Penyakit Palpebra Dan Adneksa (2)

PENYAKIT PALPEBRA DAN ADNEKSA

Dr. HALIMAH PAGARRA SpMDr. HALIMAH PAGARRA SpM

ANATOMI PALPEBRAFig.1, Upper eyelidA. The superficial layer - skin - gland of Moll and Zeis-Orbicularis Oculi-Levator palpebrae muscles

B. The deep layer-Tarsal plte-Tarsal muscle (Muller muscle)-Palpebral conjunctiva-Meibomian glands

Fig.1, Upper eyelidA. The superficial layer - skin - gland of Moll and Zeis-Orbicularis Oculi-Levator palpebrae muscles

B. The deep layer-Tarsal plte-Tarsal muscle (Muller muscle)-Palpebral conjunctiva-Meibomian glands

Structure of the eyelids: superficial and deep layers

• Superficial layer: – Thin, well vascularized layer of skin. – Sweat glands. – Modified sweat gland and sebaceous glands

(ciliary glands or glands of Moll) and sebaceous glands (glands of Zeis) in the vicinity of the eyelashes.

– Striated muscle fibers of the orbicularis oculi muscle that actively closes the eye (supplied by the facial nerve).

Structure of the eyelids: superficial and deep layers

• Superficial layer: – Thin, well vascularized layer of skin. – Sweat glands. – Modified sweat gland and sebaceous glands

(ciliary glands or glands of Moll) and sebaceous glands (glands of Zeis) in the vicinity of the eyelashes.

– Striated muscle fibers of the orbicularis oculi muscle that actively closes the eye (supplied by the facial nerve).

Deep layer: – The tarsal plate gives the eyelid firmness and shape. – Levator palpebrae that inserts into the tarsal plate

(tarsal muscle). The tarsal muscle is supplied by the sympathetic

nervous system – The palpebral conjunctiva is firmly attached to the

tarsal plate. It forms an articular layer for the eyeball.

- Every time the eye blinks, it acts like a windshield wiper and uniformly distributes glandular secretions and tears over the conjunctiva and cornea.

Deep layer: – The tarsal plate gives the eyelid firmness and shape. – Levator palpebrae that inserts into the tarsal plate

(tarsal muscle). The tarsal muscle is supplied by the sympathetic

nervous system – The palpebral conjunctiva is firmly attached to the

tarsal plate. It forms an articular layer for the eyeball.

- Every time the eye blinks, it acts like a windshield wiper and uniformly distributes glandular secretions and tears over the conjunctiva and cornea.

The eyelids are folds of muscular soft tissue that lie anterior to the eyeball and protect it from injury.

Their shape is such that the eyeball is completely covered when they are closed.

Strong mechanical, optical, and acoustic stimuli (such as a foreign body, blinding light, or sudden loud noise) “automatically” elicit an eye closing reflex.

Regular blinking (20–30 times a minute) helps to uniformly

• distribute glandular secretions and tears over the conjunctiva and cornea,

• keeping them from drying out.

The eyelids are folds of muscular soft tissue that lie anterior to the eyeball and protect it from injury.

Their shape is such that the eyeball is completely covered when they are closed.

Strong mechanical, optical, and acoustic stimuli (such as a foreign body, blinding light, or sudden loud noise) “automatically” elicit an eye closing reflex.

Regular blinking (20–30 times a minute) helps to uniformly

• distribute glandular secretions and tears over the conjunctiva and cornea,

• keeping them from drying out.

Protective function of the eyelidsProtective function of the eyelids

BLEPHARITIS

• Chronic inflammation Margo palpebra• Often in children• Etiology: Stafiloccocus infection;

parasite=ptyriasis palpebrum; vector=p.ovale; demodex folliculorum

• Predispotition:- Lack of hygiene- Exposure to dust, smoke- Cosmetic iritation- Chronic conjunctivitis2 Form:- Squamosa blepharitis- Ulceratif blepharitis

Squamosa Blepharitis

- Hard, Fibrin along the silia- Hyperemia on palpebra margo- Severe case Thickening of palpebra &

Eversion- Kalor- Erythema on cheek (sekunder seboroik

dermatitis)

Ulcerativa Blepharitis

• Red and inflammation on palpebra margo• Multipel suppurative lessions• Yellowish pus• Crusta

Treatment

• Isolated the organism and sensitivity test• Improve General health status; Hygiene;

