anatomy Eyelid Anatomy
• Understanding eyelid anatomy aids in understanding the condition and educating the patients Punctum What function does the punctum have?
Anatomy Cont…. Internal and External
• Muscle function
• Nerve innervation • Observe the patient • Positions • Identify defect
• Signs and symptoms documented
1 2/3/2018
Lid Eversion During Exam Tear Components Review Diseases: Dry eye indications Floppy Eyelid Syn • Lipid Layer – prevents Sleep Apnea Contact lens issues evaporation Lid wiper area • Aqueous Layer - hydration
• Mucus Layer – sticks tear to the eye (goblet cells)
• Other components http://optometrytimes.modernmedicine.com/optometrytimes/news/why-you-should-add-upper-lid-eversion-your-comprehensive-exam?page=0,0&_hsenc=p2ANqtz- 9PCom0pItekGCIR8adQGqsfOfYaOObxM9Cvdk34VXZaGu8iMqiVkJq0Upflhc3_L7dzas2_9r0- 1U5zRMFMwQrIu0ZAg&_hsmi=60247392&utm_campaign=Enewsletter%3A%20OD%20Newsflash&utm_content=60247392&utm_medium=email&utm_source=hs_email
Meibomian Gland Dysfunction
2 2/3/2018
Blepharospasm
(eyelid twitching) is an involuntary spasm of the eyelid muscle. The most common factors that make the muscle in the eyelid twitch are fatigue, stress, and caffeine.[7] Eyelid twitching is not considered a harmful condition and therefore there is no treatment available. Patients are however advised to get more sleep and drink less caffeine.
5th Cranial Nerve - Trigeminal Facial Nerve 7th Cranial Nerve • Corneal sensitivity • Lacrimal gland innovation • The trigeminal nerve is a nerve • The facial nerve is the responsible for sensation in the seventh cranial nerve, or face and motor functions such as simply cranial nerve VII. It biting and chewing. The largest of emerges from the brainstem the cranial nerves, its name between the pons and the derives from the fact that each medulla, controls the trigeminal nerve has three major muscles of facial expression, branches: the ophthalmic nerve, and functions in the the maxillary nerve, and the conveyance of taste mandibular nerve. The sensations from the anterior ophthalmic and maxillary nerves two-thirds of the tongue are purely sensory, and the and oral cavity mandibular nerve has sensory and motor functions
Ocular Surface Disease Meibomian Gland Evaluator
• We no longer call OSD “dry eyes”
Temporal • Nasal This disease is Central impacting millions Meibomian gland function is evaluated by assessing how glands respond to gentle force, imitating that of a deliberate blink. • Target women more than men
CLEAR OIL SECRETION NO OIL SECRETION (BLOCKED) OPAQUE SOLID SECRETION Glands are functioning using the No oil is expressed using the MGE Glands not functional; requires more MGE force than the MGE
3 2/3/2018
Lid Seal Dacryocystitis
• When you get a proper seal • Dacryocystitis is an infection of the lacrimal sac, secondary to upon a blink, the following obstruction of the nasolacrimal occurs: duct at the junction of lacrimal sac. The term derives from the – Old flora is removed from the Greek dákryon, cysta, and -itis. It ocular surface causes pain, redness, and swelling over the inner aspect of the lower – Oil is expressed from the eyelid and epiphora. When meibomian glands when the nasolacrimal duct obstruction is eyes are forced together secondary to a congenital barrier it is referred to as dacrocystocele. – Fresh tears are drawn onto the It is most commonly caused by ocular surface Staphylococcus aureus and Streptococcus pneumoniae.
Nasal Lacrimal Duct Obstruction Entropion
• Punctum: 1 upper and 1 lower • Entropion (en-TROH- pee-on) is a condition in • Lid position which your eyelid turns inward so that your • Trauma / Disease eyelashes and skin rub against the eye surface. This causes irritation • Nose surgery and discomfort.
Ectropion Eyelid Tatoo
• Ectropion (ek-TROH-pee-on) is a condition in which your • Growing trends eyelid turns outward. This leaves the inner eyelid surface exposed and prone to • Eyebrow tattooing most irritation. common form • Ectropion is more common in older adults, and it generally affects only the lower eyelid. • Permanent make-up In severe ectropion, the entire length of the eyelid is turned out. In less severe ectropion, only one segment of the eyelid sags away from the eye.
