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Miscellaneous Eyelid Diseases

 

VI. MISCELLANEOUS LID DISEASES

1. Lagophthalmos.                   3. Madarosis.

2. Tarsorrhaphy.                      4. Lid edema.

 

1. LAGOPHTHALMOS

It is incomplete closure of the palpebral fissure when lids are closed.

Etiology:-

I. Lid causes:-

1. Facial nerve paralysis as in Bell's palsy.

2. Severe ectropion.

3. Short lid e.g; after ptosis operations.

4. Coloboma of the lid either congenital or acquired.

II. Large globe as in cases of total anterior staphyloma or buphthalmos.

III. Severe proptosis as in cases of:

- Thyroid exophthalmos.

- Orbital tumours.

IV. Deep coma and general anaesthesia.

Clinical picture:-

Symptoms:

- Burning sensation, redness and sense of dryness due to exposure of cornea and conjunctiva.

- Cosmetic disfigurement.

Signs:

Incomplete closure of the lids + signs of the etiology.

Complication of exposure of cornea and conjunctiva:-

- Ulcer with lagophthalmos which occurs in the lower 1/3 (the exposed part of cornea during sleep due to Bell's phenomenon) with straight upper limit.

- Corneal and conjunctival keratinization.

- Corneal vascularization and conjunctival ulceration.

Treatment:-

1. Treatment of the cause if possible.

2. Wetting of the cornea and conjunctiva by:

- Artificial tears by day.

- Ointment by night.

- Therapeutic soft contact lens plus artificial tears.

3. Lateral tarsorrhaphy to decrease the width of palpebral fissure.

 

2. TARSORRHAPHY

Definition:-

Inducing adhesions between the upper and lower lid margins.

Types And indications:-

A. According to site:

1. Lateral tarsorrhaphy in the lateral canthal area. It is done in cases of:

- Paralytic ectropion.

- Cosmetic treatment of wide palpebral fissure.

2. Median tarsorrhaphy in the middle line of the lid. It is done to protect the cornea from ulceration in cases of:-

- Corneal anaesthesia.

- Temporary tarsorrhaphy after skin graft of the lid.

B. According to the technique:

- Temporary tarsorrhaphy for temporary indications.

- Permanent tarsorrhaphy if the cause is stationary.

 

3. MADAROSIS

It means partial or total loss of eye lashes. Its common causes are:

A. Systemic diseases as alopecia areata, syphilis and SLE.

B. Local eye diseases as:

- Repeated electrolysis.

- Following surgical and non surgical trauma as after Snellen's operation.

- Ulcerative blepharitis.

 

4. CAUSES OF LID EDEMA

I. Inflammatory exudate:

1. lid inflammations as stye and infected chalazion.

2. Conjunctivitis as MPC, PC, Spring catarrhal.

3. Acute dacryocystitis and dacryoadenitis.

4. Ocular lesions as acute congestive glaucoma, endo and panophthalmitis.

II. Passive transudate:

1. Systemic edema as in cases of renal and hart failure.

2. Cavernous sinus thrombosis and carotid - cavernous fistula.

III. Angioneurotic edema: for example; urticaria. and insect bites.