Nutrition• Crusta Warm Sodium bicarbonat

compression (3%)• Antibiotic zalf 3 times a day2-3 weeks• Crab lice / Flea Shampoo 1% lindane/0.5%

malthion/piperonil butoxide/physostigmin zalf 1%

Sequele

• Tylosis• Trichiasis• Madarosis• Poliosis• Scar• Ektropion• Silia easily brittle

b Scanning electron microscopy (SEM) image, showing a louse and a nit depositedon the eyelash.

a. In poor hygienic conditions, crab lice can infest the bases of the eyelashes

HORDEOLUMHORDEOLUM

A hordeolum is the result of an acute bacterial infection of one or more eyelid glands

A hordeolum is the result of an acute bacterial infection of one or more eyelid glands

Epidemiology and etiology. - Staphylococcus aureus is a common cause of hordeolum. - External hordeolum involves infection of the glands of Zeis or Moll. - Internal hordeolum arises from infection of the meibomian glands.Hordeolum is often associated with diabetes, gastrointestinal disorders, or acne.

Epidemiology and etiology. - Staphylococcus aureus is a common cause of hordeolum. - External hordeolum involves infection of the glands of Zeis or Moll. - Internal hordeolum arises from infection of the meibomian glands.Hordeolum is often associated with diabetes, gastrointestinal disorders, or acne.

• Symptoms and diagnostic considerations. Hordeolum presents as painful nodules with a central core of pus.

• External hordeolum appears on the margin of the eyelid where the sweat glands are located

• Internal hordeolum of a sebaceous gland is usually only revealed by everting the eyelid and usually accompanied by a more severe reaction such as conjunctivitis or chemosis of the bulbar conjunctiva. Pseudoptosis and swelling of the preauricular lymph nodes may also occur.

External hordeolumA painful inflamedhordeolum is usually caused by Staphylococcusaureus infection of an eyelid gland.

Differential diagnosis. • Chalazion(tender to palpation) and

inflammation of the lacrimal glands (rarer and more painful).

Differential diagnosis. • Chalazion(tender to palpation) and

inflammation of the lacrimal glands (rarer and more painful).

Treatment. • Antibiotic ointments and application of dry

heat (red heat lamp) will rapidly heal the lesion.

Treatment. • Antibiotic ointments and application of dry

heat (red heat lamp) will rapidly heal the lesion.

Clinical course and prognosis. • After eruption and drainage of the pus, the symptoms will rapidly disappear. The

prognosis is good.

Clinical course and prognosis. • After eruption and drainage of the pus, the symptoms will rapidly disappear. The

prognosis is good.

CHALAZIONCHALAZION

• Definition: Firm nodular bulb within the tarsus.

• Definition: Firm nodular bulb within the tarsus.

Epidemiology and etiology. Chalazia occur relatively frequently and are caused by a chronic granulomatous inflammation due to buildup of secretion from the meibomian gland.

Epidemiology and etiology. Chalazia occur relatively frequently and are caused by a chronic granulomatous inflammation due to buildup of secretion from the meibomian gland.

• Symptoms. The firm painless nodule develops very slowly.

• Aside from the cosmetic flaw, it is usually asymptomatic

• Symptoms. The firm painless nodule develops very slowly.

• Aside from the cosmetic flaw, it is usually asymptomatic

Differential diagnosis. - Hordeolum (tender to palpation) and adenocarcinoma

Differential diagnosis. - Hordeolum (tender to palpation) and adenocarcinoma

Treatment. Surgical incision is usually unavoidableTreatment. Surgical incision is usually unavoidable

Chalazion:Painful to palpation, the chalazion iscaused by a chronic build-up of secretionsfrom the meibomian glands.

Prognosis. • Good, except for the chance of local

recurrence

Prognosis. • Good, except for the chance of local

recurrence

Treatment. Surgical incision is usually unavoidable

Treatment. Surgical incision is usually unavoidable

Surgical removal of a chalazion

After the chalazion clamp has been introduced and the lesion incised with a scalpel, the fatty contentsare removed with a curet.

