penyakit palpebra dan adneksa (2)

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  • Dr. HALIMAH PAGARRA SpM

  • ANATOMI PALPEBRAFig.1, Upper eyelidA. The superficial layer - skin - gland of Moll and ZeisOrbicularis OculiLevator palpebrae muscles

    B. The deep layerTarsal plteTarsal muscle (Muller muscle)Palpebral conjunctivaMeibomian glands

  • Structure of the eyelids: superficial and deep layersSuperficial 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.

  • 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 (2030 times a minute) helps to uniformlydistribute glandular secretions and tears over the conjunctiva and cornea,keeping them from drying out.Protective function of the eyelids

  • BLEPHARITISChronic inflammation Margo palpebraOften in childrenEtiology: Stafiloccocus infection; parasite=ptyriasis palpebrum; vector=p.ovale; demodex folliculorum

  • Predispotition:Lack of hygieneExposure to dust, smokeCosmetic iritationChronic conjunctivitis2 Form:Squamosa blepharitisUlceratif blepharitis

  • Squamosa BlepharitisHard, Fibrin along the siliaHyperemia on palpebra margoSevere case Thickening of palpebra & EversionKalorErythema on cheek (sekunder seboroik dermatitis)

  • Ulcerativa BlepharitisRed and inflammation on palpebra margoMultipel suppurative lessionsYellowish pusCrusta

  • TreatmentIsolated the organism and sensitivity testImprove General health status; Hygiene; NutritionCrusta Warm Sodium bicarbonat compression (3%)Antibiotic zalf 3 times a day2-3 weeksCrab lice / Flea Shampoo 1% lindane/0.5% malthion/piperonil butoxide/physostigmin zalf 1%

  • SequeleTylosisTrichiasisMadarosisPoliosisScarEktropionSilia 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

  • HORDEOLUMA hordeolum is the result of an acute bacterial infection of one or more eyelid glandsEpidemiology 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 locatedInternal 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).

  • 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.

  • CHALAZION

    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.

  • Symptoms. The firm painless nodule develops very slowly. Aside from the cosmetic flaw, it is usually asymptomaticDifferential diagnosis. - Hordeolum (tender to palpation) and adenocarcinomaTreatment. 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 recurrenceTreatment. 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 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 Herings 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

  • AnatomiThe lacrimal system consist of :Tear secreation structureTear drainage structure

  • DACRYOCYSTITIS

    Disorders of the lower lacrimal systemInflammation of the lacrimal sac is the most frequent disorder of the lower lacrimal systemUsually the result of obstruction of the nasolacrimal duct and is unilateral in most cases

  • Acute DacryocystitisEpidemiology: Most frequently adults between the ages of 50 and 60 EtiologyThe cause is usually a stenosis within the lacrimal sac. The retention of tear fluid leads to infection from staphylococci, pneumococci, pseudomonas or other pathogenics

  • Fig. 3.9 typycal symptoms include highly inflamed , painful swelling in the vicinity of the lacrimal sac.

  • 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)

  • ``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.

  • 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.