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  • Eye Lids and Lacrimal System

  • AnatomyConsists of :Very thin , loose, fatty less, skin muscles, artery & veins, lymph, nerve, glands tied up by tissues which being compact in the posterior area, called Tarsus deeper layer : conjunctiva tarsalCilia (2-3 lines) found at the margo, thatGlands : Zeis : FatMoll : SweatMeibom : 20 - 25 glandsbignarrow straight-lineat tarsusproducing fat

  • Tarsus :build eyelids structuresuperior ( height : 10 mm) is bigger than inferior ( height : 4,5 mm)width : 29 mmVascularization :A/V ophthalmicA/V lacrimalisSensoric Inervation : from N V

  • Muscles :Orbicular oculli muscle :circularfunction : to open or close the lidsinervation from N IIILevator palebra muscle :attached to upper border of the tarsus and middle portion of the skininervation from N IIIMullers muscle :smooth muscleinsertion : at the proximal edge of the tarsussymphatic nerve ?

  • The function of palpebra :To protect the eye ball from external physic or chemist injuries/traumaTo keep the eye ball surface wet and slippery with well distributing tears and glands secretion productions

  • Eyelid DiseasesInfectionHordeolumSuppurative acute infection at eyelids gland caused by StaphylococcusHordeolum internum : at meibom gland

  • Hordeolum eksternum : at zeis, mole gland

    Therapy :Systemic & local antibioticsIncision :mostly common on hordeolum externumSkin incision : margoConjuctival incision : margoComplication : eyelids abscess

  • KalazionChronic lipogranulomal inflammation at the meibom glandred-purple painless nodule at the conjunctivaTherapy : incision

  • eyelids abscessoriginates from hordeolum or severe eyebrow infectionsTherapy :Local and systemic antibioticsincision skin line

  • Blepharitisbilateralchronic infection at the edge of the eye lidSquamous blepharitis (seborrhea) :clinical signs : itching, burning, Squamous seborroic at the lashTh/ : cleaning with wet cotton, corticosteroid ointment

  • Ulcerate blepharitis :margo infection caused by staphylococci at children with bad general conditionclinical signs : red palpebra, Squamous sebhorroic, ulceration along margo covered by crust,lose of lash, margo distortion (if chronic and severe)Th/ : improving general condition, clean the crust with wet cotton, antibiotic ointment

  • Herpes Zoster OphtalmicaE/ : herpes zoster viralclinical signs : very pain and burning (caused by disturbances of the first branch of nervus V)Th/ : analgetic, antiviral (acyclovir), antibiotic (to prevent from secondary infection) and local corticosteroid

  • ALERGYClinical signs : oedema of palpebraType : anaphilactic and atopy (urticaria and angioneurotic edema) contact allergy (cosmetic)Th/ : eliminate etiological agentlocal and systemic steroid ( depend on the E/)

  • TumorBenign :naevus

  • verucca

  • xanthelasma : yellowing plaque, irregular esp.. at medialTh/ : excision (for cosmetic reason)

  • milium :small and white papil (lenticular)caused by retention of sebacea gland

  • Haemangiom (vascular tumor)Cavernous haemangiom :consists of the big branch of vein at subcutanblueingchange at vaso dilatation --> bigger if crying

  • Capilary haemangiom :consist of widing capillaryredTh/ :cryoangulation (if big and disturbing)steroid injection

  • MalignantBasal Cell Ca (Rodent Ulcer) ~ 95%at geriatricmost common occur on inferior palpebra (esp. at medial cantus of margo)clinical signs : ulcerative node, irregular, pigmentation, metastation rareTh/ : excision and radio th/

  • Squamous Cell Ca (Epithelioma)at geriatricesp. at superior palpebrametastation to preauricular nodes through lymphatic systemTh/ : wide excision

  • Malignant Melanomacomes from the metastation of conjuntival melanomaTh/ : radical operation --> exenterating

  • Sebaceous Cell Caat gland. Meibom similar with Kalazion --> repeat growing multifocalmetastation : rareTh/ : wide excision

  • Palpebra Position AnomalyEntropion eyelids margo directing into the eye ball --> the lash touch the cornea (Trichiasis) --> irritation at cornea --> corneal ulcer

  • cicatrical Entropioncaused by cicatrix at tarsal conjunctive and tarsusE/ : trauma and trachoma (SBL tarsotomic th/ - Sie Boen Lian)

  • Senile EntropionTh/ : blepharoplasty (reconstruction)

  • Ektropioneyelids margo directing outside --> conjunctive is not well covering --> thick, red, like chronic conjunctivitis

  • Senile Ectropion :caused by loosing of muscleat inferior palpebra

    Paralytic Ectropion :caused by paralyze of M.orbicularis oculi

  • Cicatric Ectropion

    Th/ : blepharoplasty/reconstruction

  • Simblepharonthe condition of attachment of palpebra and eye ball (usually with cornea or bulbic conjunctive)Th/ : leave the condition alone (if small) and simblepharectomy

  • Lagophthalmusthe condition which is eyelids aperture can not close perfectlyE/ : paralyze of N.VII, cicatrix, proptosis, tumorcomplication : xerosis (drying)

  • Ptosisthe condition which is superior palpebra can not open perfectlyunilateral/bilateralcongenital ptosisacquired ptosis senilemyogenicneurogenic (paralyze of N.III)traumaticmechanic (tumor)Th/ :fasanela servat if some and the function of levator still goodshorting levator from skin and conjunctive

  • APPARATUS LACRIMALISBuilt of :Secretion section --> tears productionorbital glandeyelids glandgland. KrauseExcretion section --> draining the tears into the cavum nasal

  • Tearrather alcalyccontaining NaCl, such a lyzozym enzyme that bacteriostatic Normal : tear dampened the eye ball --> the excesses are evaporates and drainating to lachrymal punctum caused by eye blinkingmeasure with Schirmer Test

  • Clinical features of lachrymal system disturbancesDry eyecaused by decrease of producing tear occur at :conjunctival cicatrix caused by trachoma/traumaSjorgen syndromeSteven Johnson syndrome

  • deficiency of Vit Alagophthalmous

  • Epiphorathe disturbance of tear excretionOccur on :lachrymal punctum position disturbanceparalyze of M. orbicularis --> weaking the canaliculi suction effectobstruction of nasolacrimal duct and sac

  • Determining a lachrymal system disturbancespunctum inspectionpalpation at sac areapush --> the secret come out

  • testanelprobing with probe from Bowmandacryosistograph with contrastdacryoskintilograph, sophisticated, with radioactive

  • The congenital disturbances of nasolacrimal systemNasolacrimal duct obstructionoftentemporary/permanent characteristicTh/ :antibiotic dropmassage of lachrymal sacirrigation probing

  • Punctum anomalyno punctumpunctum evertionloose palpebra -----> facial paralysiscicatrix -----> old ageTh/ : reconstruction

  • Nasolacrimal system infectionAcute dacrioadenitissigns : lachrymal gland red, edema, pain, blepharoptosis (sometime)E/ :adult : gonorrhoicachildren : with another disease --> parotitis

  • Chronic dacrioadenitisslow edemanot painoften at TB, leukemia, trachomaTh/ : depend on the etiological agent

  • Chronic dacriosistitiscaused by the obstruction of nasolacrimal ductchildren and adultsigns : epiphorepush at sac area --> yellow thick fluid from the punctumTh/ : topical and systemic antibioticif obstruction --> dacriosistorinostomi

  • Lacrimal sac tumorbenignsquamous papilomamalignantepidermoid CaTh/operation (cystectomy)radiation