EYELID RETRACTIONEYELID RETRACTION

Eyelid retraction is present when the upper eyelid is displaced superiorly or the lower eyelid, inferiorly, exposing sclera between the limbus and the eyelid margin. Lower eyelid retraction may also be a normal anatomical variant in patients with sallow orbit or certain genetic Orbital or eyelid characteristics.Retraction eyelid often leads to laghophthalmos and exposure keratitis.The effects of these condition can range from ocular irritation and discomfort to vision threatening corneal decompensation

Eyelid retraction can have local, systemic, or central nervous syestem causes. The most common causes of

eyelid retraction are thyroid-associated orbitopathy (TAO), recession of the vertical rectus muscles, overly aggressive skin excision in blepharoplasty, and over

compensation for a contralateral ptosis (in accordance with Hering’s law).

TAO is the most common cause of both superior and inferior eyelid retraction, as well as the most common

cause of unilateral or bilateral proptosis (fig. 12-18). Because proptosis commonly coexists with and may mimic eyelid retraction in patient with TAO, these condition must be distinguished from each other

through eyelid measurements and exophthalmometry. A common finding in thyroid related eyelid retraction is

lateral flare. In this condition, the eyelid retraction is more severe laterally than medially.

Eyelid retraction may also be caused by recession of the vertical rectus muscles, owing to anatomical

connections between the superior rectus and the levator muscles in the upper eyelid and between the inferior

rectus muscle and capsulopalpebral fascia in the lower eyelid.

DACRYOCYSTITIS

Anatomi

The lacrimal system consist of :1.Tear secreation structure2.Tear drainage structure

DACRYOCYSTITIS

• Disorders of the lower lacrimal system• Inflammation of the lacrimal sac is the most

frequent disorder of the lower lacrimal system• Usually the result of obstruction of the

nasolacrimal duct and is unilateral in most cases

Acute Dacryocystitis

• Epidemiology: • Most frequently adults between the ages of

50 and 60 • Etiology• The cause is usually a stenosis within the

lacrimal sac. The retention of tear fluid leads to infection from staphylococci, pneumococci, pseudomonas or other pathogenics

• Epidemiology: • Most frequently adults between the ages of

50 and 60 • Etiology• The cause is usually a stenosis within the

lacrimal sac. The retention of tear fluid leads to infection from staphylococci, pneumococci, pseudomonas or other pathogenics

Symptons ; clinical symptoms include highly imflamed, painful swelling in the vicinity of the lacrimal sac (fig. 3.9)

that may be accompanied by malaise, fever, and involvement of the regional lymph nodes. The pain may

be referred as far as the forehead and teeth. An abscess in the lacrimal sac may form in advanced

disorders ; it can spontaneusly rupture the skin and form a draining fistula.

Fig. 3.9 typycal symptoms include highly inflamed , painful swelling in the

vicinity of the lacrimal sac.

Acute inflamation that has spread to the surrounding tissue of the eyelids and cheek entails a risk of sepsis

and cavernous sinus thrombosis, which is a life threatening complication.

Diagnostic Considerations : radiographic contrast studies or digital substraction dacryocystography can visualize the obstruction for preoperative planning. These studies should be avoided during the acute phase of disorder becauses of the risk of pathogen dissemination.Differential Diagnosis : •Hordeolum (small, ciscumscribed, nonmobile inflamed swelling)•Orbital cellulitis (usually associated with reduced motility of the eyeball)

Treatment : acute cases are treated with local and systemic antibiotic according to the spesific pathogens detected. Disinfectant compresses (such as a 1 : 1000

rivanol solution ) can also positively influence the clinical course of the disorder. Pus from a fluctuating

abscess is best drained through a stab incision following cryoanethesia with a refrigerant spray.

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Sympton and diagnostic considerations : the initial characteristic of chronic dacryocystitis is increased lacrimation. Sign of inflamation are not usually present. Applying pressure to the inflamed lacrimal sac causes large quantities of transparent mucoid pus to regurgitate through the punctum .

Chronic inflamation of the lacrimal sac can lead to a serpiginous corneal ulcer.

Treatment : surgical intervention is the only effective treatment in the vast majority of cases. This invelves either a dacryocystorhinostomy (creation of a direct connection between the lacrimal sac , see figs. 3.10 a-c)and the nasal mucosa or removal of the lacrimal sac.

Neonatal Dacryocystitis

Etiology: Approximately 6 % of newborns have a stenosis of the mouth of the nasolacrimal duct due to a persistent mucosal fold (Lacrimal fold or valve of Hasner). The resulting of tear fluid provides ideal growth conditions for bacteria,particulary staphylococci, streptococci and pneumococci.