2/17/2015 1 Eyes Wide (And) Shut Elyse Chaglasian OD FAAO Associate Professor Illinois College of Optometry Illinois Eye Institute 2/22/15 No financial disclosures Eyelids I. Function II. Anatomy III. Conditions IV. Eyelash Conditions V. Infection / Inflammation VI. Makeup Eyelids I. Function II. Anatomy III. Conditions IV. Eyelash conditions V. Infection / Inflammation VI. Makeup Eyelids: Function I. Protection of ocular surface From environmental factors, light, trauma Via lid closure Gentle or forced From dessication and infection Via tear production & distribution Evaluate blinking “RIB” Eyelashes are first line of defense Eyelids: Function II. Tear film maintenance Proper balance of components Via evaporation prevention Meibomian glands, Zeiss and Moll III. Tear flow Via proper apposition of lids to ocular surface Into puncta
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
2/17/2015
1
Eyes Wide (And) Shut
Elyse Chaglasian OD FAAOAssociate Professor
Illinois College of OptometryIllinois Eye Institute
2/22/15
No financial disclosures
Eyelids
I. Function
II. Anatomy
III. Conditions
IV. Eyelash Conditions
V. Infection / Inflammation
VI. Makeup
Eyelids
I. Function
II. Anatomy
III. Conditions
IV. Eyelash conditions
V. Infection / Inflammation
VI. Makeup
Eyelids: Function
I. Protection of ocular surface
From environmental factors, light, trauma
Via lid closure
Gentle or forced
From dessication and infection
Via tear production & distribution
Evaluate blinking
“RIB”
Eyelashes are first line of defense
Eyelids: Function
II. Tear film maintenance
Proper balance of components
Via evaporation prevention
Meibomian glands, Zeiss and Moll
III. Tear flow
Via proper apposition of lids to ocular surface
Into puncta
2/17/2015
2
Eyelids
I. Function
II. Anatomy
III. Conditions
IV. Eyelash conditions
V. Infection / Inflammation
VI. Makeup
Eyelids: Anatomy
Tarsal Plate
Muscles
Orbital Septum
Eyelids: Anatomy‐Tarsal Plate
Provides structural support
Superior plate ~10 mm
Inferior plate ~5 mm
Conj on outside, skin inside
Meibomian glands, eyelashes
Eyelids: Anatomy‐Muscles
I. Orbicularis Oculi
II. Levator palpebrae
III. Mullers
Eyelids: Anatomy‐Muscles: Upper Lid
Raises the lid/opens the eye
Levator palpebrae muscle
Mullers (superior tarsal) muscle
Lowers the lid/closes the eye
Obicularis Oculi muscle
Eyelids: Anatomy‐Muscles: Lower Lid
Inferior Tarsal
Capsulopalpebral fascia (CPF)
Incorporates IR & IO muscles
2/17/2015
3
Eyelids: Anatomy: Orbital Septum
Barrier between orbit & lid tissues
Fuses with the levator in upper lid & CPF in lower lid
Prevents fat protrusion, edema, hemorrhage
Orbicularis Oculi
Ringlike band of muscle
Anatagonist to levator muscle
1. Orbital portion Forced closure (squeezing, winking)
Bartley GB. The epidemiologic characteristics and clinical course of ophthalmology associated autoimmune thyroid disease in Olmstead County, MN. Trans Am Ophthalmol Soc 1994;92:477‐588.