4 2/3/2018
Floppy Eye Lid Syndrome Cancer of the lids
• Lid laxity on upper or • Look for unexplained lower lids missing eyelashes upon slit lamp exam
• More common • Early detection and intervention produces • Dx often missed most successful outcomes • Reoccurring eye infections
Surgery Gold Weights
• Ocular facial plastic surgeon
• Mistakes can be permanent
• Seek specialist
Dermatochalasis Causes of Droopy Lids
Over 425 cause of droopy eyelids • Aging • Muscular • Neurological • Congenital • Acquired – Disease – Trauma
5 2/3/2018
• Marcus Gunn phenomenon Ablepharia Marcus Gunn (a.k.a. Marcus Gunn Jaw- Winking[1][2] or Trigemino- • Ablepharia oculomotor Synkineses) is an Rachel Schoffner, ESG, Memphis, TN autosomal-dominant condition (ablepharon) Congenital with incomplete penetrance, in absence of or reduction which nursing infants will have in the size of the eyelids rhythmic upward jerking of their upper eyelid. This condition is characterized as a synkinesis: when two or more muscles that are independently innervated have either simultaneous or coordinated movements
Yamada K, Hunter DG, Andrews C, Engle EC (September 2005). "A novel KIF21A mutation in a patient with congenital fibrosis of the extraocular muscles and Marcus Gunn jaw-winking phenomenon
Chalazions Cyst and Tumors
• Ocular Facial Plastic Surgeon
• Some are cancerous
• Refer immediately for suspicious growth
Warm Compresses • Sarcoidosis is the growth Sarcoidosis of tiny collections of inflammatory cells • Treatment for Chalazions (granulomas) in different should be explained parts of your body — • Repetitive treatments of most commonly the lungs, lymph nodes, eyes hot water to the face can and skin. complicate the diseased • Doctors believe • Wash clothes maintain sarcoidosis results from bacteria, use caution the body's immune system responding to an • There are masks available unknown substance, most for heat therapy likely something inhaled from the air.
6 2/3/2018
Sarcoidosis 2
DEMODEX Demodex = Parasitic Infection • Can be found in adults and children • Translucent sleeve around cilia • Demodex can be found on the base of the eye lash and can be seen by using a microscope • They live on the lash approximately for 4-6 weeks, so treatment has to last for 8 weeks to destroy the mites and their eggs. Eliminate the food source and mites die. • Bolo for patient’s with Rosacea • Mites are more active a night, medicate BID
Demodex • Demodex can be found on the base of the eye lash and can be seen by using a microscope • They live on the lash approximately for 4-6 weeks, so treatment has to last for 8 weeks to Demodex mites are microscopic ectoparasites found in human skin. destroy the mites and their eggs. Eliminate They are extremely common, and their rate of infestation increases with age. The life span of demodex outside the living body is very the food source and mites die. limited. Direct contact is thought to be required for transmission of the • Bolo for patient’s with Rosacea mites. The lifecycle of demodex from egg/molt to an adult is quite short and no longer than two to three weeks. The adult stage is less • Children have Demodex too than a week, and this is when mating occurs. • Mites are more active a night, medicate BID http://optometrytimes.modernmedicine.com/optometrytimes/news/what-s-all-craze-about- demodex?utm_campaign=Sponsored+Resource+Center&utm_source=hs_email&utm_medium=email&utm_content=2797580 4&_hsenc=p2ANqtz-9RsjbCo6ARW9K6ewHdPGSW9_GFvfzPrTVsnruZAxgW95Rtbq3l-20_X9FnLxABA9txzjnT- VaXg9qWKRNXkC_9dj1nUw&_hsmi=27975804 http://www.reviewofophthalmology.com/content/c/36411#.dpuf
7 2/3/2018
Ptosis Trauma 1
• Congenital • Acquired – Traumatic – Dermatochalasis – Muscle involvement – Nerve innervation • Pseudo
Trauma Cont… Trauma 2 Door Hook
• Ocular Facial Surgeon
• Emergency room repairs
• Children
Dermatochalasis Surgery Eyelid Tumor
• Very common • Can be serious, even deadly • Drooping eyelids due to excess skin • Testing is highly recommended • Not cosmetic • Mohs dermatologist will • Insurance covers likely be included in the process
8 2/3/2018
Ptosis Repair Eczema
• Eyelid eczema: Eyelid eczema is a chronic skin condition affecting the eyelids. The skin of the eyelids becomes itchy, red and scaly. Often other parts of the body also have eczema
Hemangioma Disease (Shingles)
• A hemangioma is a • Shingles, also known as benign and usually self- zoster, herpes zoster, or involuting tumor of the zona, is a viral disease endothelial cells that line characterized by a painful blood vessels that is skin rash with blisters characterised by involving a limited area. increased number of Typically the rash occurs normal or abnormal on either the left or right vessels filled with blood. of the body or face in a It usually appears in the single stripe. Two to four first weeks of life and days before the rash grows most rapidly over occurs there may be pain the first six months. or tingling in the area.
Trichiasis Xanthalasma
• Trichiasis is a medical term for abnormally positioned eyelashes that grow back toward the eye, touching the cornea or conjunctiva. This can be caused by infection, inflammation, autoimmune conditions, congenital defects, eyelid agenesis and trauma such as burns or eyelid injury
9 2/3/2018
Clogged Meibomian Glands New Treatments
• MDG = meibomian • Ocular Lid Scrubs gland dysfunction • HypoChlor is OTC • Avenova with neutrox Rx • Major contributor to – Hypoclorus acid has a bacteria Ocular Surface Disease killing capacity – Everyday lid care • Should be inspected at – Removes germs and bacteria every comprehensive – Stable for 3 years in glass bottle exam and when case Hx – Medvantx Mail Order dictates $35 or $60 • Debriding unclogs Avenova Contact: Rhonda Schuletes 225-397-1335
New advancing implant Impact Upon Vision
• Spectacles – Changes in vision • Technology is always • Contact Lenses being developed and we must consider new – Comfort advances as potential options for our patients
Thank you
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