www.ophthalclass.blogspot.com has the complete class and MCQs on lids and adnexa for undergraduate medical students. Class 1 in the series deals with the basic anatomy of the eyelid and the eyelid margin. A few of the congenital eyelid disorders are mentioned. Special emphasis is given to blepharitis – inflammation of the eyelid margin, its types, clinical features and management. Next, common causes of eyelid swellings including hordeolum or stye and chalazion are discussed. Finally a brief mention is made about disorders of the eyelashes – trichiasis, poliosis, madarosis and distichiasis.

1. THE EYELIDS and the eyelid margin Dr. Anupama Karanth www.ophthalclass.blogspot.com

2. Anatomy What does it have?

3. Anatomy In simpler terms Anterior lamella skin and orbicularis Posterior lamella tarsus and conjunctiva

4. Development The story begins very early… Two folds of ectoderm and mesoderm appear at 8 weeks

5. Development …and fuse by the tenth week

6. Development They separate again in the seventh month

7. Congenital anomalies

8. Congenital anomalies Blepharophimosis syndrome Ptosis Epicanthusinversus Horizontally shortened palpebral aperture

9. Congenital anomalies

10. The eyelid margin Posterior edge sharp mucocutaneous junction Meibomian orifices Gray line ( muscle of Riolan) Lash line Anterior edge

11. Eyelid inflammation

12. Eyelid inflammation

13. Anterior blepharitis

14. Clinical features of anterior blepharitis

15. Ulcerative blepharitis

16. Squamousblepharitis

17. Management of anterior blepharitis Lid hygiene Warm compresses Mechanical removal of crusts and scales by scrubbing Baby shampoo as scrubbing solution Application of antibiotic eye ointment (Staphylococcal) Anti-dandruff shampoo for scalp (Squamous)

18. Posterior blepharitisMeibomian gland disease/meibomianitis Symptoms Nonspecific, burning, itching, redness Associated condition Acne rosacea Complications Secondary dry eyes Epithelial keratitis Recurrent styes / chalazia Papillary conjunctivitis

19. Clinical features of posterior blepharitis Meibomian orifices Pouting, obstructed, oily globules Telangiectasia around orifices Digital pressure on lid margin Hyposecretion Hypersecretion – foamy, turbid or tooth paste like secretion

20. Meibomian gland disease Foamy secretion Blocked meibomian orifices

21. Management of posterior blepharitis Warm compresses Lid massage to express oily secretion Short term antibiotic – steroid eye ointment, ocular lubricants In severe cases and in acne rosacea – oral tetracycline / doxycycline for at least 6-8 weeks

22. Eyelid gland inflammations Acute inflammation (stye) Staphylococcal infection Glands of Zeiss / Moll (associated with hair follicles) – Hordeolumexternum Meibomian glands – Hordeoluminternum Acute, painful and tender nodular swellings of the lid

23. Hordeolum Hordeoluminternum Hordeolumexternum

24. Acute infection (Staphylococcal abscess) Internal hordeolumExternal hordeolum Meibomian gland Tarsal plate Zeis or Moll glands Lid margin

25. Multiple styes

26. Hordeolum Management of hordeolum Mainstay of therapy – hot compreses If pus pointing present at eyelash base – remove eyelash If pus pointing at the skin or conjunctiva – drain pus If associated with blepharitis – treat blepharitis

27. Hordeoluminternum Pointing on the skin

28. Internal hordeolum Pointing on the conjunctival side

29. Eyelid gland inflammations Chronic inflammation of meibomian gland – Chalazion Meibomian cyst Chronic Sterile Granulomatous inflammation Blocked meibomian gland orifice Painless, non-tender nodular swelling of the eyelid

30. Chalazion Chalazion breaking through the conjunctiva 1A 1B

31. Recurrent chalazia

32. Management of chalazion

33. Incision and curettage

34. Local anesthesia

35. Chalazion clamp

36. Incision

37. Curettage

38. Clamp removed

39. The eyelid infections Molluscumcontagiosum

40. The eyelid infections Herpes zoster ophthalmicus

41. Eyelash disorders Trichiasis Inturned eyelash Poliosis White colored lashes Madarosis Loss of lashes Distichiasis Lashes from meibomian orifices

42. Trichiasis

43. Poliosis

44. Distichiasis