Thyroid Eye Disease‐ Treatment
Control of thyroid hormones
Smoking cessation
Head elevation
Lubrication, lid closure
Prism
Steroids ‐ acute only
Radiation ‐ acute only
Surgery
Orbital decompression
Proptosis & CON
Botox prevents contraction of MR during surgery
Strabismus
Eyelid
2/17/2015
10
Floppy Eyelid Syndrome
Generalized laxity of lid tissues
Easy superior lid eversion
Papillary reaction
Associated with:
Tear film abnormalities
Lipid deficiency
Reduced TBUT
Eyelash ptosis
Lagophthalmos
Ectropion
Floppy Eyelid Syndrome
Strong association with obstructive sleep apnea syndrome Obesity Male Larger neck girth (>17” M, >16” F) Snoring Alcohol use Keratoconus GLC NA‐AION
Floppy Eyelid Syndrome Treatment
Overnight shield
Surgery
Wedge excision, canthal tendon repair
Eyelids
I. Function
II. Anatomy
III. Eyelid conditions
IV. Eyelash conditions
V. Infection / Inflammation
VI. Makeup
Eyelash conditions
a. Trichiasis
b. Distichiasis
c. Madarosis
d. Poliosis
Trichiasis ‐ causes
Aging changes
Trauma
Trachoma
OCP
Stevens ‐Johnson
Leprosy
2/17/2015
11
Trichiasis ‐ treatment
Lubrication
Epilation
4‐6 weeks
Laser Ablation
Cryotherapy
Radiofrequency ablation
Entropion repair
Distichiasis
Extra row of lashes in place of meibomian glands
Most congenital Lymphedema‐Distichiasis
(LD) syndrome
Acquired Entropion Chronic blepharitis OCP Stevens ‐ Johnson Burns
Distichiasis ‐ treatment
Observation if asymptomatic
If symptomatic
Epilation
Cryotherapy
Trephination
Wedge resection
Microhyfrecation
Lid splitting procedure with cryotherapy
Madarosis ‐ causes
Chronic inflammation Blepharitis
Allergy
Alopecia, SLE, scleroderma, psoriasis, thyroid
Trauma
Eyelid tumors & treatment
Makeup reaction
Eyelid tattooing
Trichotillomania
Medications
Miotics, cholesterol, anticoags, Botox
HIV/AIDS
Sickle cell
Madarosis ‐ treatment
Latisse
Treat underlying cause
Discontinue offending agent
Poliosis
Most commonly associated with VKH Syndrome(uveitis‐vitiligo‐alopecia‐poliosis) Also: tuberous sclerosis, Marfan’s, sarcoid, bleph, herpes zoster, sympathetic ophthalmia
Medications: post fungal, latanoprost (Report)
2/17/2015
12
Eyelids
I. Function
II. Anatomy
III. Eyelid conditions
IV. Eyelash conditions
V. Infection / Inflammation
VI. Makeup
Infection/Inflammation
Blepharitis
Anterior
Staph/ Strep
Posterior
Molluscum
Demodex
Blepharitis sequlae
Hordeolum Infection
External = Zeiss or Moll; Internal = Meibomian
Chalazian Sterile, granulomatous inflammation of meibomian gland
Dry eyes
Punctate keratopathy
Staph hypersensitivity keratitis
Phlyctenules
Anterior Blepharitis
Staph Strep
Epidermis, aureus
Younger
Collarettes
Madarosis
Waxes and wanes
Seborrheic
Older
Nonobstructive
Greasy, soft scales
Chronic
Associated with dandruff
Anterior Bleph ‐ treatment
Lid scrubs/foams
Baby shampoo?
Demodex treatment
Omega 3 (FSO)
Azasite
Antibiotic ointment
Alodox kit
Tranquileyes with heat packs
Ocusoft cleanser/pads
Doxy 20 mg
BlephEx
In office procedure
Removes biofilm, scurf
6‐8 minutes, q4‐6 months
Not covered by insurance
2/17/2015
13
Posterior Blepharitis
aka Meibomian Gland Dysfunction
Lipid film insufficiency
TBUT due to evaporation
Bacterial lipases degrade meibum
67% over age 60
Often co‐exists with anterior bleph
Seen with rosacea, distichiasis, accutane, taxotere usage
Stage 1: Asymptomatic, Minimalsigns=>> Pt education, lid hygiene